Week 2 - Neuropsychological assessment Flashcards
What is the purpose of a referral?
Initiatives neuropsychological assessment process
Provides basic informative details
Asks a referral question
What is involved in the preliminary information gathering stage?
research
eg. look at radiology reports
What are some things to consider when researching support services treatments?
Behaviours
Physical limitations
Cognitive profile
Everyday functioning
What is included in a clinical interview?
A reconstruction of clinical issues and history
Data to understand
What was the person like beforehand?
Observe behaviour
What is the goal of neuropsych?
To predict or decide on a clinical category
What are the clinical categories?
Diagnosis vs no diagnosis
Impaired vs not impaired
Severe impairment vs mild impairment
How does additional information affect the specificity of the testing you do?
Increase sensitivity and specificity
What is sensitivity?
The probability that a test correctly identifies a clinical category given they actually do have it
What is specificity?
The probability that the test correctly detects or classifies a normal performance
What does a true negative refer to?
Specificity
What does true positive refer to?
Sensitivity
What are some examples of important historical information to collect?
Basic demographic data
Medical history
Legal history
Many more
How does self-reported cognitive functioning help diagnosis?
Helps to establish insight into difficulties
Helps to guide what tests need to be administered
________ is a catalyst for change
Insight
What are the steps to interviewing volunteers?
- Broad questioning
Always ask about ‘thinking’ difficulties first - If information not volunteered, prompt the client to think about difficulties in various cognitive domains
- If they still don’t volunteer information, ask more specific situational questions as a prompt if you think it is necessary
- where difficulties are indicated, be inquisitive about it. Aim to develop a clear understanding of the exact nature of the difficulty
What causes may undermine a neuropsychological assessment?
Anxiety
too hot or cold
Subjected to unusual or unpredictable sights and sounds
Why may some patients not give their best efforts during neuropsychological testing?
Referred involuntarily
Do not understand reason for assessment
Can take advantage of the opportunity to work to potential
When setting up a room for neurological testing, what should be considered?
little to no distractions
Close curtains/blinds if there is a window to prevent glare
No noise
Welcome and friendly appearance
Conservatively decorated
Why is it important to keep your testing tools close?
- decrease assessment time
- smooth transition from one test to the next
How should the researcher order tasks?
To avoid discouraging patient early, start with easy tasks and move to harder ones
When is it appropriate to stretch testing out across multiple sessions?
For patients who are easily distractible,
when they have low energy levels
The underlying assumption of neuropsychological testing is that performance of patients represent their best efforts. True or false?
False
Patients may not give their best effort because:
a) they are depressed
b) they are involved in litigation
c) they are medically ill
d) all of the above
d
Any room is sufficient for testing
True of false?
False
Is it preferable to complete testing in one day
True or false
True
It is easy to determine through simple observation that a patient is applying adequate effort to the task at hand. True or false?
True
Which of the following is not true?
a) examiners should score as they go
b) examiners should observe the patient’s behaviour
c) examiners should record every statement by a patient
d) examiners should keep test materials ready
c
It is permissible to violate standardised testing procedures for the sake of testing the limits. True or false
False
If testing the limits is required for additional info, it should only occur after a test has been administered according to standard procedures
Test administration requires
a) helping patients with explanations of direction
b) following test instructions exactly
c) using a wall clock to time tests
d) informing patients that their answers are correct
b
The examiner who is thoroughly familiar with the scoring guidelines is best able to discern the score value of a response quickly and accurately.
True or false
True
Pantomime and gestures may have to be used when testing individuals with impairments in
a) hearing
b) vision
c) motor impairments
d) memory
a
How does the examiner increase the likelihood of adequate motivation in an assessment?
Spend some time before the formal testing explicitly asking the patient whether she/he understands the reasons for the examination and let them ask questions.
What are formal tests of malingering or dissimulation?
Tests that identify if somebody may have a motivation to perform poorly by comparing their performance with people who have brain damage
What are some behavioural observations that a clinician can use to indicate a client’s degree of effore?
Appearance
Arousal
Attitude towards examiner
Attitude towards test
Level of cooperation, effort and attention
Work habits
speech and language
Behaviours (Motivation, anxiety, affective state)
What are some behavioural observations that a clinician can use to indicate a client’s degree of effort?
Appearance
Arousal
Attitude towards examiner
Attitude towards test
Level of cooperation, effort and attention
Work habits
speech and language
Behaviours (Motivation, anxiety, affective state)
Should clinicians help clients by explaining words in questions?
Only if the manual allows explanations
What are the common errors that Kaufman and Lichtenberger (1999) pointed out in obtaining scaled score?
Writing illegibly
Using the wrong age reference table
misreading across rows of the score conversion tables
What test may be used when assessing blind child’s non-verbal skills?
Hays-biney, perkins-binet or blind learning aptitude test
What are some tests of non-verbal intelligence for children and young adults?
Naglieri Nonverbal Ability test - individual assessment
What patients may be at particular disadvantage on speeded tasks and nonverbal tasks?
Patients with motor disabilities
What are some possible test battery modifications for individuals with aphasia?
Establish that an adequate output channel exists
Document aphasic features with tests such as the BDAE or WAB
Use nonverbal tests
Give directions through pantomime and gesture
What are some possible test battery modifications for individuals with motor impairments>
Assess overall cognitive ability with verbal and motor-free tasks
Avoid speeded motor tasks
test motor abilities without time constraints
A person has had a middle cerebral artery stroke. What deficits are associated with those?
Possibility of acquired language deficits
What is a measure that is sensitive to aphasic deficits?
Boston Diagnostic Aphasia Examination
A test battery usually needs…
- To include various measures of attention to explore the attentional matrix of a patient
- Measures of executive functions such as reasoning, planning, organisation, set establishment and maintenance, and measures of verbal and visual learning and memory
- Assessment of language and perhaps academic skills
- Visual, tactile and motor abilities
- motivation, effort and emotional function
What are the four domains of test selection?
Referral question
Appropriateness
Comprehensiveness
Fixed vs flexible battery
