C H A P T E R 1 5
Neuropsychological Assessment
Across
5. A pattern of subtest scores on a Wechsler test that Wechsler himself viewed as suggestive of neurological deficit is called a _______ index or quotient. Hint: Like Dairy Queen, it may be abbreviated “DQ.” 6. It’s a type of item that taps conceptual,
visual-motor, planning, and other cognitive abilities by means of a task in which the testtaker must connect the circles
in a logical fashion. It is called a _______-_______ item.
8. A type of assessment that focuses on the relationship between brain functioning and behavior is _______ assessment.
10. Study of the pattern of test scores on a Wechsler (or other) test for the purpose of identifying a configuration known to be associated with a particular diagnosis is called _______ analysis. 4 5 2 1 3 6 8 9 10 7 11 12 13 14 16 17 19 15 18 20 21 23 22
Instructions Identify what is described, answer a question, or fill in the blank to complete this crossword puzzle based on material presented in Chapter 15 of your textbook.
Puzzle 15
13. A prepackaged test battery containing a number of stan-dardized tests to be administered in a prescribed fashion is referred to as a _______ battery.
14. The Bender is an example of a test that is designed to measure _______ _______ ability. (Hint: It’s a hyphen-ated word.)
16. It’s a task that entails identifying a pictured stimulus in a neuropsychological context, for example, in response to items in the Boston Naming Test. This task is referred to as _______ naming.
19. Memory for how to do certain things or perform certain functions like riding a bicycle or making entries on a keyboard is referred to as _______ memory.
21. A loss of ability to express oneself or to understand spoken or written language due to neurological deficit. Hint: Not to be confused with a condition in which the desire to eat is lost or diminished.
22. It’s composed of various kinds of neurons or nerve cells. The part that consists of the brain and the spinal cord is referred to as the _______ nervous system. 23. It’s a procedure for evaluation or treatment that does
not involve intrusion (by surgical procedure, x-ray, or any other manner) into the client’s body. Observation of a client walking or skipping is an example of such a _______ procedure.
Down
1. Draw on your knowledge of well-known neuropsycho-logical screening instruments to come up with a gestalt for a famous name that is synonymous with this test. 2. It’s both a reference (now seldom used) to organic brain
damage and a type of functional consequence that attends such damage.
3. Memory of factual material is referred to as _______ memory.
4. Any past complaints a client has regarding sensory or motor problems, disturbances in balance, memory, speech, body temperature control, and the like will all be noted as part of a neuropsychological _______ . 7. The Bruininks-Oseretsky tests not only one’s ability to
pronounce it but gross and fine _______ skills as well. 8. A neuropsychological test battery for children,
devel-oped in part on the basis of Luria’s work.
9. It’s composed of various kinds of neurons or nerve cells. The part of it referred to as the _______ nervous system consists of neurons that convey messages to and from the rest of the body but excludes the brain and the spinal cord.
11. The phenomenon of _______ control results from the fact that each of the two cerebral hemispheres receives sensory information from the opposite side of the body and also controls motor responses on the opposite side of the body.
12. Organizing, planning, cognitive flexibility, inhibition of impulses, and other activities associated with the
frontal and prefrontal lobes of the brain are referred to as _______ functions.
13. It’s a group of tests hand-picked by the assessor for the purpose of providing an answer to the referral question. It’s referred to as a(n) _______ battery.
14. The Field of Search is an example of a(n) _______ test. 15. A digits-backward task is one way to test it.
17. The branch of medicine that focuses on the nervous system and its disorders is called _______ .
18. The term organicitywas once synonymous with brain _______ .
20. A puzzle useful as a tool for evaluating executive func-tioning is the Tower of _______ .
E X E R C I S E 15 - 1
MOVIES AND MEASUREMENT
OBJECTIVE
To research a measure of coordination
BACKGROUND
Tests may be used to measure various aspects of neuropsy-chological functioning. Sometimes finding a test to measure a specific aspect of neuropsychological functioning takes a little research.
YOUR TASK
Conduct research to identify an instrument designed to mea-sure gross motor coordination. Write a brief review of one such instrument.
The Scarecrow in The Wizard of Oz evidenced remarkable psychomotor coordination for someone sansbrain.
E X E R C I S E 15 - 2
THE NEUROPSYCHOLOGICAL
EXAMINATION
OBJECTIVE
To enhance understanding of and provide firsthand experi-ence with a neurological assessment measure
BACKGROUND
A neuropsychological examination may be undertaken for any number of reasons from general screening purposes to locating the specific site of a neurological lesion. The exact form of the neuropsychological examination (as well as the nature of the tests and measurement procedures employed) will vary as a function of factors such as the purpose of the examination, the thoroughness of the examination, and the neurological intactness of the examinee. In addition to the administration of psychological tests and/or prepackaged test batteries, a history-taking and a physical examination may also be part of the neuropsychological examination. In
Tables 15-1 and 15-2, we have described some of the tests that could be used in a neuropsychological examination; more specifically, these are tests that could be used to evalu-ate (1) muscle coordination and (2) the intactness of some of the 12 cranial nerves.
YOUR TASK
1. You are a neuropsychologist charged with performing routine neurological screenings on all students in your school who are enrolled in a psychological testing course. Select any three of the four tests described in Table 15-1 and administer these tests to a fellow student in the class.
2. Select any three of the four tests described in Table 15-2 and administer these tests to the same student to whom you had administered the other three tests.
3. Write a brief report of your findings. Include in your report a note about what other tests or prepackaged test batteries you would have also wanted to administer and explain why.
4. Now, trade places—you become the patient and your partner “plays doctor.”
TABLE 15-1 Some Tests Used to Evaluate Muscle Coordination Walking-Running-Skipping
If the examiner has not had a chance to watch the patient walk for any distance, he or she may ask the patient to do so as part of the examination. We tend to take walking for granted; but, neurologically speaking, it is a highly complex activity that involves proper integration of many varied components of the nervous system. Sometimes abnormalities in gait may be due to nonneuro-logical causes; if, for example, a severe case of bunions is suspected as the cause of the difficulty, the examiner may ask the patient to remove his or her shoes and socks so that the feet may be physically inspected. Highly trained examiners are additionally sensitive to subtle abnormalities in, for example, arm movements while the patient walks, runs, or skips.
Standing-Still (technically, the Romberg test)
The patient is asked to stand still with feet together, head erect, and eyes open. Whether the patient has arms extended straight out or at his or her side and whether or not the patient is wearing shoes or other clothing will be a matter of the examiner’s preference. The patient is next instructed to close his or her eyes. The critical variable is the amount of sway exhibited by the patient once the eyes are closed. Since normal persons may sway somewhat with their eyes closed, experience and training are required to determine when the amount of sway is indicative of pathology.
Nose-Finger-Nose
The patient’s task here is to touch his or her nose with the tip of his or her index finger, then touch the examiner’s finger, and then touch his or her own nose again. The sequence is repeated many times with each hand. This test, as well as many similar ones (such as the toe-finger test, the finger-nose test, the heel-knee test), is designed to assess, among other things, cerebellar functioning. Finger Wiggle
The examiner models finger wiggling (that is, playing an imaginary piano or typing), and then the patient is asked to do the same. Typically, the nondominant hand cannot be wiggled as quickly as the dominant hand, but it takes a trained eye to pick up a significant decrease in rate. The experienced examiner will also be looking for abnormalities in the precision of the movements and the rhythm of the movements, “mirror movements” (uncontrolled similar movements in the other hand when instructed to wiggle only one), and other abnormal involuntary movements. Like the nose-finger test, finger wiggling supplies information concerning the quality of involuntary movement and muscular coordination. A related task involves tongue wiggling.
E X E R C I S E 15 - 3
SOME TOOLS OF
NEURO-PSYCHOLOGICAL ASSESSMENT
USED IN THE
CHAPPLE
CASE
OBJECTIVE
To research and explore information about a tool of neu-ropsychological assessment
BACKGROUND
The Chapplecase, as well as the Daubertstandard applied in that case, is discussed in your text. Let’s elaborate on that discussion by listing some of the formal tests and measure-ment techniques employed by two of the psychologists involved in that case. The flexible battery administered by the clinical psychologist who initially examined the boy included the following tests:
• the Aphasia Screening Test • the Benton Visual Retention Test • Knox Cube
• Rey Complex Figure Test • Seashore Rhythm Test • Trails
• Wisconsin Card Sorting Test
In addition, the flexible battery included other tests such as Draw a Bicycle, Draw a Clock, Draw a Family, Draw a Person, Category Test, Incomplete Sentences, Lateral Domi-nance Test, Manual Finger Tapping Test, Peabody Picture Vocabulary Test, subtests of the Woodcock-Johnson, the WISC-R, and the WRAT-R.
The flexible battery administered by the neuropsycholo-gist one year after the auto accident included the following tests and measurement techniques:
• Trails
• Sentence Imitation
• Word Sequence and Oral Direction
(subtests of the Detroit Test of Learning Aptitude)
TABLE 15-2 Some Tests Used in the Assessment of Intactness of the 12 Cranial Nerves
Cranial Nerve Test
I (olfactory nerve) Closing one nostril with a finger, the examiner places some odiferous substance under the nostril being tested and asks whether the smell is perceived. Subjects who perceive it are next asked to identify it. Failure to perceive an odor when one is presented may be indicative of lesions of the olfactory nerve, a brain tumor, or other medical conditions. Of course, failure may be due to other factors, such as
oppositional tendencies on the part of the patient or intranasal disease, and such factors must be ruled out as causal.
II (optic nerve) Assessment of the intactness of the second cranial nerve is a highly complicated procedure, for this is a sensory nerve with functions related to visual acuity and peripheral vision. A Snellen eye chart will therefore be one of the tools used by the physician in assessing optic nerve function. If the subject at a distance of 20 feet from the chart is able to read the small numbers or letters in the line labeled line “20,” then the subject is said to have 20/20 vision in the eye being tested. 20/20 vision is only a standard; and while many persons can read only the larger print at higher numbers on the chart (that is, a person who reads the letters on line “40” of the chart would be said to have a distance vision of 20/40), some persons have better than 20/20 vision. An individual who could read the line labeled “15” on the Snellen eye chart would be said to have 20/15 vision.
V (trigeminal nerve) The trigeminal nerve supplies sensory information from the face, and it supplies motor information to and from the muscles involved in chewing. Information regarding the functioning of this nerve will be examined by the use of tests for facial pain (pinpricks will be made by the physician), facial sensitivity to different temperatures, and other sensations. Another part of the examination will entail having the subject clamp his or her jaw shut. The physician will then feel and inspect the facial muscles for weakness and other abnormalities.
VIII(acoustic nerve) The acoustic nerve has functions related to the sense of hearing and the sense of balance. Hearing may be formally assessed by the use of an apparatus called the audiometer. More frequently, the routine assessment of hearing will involve the use of a so-called “dollar watch.” Provided the examination room is quiet, an individual with normal hearing should be able to hear a dollar watch ticking at a distance of about 40 inches from each ear (30 inches if the room is not very quiet). Other quick tests of hearing involve the placement of a vibrating tuning fork on various portions of the skull. Individuals who complain of dizziness, vertigo, disturbances in balance, and so forth may have their vestibular system examined by means of specific tests.
• Taylor Complex Figure Test • Hooper Visual Organization Test • Attention Capacity
(subtest of the Auditory Verbal Learning Test) • Sound and Visual Symbol Recall Test • Paragraph copy test
Other tests administered by the neuropsychologist in-cluded the Kaufman Brief Intelligence Test, the Individual Achievement Test, and the Wechsler Reading Comprehen-sion and Listening ComprehenComprehen-sion Test.
YOUR TASK
Select one of the tests or measurement techniques in the bulleted list and write a brief report on it. The focus of the report should be on how such a test or technique might be employed as part of a flexible neuropsychological test battery. Your report should include information about the validity, reliability, and generalizability of the test or tech-nique. Explain how historical and other archival data related to the assessee could help in drawing sound conclu-sions from the utilization of this test or technique. For the purpose of your report, write about the latest revision of the test chosen.
E X E R C I S E 15 - 4
UPDATE ON
CHAPPLE
OBJECTIVETo make information related to the Chapplecase current and relevant to contemporary neuropsychological practice.
BACKGROUND
The previous exercise (15-3) provided some firsthand familiarity with the tools used in the Chapplecase. But what has been going on in courtrooms throughout the United States since the decision in Chapple was handed-down in 1994?
YOUR TASK
Update what has been going on in the United States case law regarding fixed versus flexible batteries since Chapple was handed-down by a federal district court in 1994. For starters, you may wish to consult resources such as Reed (1996), which provides a sound grounding in Chapple, and more recent writings (such as Bigler, 2007; Russell, 2007; and, Horn, 2008).
E X E R C I S E 15 - 5
DOES ANYBODY EVER REALLY
KNOW WHAT TIME IT IS?
OBJECTIVE
To contrast and compare various scoring systems available for the clock-drawing test (CDT).
BACKGROUND
A dozen or so scoring systems exist for scoring the neu-ropsychological quick screening clinical technique known as the clock-drawing test (CDT).
YOUR TASK
Research the techniques being used to score the CDT and then write a report in which you indicate your opinion as to which is the all-around best scoring system and why. For starters, you may wish to visit these three sites on the Inter-net for more information about the CDT:
http://www.neurosurvival.ca/ClinicalAssistant/scales/ clock_drawing_test.htm http://alzheimers.about.com/od/diagnosisissues/a/clock _test.htm http://www.cumc.columbia.edu/news/review/pdf/p30-34.pdf E X E R C I S E 15 - 6
INTERVIEW WITH A
NEUROPSYCHOLOGIST
OBJECTIVETo construct an interview consisting of ten questions you would like to ask a practicing neuropsychologist and then conduct the interview
BACKGROUND
As you read about psychologists in various specialties and the tests and assessment procedures they use in practice, a wealth of questions may arise. Here is your chance to pose any questions you may have about neuropsychological as-sessment to a practicing neuropsychologist. Your questions may relate to any facet of a neuropsychologist’s work—how such work interfaces with medicine, how research is put into practice, and how such a career has its own unique rewards and drawbacks. Check with your instructor before arranging this interview, as it may prove more feasible to have your instructor arrange a class visit by a neuropsychologist.
YOUR TASK
Write your interview questions and be prepared to arrange and conduct the interview upon assignment of this exercise by your instructor.
E X E R C I S E 15 - 7
PICK A
NEURO-PSYCHOLOGICAL TEST
OBJECTIVE
To learn more about neuropsychological tests not reviewed in the textbook
BACKGROUND
The approach in your textbook is to highlight only a few of the many tests that exist in any given area. For every test
covered in your textbook there may well be dozens of other tests designed to measure the same variable or variables.
YOUR TASK
A list of neuropsychological tests, along with a brief de-scription of each, follows in Table 15-3. From this list, select one test that you think you would like to know more about. Then, use all of the resources at your disposal to answer the following:
1. Describe what the test measures.
2. Who would be most apt to use this test? Why? Include in your answer sample questions the test user might hope to answer through the use of this test.
3. Who would be most apt to take this test? Why?
4. Describe the full range of people to whom it would be appropriate to administer this test, including comments about who would be inappropriate.
5. Describe what is known about the test’s reliability.
TABLE 15-3 Some Neuropsychological Tests and Test Batteries
Test Description
Neurobehavioral Assessment For use with preterm infants ranging in conceptual age from 32 weeks to term, this test of the Preterm Infant assesses the effects of medical as well as other complications (such as maternal
substance addiction) on preterm infants.
McCarron-Dial System For ages 3 and up, this test battery is designed to be of particular utility in meeting the therapy needs of handicapped persons.
Children’s Category Test For ages 5 through 16 years, this test is designed to measure complex intellectual functioning, including concept formation and memory.
Portable Tactile Performance Test For ages 5 and up, this test focuses on the evaluation of tactual performance. Benton Visual Retention Test For ages 8 years to adult, this test measures visual perception, memory, and
visuoconstructive abilities.
Wisconsin Card Sorting Test Revised For ages 6.5 through 89, this test is designed to measure several neurological variables, including abstract thinking and perseverative thinking.
Behavior Change Inventory For children and adults, this test focuses on the evaluation of the effects of head injury. Ross Information Processing For adolescents and adults, this test focuses on the evaluation of communication
Assessment disorder among people with head injuries.
Boston Diagnostic Aphasia For adults, this test is designed to focus on the nature of deficits in aphasia as well as
Examination common clusters of deficit.
Mini Inventory of Right Brain Injury For ages 18 and up, this test focuses on the evaluation of deficit due to injury of the right hemisphere of the brain.
Stroop Neuropsychological For ages 18 and up, this is a general neuropsychological screening test designed for
Screening Test individual administration.
Bedside Evaluation and Screening For adults, this is a test of language ability for patients who have suffered neurological
Test of Aphasia damage.
Sklar Aphasia Scale For adults, this test is designed to measure the nature and severity of language disability following neurological damage.
Cognitive Behavior Rating Scales For adults and capable of being group-administered, this measure of cognitive impair-ment and behavioral deficit is completed by informants familiar with the assessee. Dementia Rating Scale For adults, this measure is designed to evaluate the cognitive status of an individual
with known impairment.
Rivermead Perceptual Assessment For adults, this test measures nature and degree of visual deficit following stroke or a
6. Describe what is known about the test’s validity.
7. Imagining that you are a measurement consultant, would you recommend this test to clients who are test users? Why or why not?
REFERENCES
Bigler, E. D. (2007). A motion to exclude and the “fixed” versus “flexible” battery in forensic neuropsychology: Challenges to the practice of clinical neuropsychology. Archives of Clinical Neuropsychology, 22(1), 45–51.
Hom, J. (2008). Response to Bigler (2007): The sky is not falling.
Archives of Clinical Neuropsychology, 23(1) 125–128.
Reed, J. E. (1996). Fixed vs. flexible neuropsychological test batteries under the Daubert standard for the admissibility of scientific evidence. Behavioral Sciences & the Law, 14(3), 315–322. Russell, E. W. (2007). Commentary on “A motion to exclude and the
‘fixed’ versus ‘flexible’ battery in forensic neuropsychology.
Archives of Clinical Neuropsychology, 22(6), 787–790.
THE 4-QUESTION CHALLENGE
1. A patient with known damage to brain lobes complains of a severely impaired visual field. Which lobes of the brain have the highest probability of having been damaged? a. frontal lobes
b. temporal lobes c. occipital lobes d. parietal lobes 2. The term organicity
a. has been used interchangeably with “brain damage.” b. is not synonymous with “brain damage.”
c. has been used interchangeably with “neurological damage.”
d. all of the above
E X E R C I S E 15 - 8
PICK A STUDY:f MRI:fff
OBJECTIVE
To conduct independent study on a topic related to the use
BACKGROUND
: f
of fMRI in neuropsychological research.
The term MRI is an acronym for functional magnetic reso-nance imaging. It refers to an imaging procedure that creates real-time, moving images of internal functioning. These images are particularly useful in identifying which parts of the brain are active at various times and during various tasks.
YOUR TASK
Select one of the MRI studies listed below to summarizen and report on. Do some independent research on the topic to update the study and to report on related research. Write a written report of two typewritten pages or so, and be pre-pared to present your findings to the class if called upon to
1. "What Can fMRI Tell Us about the Locus of Learning?" (Dorjee & Bowers, 2012).
“ ”
“
2. "Impaired Executive Function Signals in Motor Brain " Regions in Parkinson's Disease" (Cameron et al., 2012). ’ ” “
3. "fMRI Reactivity on a Delay Discounting Task Predicts Weight Gain in Obese Women" (Kishinevsky et al., (2012).
“
4. "Brain fMRI Reactivity to Smoking-Related Images Be-fore and During Extended Smoking Abstinence (Janes, et al., 2009).
“
5. "Video Game Play Changes Spatial and Verbal Memory: ”
Rehabilitation of a Single Case with Traumatic Brain In-jury," (Caglio et al., 2009).”
“ ”
6. "Towards Clinical Trials of Lie Detection with fMRI (Hakun et al., 2009).
“ ”
7. "The Neural Response to Facial Attractiveness, (Chatter-jee et al., 2009).
(Suppl2), S195–S197.
Caglio, M., Latini-Corazzini, L., D agata, F., et al. (2009). Video game play changes spatial and verbal memory: Rehabilitation of a single case with traumatic brain injury. Cognitive Proces-sing, 10
’
(2), 1156–1170.
Cameron, I. G., Pari, G., Alahyane, N., et al. (2012). Impaired execu-tive function signals in motor brain regions in Parkinson s disease.
NeuroImage, 60
Chatterjee, A., Thomas, A., Smith, S. E., & Aguirre, G. K. (2009). The neural response to facial attractiveness. Neuropsychology, 23
’
(2), 135–143.
&
Dorjee, D., Bowers J. S. (2012). What can fMRI tell us about the locus of learning? Cortex: A urnal Devoted to the Study of the x Jo d Nervous System and Behaviour, 48(4), 509–514.
Hakun, J. G., Ruparel, K., Seelig, D., et al. (2009). Towards clinical trials of lie detection with fMRI. Social Neuroscience, 4(6), 518–527.
Janes, A. C., Fredrick, B., Richardt, S., et al. (2009). Brain fMRI vity to smoking-related images before and during extended smoking abstinence. Experimental and Clinical Psychopharmacology, 177(6), 365–373.
(2), 582–592.
Kishinevsky, F. I., Cox, J. E., Murdaugh, D. L., et al. (2012). fMRI reactivity on a delay discounting task predicts weight gain in obese women. Appetite, 58
do so by your instructor.
”
f
3. Which is nota test a neuropsychologist would typically administer to routinely evaluate muscle coordination? a. the finger wiggle test
b. the nose wiggle test c. the standing-still test
d. the walking-running-skipping test
4. The Bender is a test that entails a. copying designs.
b. interpreting proverbs. c. connecting dots. d. all of the above
