W10 - Neuropsych Assessment & Rehabilitation

Question 1

Recap: When testing for pre-morbid ability - NART and WAIS-5 test, what are the 5 retained subtests?

Answer 1

1. Verbal Comprehension
2. Visual Spatial
3. Fluid Reasoning
4. Working Memory
5. Processing Speed

Question 2

What are 2 tests in Verbal comprehension?

Answer 2

1. Similarities, (how are 2 words alike?)
2. Vocab (tell me what each word means) - info comprehension

Question 3

What 2 tests are Visual Spatial subtest?

Answer 3

1. Block design
2. Visual puzzles (which 3 pieces go together to make this puzzle?

Question 4

What 4 tests are Fluid Reasoning subtest?

Answer 4

1. Matrix reasoning (choose missing picture)
2. Figure weights (which one balances the scales?)
3. Arithmetic (increasingly harder maths questions, good for testing the limits)
4. Picture arrangement, not used anymore, in schizophrenia research, eg., put the picture in order)

Question 5

What 4 tests are in Working Memory?

Answer 5

1. Digits forward
2. Digits sequencing
3. Digits backward
4. Letter-number sequence

Question 6

What 2 tests are in Processing Speed?

Answer 6

1. Coding
2. Symbol search

Question 7

1. If patient can ONLY solve arithmetic using pen and paper, they may have…
2. If can’t solve it regards of tools used, they may have…

Answer 7

1. Working memory issue
2. Arithmetic issue

Question 8

What is mean and SD of the WAIS?

Answer 8

1. WAIS-5 ability mean is 10,
2. -+3 respective S.D above/below the mean:
   *7 is 1 SD below mean
   * 13 is 1 SD above

Question 9

What SD do you need to demarcate a potential NP problem?

Is this debated?

Answer 9

1. Need to find patients with performance with MORE THAN 1 SD BELOW THE MEAN - significantly below average performance to demarcate whether an NP problem is present
2. Yes - some argue it is needed to have 2 SD below to consider the patient has a NP problem
3. Need to take into consideration the patients premorbid ability, influences how you interpret their post-morbid results, eg., an average score still could represent a deficit if the patient previously had superior cognitions

Question 10

What kinds of studies is cognitive vs. clinical neuropsych interested in?

Answer 10

1. Cognitive NP - mostly interested in SINGLE-CASE studies, pattern of spared/impaired abilities in individuals, to infer building blocks of cognition, regardless of location in the brain
2. Clinical NP is most interested in group-studies - infers function of a brain region by taking many patients with lesions to that region, examining patterns of impaired/spared abilities
   Interested in the brain/behaviour relationship via testing

Still not doing enough rehabilitation, mostly still testing and research

Question 11

What are the 2 editorial beliefs in neuropsychology? (Coltheart, 1984)?

Answer 11

1. Adequate theory of clinical NP is best developed with explaining disorders of cognition by making use of theoretical developments of (experimental) cognitive psychology
2. Cognitive psychologists wanting to test theories of mental activity, should NOT confine themselves to studying neurologically healthy cognitive patients, but should also study patients with impaired cognitions
3. Groups of healthy often student populations do not generalise to different developmental stages and those with abnormal cognition

Question 12

What is the debate about the use of single or series of case studies?

Answer 12

1. Rapp: Major debate about whether researchers should do SINGLE or GROUP cases studies
2. Majority of papers tried to comprise by saying single-case studies aren’t comprehensive, and hard to distinguish whether the individual had premorbid cognitive problems that may be interfering with the performance of post-morbid ability
3. Series of case studies - look for patterns of spared/impaired abilities for brain/behaviour relationships

Question 13

What are the 2 types of group case studies outlined by McCloskey and Caramazza, 1988?

Answer 13

NOT HELPFUL
1a. When data is aggregated whereby performance patterns of an individual subjects cannot be recovered from the aggregate results

b. When data is average across subtests, eg., block building + visual puzzles = visuospatial score ability.

If two subtests yield different results, have to break down further, and isolate what is similar about the tests and what is different, eg., does one visuospatial test have a speed component or use pen/paper?

HELPFUL
2. When data from multiple cases maintains its individual identity are brought to investigate or address a theoretical question of interest - considering all cases

Question 14

How should sample selection for the multiple-case or series of case studies approach be selected?

What is Broad Theoretical Selection?

Answer 14

= a selection with a full range of predictions based on a solid theory, and need a full set of patterns, including
Cases that are predicted are observed, AND
Cases that were not predicted and not observed
Set the theory, and evaluate cases based on whether they fit the theory

Question 15

How should sample selection for the multiple-case or series of case studies approach be selected?

What is Neuroanatomical Involvement?

Answer 15

1. patients are grouped by objective criteria
2. Example: patients with localised brain lesions compared to patients with adjacent cortex lesions

Question 16

What are the limitations of using
neuroanatomical Involvement in selecting patients?

Answer 16

1. Limited to the location of where you’re working - requires finding many patients with specific lesions, eg., California, London or collaborating
2. Limited to the rise in neural networks over localised brain regions, Can patients with separate localised regions really be compared?
3. Damage to a localised area also thus damages connections to nearby areas and affect their functioning in unpredictable and unique ways, unilateral neglect : which does not conform to a clearly specific pattern of lesion site, can occur from many types of damage

Question 17

Where are the various locations of lesions found in neglect?

Answer 17

1. Found lesions at DLPFC, posterior-parietal lobe AND temporal parietal junction in patients with neglect at hyper-acute (tested within 5 days) and sub-acute level (tested within 1-2 weeks)

Question 18

Having different brain patterns at sub and hyper acute poses the question: what is the best time to recruit BD patients?

Answer 18

Solution = Hussain example research, have to be super precise, “this is the area I’m look at, and this is the time I’m looking at it in the MRIs”

If you want to argue his findings, you have to do the exact comparison / same methods, time and location

Need 3 types of groups, patients with lesion in area 1, patients with lesion in area 2, and a group of neurologically healthy people

Question 19

How should sample selection for the multiple-case or series of case studies approach be selected?

What is Clinical Syndrome?

Answer 19

argues you cannot chose patients by syndrome, as patients with neglect, for example, have a LOT of different symptoms, and some symptoms may be part of other syndromes - thus you should prioritise picking patients on specific SYMPTOMS over their diagnosed SYNDROME

But this approach goes against main goal of cog NP, which studies single symptoms over clusters of related symptoms, called syndromes

Question 20

What are the 3 ways sample selection for the multiple-case or series of case studies approach could be selected?

Answer 20

1. Broad Theoretical Selection
2. Neuroanatomical Involvement
3. Clinical Symptoms
4. Consecutive Hospital Admissions (Stroke Unit)

Question 21

What is the debate regarding the usefulness of syndromes vs. singular symptoms?

Answer 21

1. Buxbaum argues that every possible fractionation of neglect has been reported, so how do we group these people that have neglect?
2. Carammaza, Coltheart, 2006 = practical purposes of studying unique syndromes is to amass knowledge that generalises across people
3. Response: universality assumption can infer that although patient X and Y now have very different systems from brain damage, they should have had the same system pre-morbidly, which we can use info about normal systems to make inferences about studying patients X and Y

Snowflake analogy to case studies
While case studies are like snowflakes, they also have similarities. Thus a falsifiable theory of snowflake generation produces the following predictions:

All snowflakes are snow crystals or made from snow crystals (universality)
All snow crystals can have 3, 6 or 12 sides, but NOT 4,5,8 sides - just as one patient can refuse some hypothesis about cognitive architecture by yielding a pattern that shouldnt occur according to the hypothesis, so can a single snowflake refuse a theory of snowflakes by having 4, 5, or 8 sides
“If my theory will be supported, this pattern will happen” and vise versa

Question 22

What is the first first assessed for unilateral visuospatial neglect?

Answer 22

1. Behavioural Inattention Test (BIT) (done by occupational therapists)

Question 23

What is the normal period of time to study patients with stable, persisting neglect, where other effects of stroke have settled down?

Answer 23

3 months post stroke

Question 24

When did Aimola, 1999 test patients?

Answer 24

4-6 weeks post CVA (cerebrovascular accident, stroke)

Question 25

How do you established some form of neglect or extinction deficit?

Answer 25

Confrontation test “Look at my nose”, while I hold 2 hands up, “tell me when one of the moves” - tell the difference between neglect and extinction

Question 26

What are the 2 reasons left hemisphere damaged not often studied in neglect?

Answer 26

1. Neglect following left hemisphere damage is less likely to persist after months 2. Left hemisphere damage often results in severe language and communication problems,

Question 27

What 2 things does the cookie theft picture test for? What are the findings for neglect?

Answer 27

1. Test for language comprehension: Assess whether person understands and can explain verbally 2. Test for neglect: Assess whether person can perceive the visual information on the left side (neglect involves processing not reaching parietal area from occipital area) People with neglect do NOT report the left sided ‘cookie theft’ scene

Question 28

What does the Information & Orientation Test (testing orientation to time/place) ask?

Answer 28

What is your full name? How old are you? When / where were you born? What is the time / date? What is the name of this city?

Question 29

What are the 4 Visual Object and Space Perception Battery - (tests for neglect)?

Answer 29

1. Shape Detection Screening - Have to say YES if letter X is on the card, and NO if there is no X No further tests on neglect if they fail this, indicates vision problems 2. Object Perception Subtest: Incomplete Letters Practice items (F) and (B) are shown, then patient is asked to identify and name the next set of letters that are rather ‘incomplete’ 3. Object Decision Silhouettes Asks patient to identity and point to the silhouette of a real object in a scene of random nonsense shapes 4. Object Perception Subject: Progressive Silhouettes Assess progressively easier of silhouettes of objects, has been normally distributed about how long it normally takes a healthy person to identity it, rotates from 90˚ degrees

Question 30

What is Heilman's definition of unilateral neglect?

Answer 30

“a deficit in the ability to report, respond to, or orient to information presented on the side of space opposite to the cerebral lesion” (Heilman, 1994)

Question 31

How does Mesulam define the issue of neglect?

Answer 31

“The deficit is not of seeing, hearing, feeling or moving - but of looking, listening, touching and exploring (perception)” - Mesulam, 1981

Question 32

What is viewer vs. stimulus centered neglect + variations?

Answer 32

1. Viewer-centered neglect: Picture A shows a patient with neglect to the left side of all the lines 2. Stimulus centered neglect: Picture B shows a patient with neglect to each left side of both groups of lines/stimulus, indicates different subtypes of neglect, 3. Some patients with neglect will show incomplete perception of the left side, but less detailed than the right side

Question 33

What is extinction?

Answer 33

1. the inability to perceive two simultaneous stimuli in each visual field. 2. While neglect is the complete inability to respond to stimuli on the left side, a patient with extinct ONLY NEGLECT THE LEFT / will not respond to it if there’s competing on the right” 3. Competing information on the right will stop reporting on the left, even if perception of the left / contralesional side is preserved

Question 34

What modalities can neglect/extinction occur in?

Answer 34

Neglect or extinct can occur at the visual, tactile or auditory modularity presented to the side of space opposite to the cerebral lesion (contralesional side)

Question 35

Why is extinction hard to prove?

Answer 35

1. Separating neglect/extinction in the real world conditions is always almost impossible, as there is almost always something occurring on both sides of the visual field 2. Only in lab studies can you distinguish between patients with neglect vs. extinction 3. Unsure about evidence of extinction

Question 36

What kind of damage is neglect vs. extinction said to occur in?

Answer 36

1. Neglect is thought to be from cortical damage, extinction is thought to be from more subcortical damage