W3 - Assessment Flashcards
(87 cards)
1
Q
How does clin. neuropsych differ to the others?
A
- An applied science from clinical neurosciences/neurology and cognitive neuroscience, education,
- Specialisation within clinical psychology, focused on brain injury or neurological diseases
- Follows instructions exactly from text book, relies on same techniques as clinical psychology
- Distinction = Conceptual frame of reference takes brain function as point of departure
2
Q
What is the difference between HM and KF?
A
- A double dissociation,
HM has STM deficits, LTM intact, while KF had STM intact and LTM deficits
3
Q
How did HM/KF challenge hierachical model of memory?
A
HM’s ability to retain procedural memory and KF’s impaired STM challenged the notion that the memory module was hierarchical whereby information flowed unilaterally from short term memory to long term memory
4
Q
What are the 5 purposes of neuropsychological examination?
A
- Diagnosis - discriminating between psychiatric and neurological symptoms, Alzheimer’s vs. TBI
- Patient care & planning: capacity to return to work, driving, managing finances, interacting with family, being independent
- Treatment: plan and remediation - precisely how it has affected the patient - what remains intact/impaired
- Research - involves development, standardisation and evaluation of neuropsychological assessment, very sensitive and perceive tools for understanding brain pathology
- Forensic neuropsychology / legal = concerning criminals OR patients experienced an injury at work, informing court cases
5
Q
What’s an example of needing others around patient for assessment?
A
case of 55-year old management expert, thought he could go back to work before he could, important to bring a family member in
6
Q
What’s an example of needing multiple tests?
A
case of a 27-year old logger, removal of a hematoma, had psychiatric disturbances/psychosis, needed to re-test twice/thrice to properly complete the exam
7
Q
What are the 2 examples showing how injuries/disease is not about where it is in the brain, but about precisely how it has affected the patients?
A
- 30 year-old lawyer had frontal problems with prospective memory (remembering to remember things, leaving memory log book everywhere) - treatment was not effective
- 42-year old civil engineer with severe attentional-memory deficits, had strong emotional and motivational capacity and self-awareness, very effective treatment with a memory log book
7
Q
What’s an example of perplexity and self-doubt in influencing performance and patient confidence?
A
45-year old primary school teacher = very common symptom of perplexity about self-doubt after a TBI, emotionally draining and making her feel insecure
24-year old bank teller, informing patients of self-doubt is a normal part of a TBI, without being told, she lost confidence and become depressed
8
Q
What are the 4 trials in the Rey Complex Figure test?
A
- Copy trial = Look at this figure, copy it only a sheet of paper:
3-minute delay = with unrelated verbal, do not give any other visuospatial test - Immediate Recall IR Trial = 30 minutes following Copy trial, finding that no difference in memory 20-45 minutes following copy trial
- Delayed Recall DR Trial = copy a figure again but this time from memory on the paper
- Recognition trial = after delayed recall, consisting of 24 geometric figures, 12 scoring elements from the stimulus figure, plus 12 distractors
9
Q
What 4 things can you learn (as an examiner) from the Rey Complex Figure Test?
A
Is the problem with global/local memory, visuospatial or constructional?
- Global vs. local processing (remembering whole vs. finer details)
- What elements you remember, eg., stimulus features or when you did it
- Visuospatial ability
- Constructional abilities - cannot reproduce an image via drawing/fine motor skills
10
Q
What bad/good way could we test what order the Rey test is done in?
If you wanted to tell where it was about frontal lobe ability - Sometimes the problem is not memory but a lack of unconscious frontal planning, leading to bad performance
A
- BAD = looked to see if the frontal lobes where planning, watch the patient do a different component, you switch their coloured pencils
Bad because it’s incredibly distracting
GOOD = While you watch the patient, you switch your own coloured pencils when you believe the patient is moving onto the next component of the picture
11
Q
How does a neurologist examine the brain?
refers to a neuropsych for more comprehensive treatment,
A
- Looking at strength, efficiency, patient responses to commands, questions, reactivity, challenges to muscle groups and motor patterns
- Body structures, evidence of brain dysfunction via retina swelling or atrophied muscles
- Behavioural patterns from neuroanatomical subsystems, in relatively course gradations, eg., reflex responses
- A brief mental status portion, focusing on higher behavioural functions, language, memory, attention and praxis (overlapping with the neuropsychologist
12
Q
How does a NP examine the brain?
A
Means of measuring the most complex human behaviour, memory, drawing, perception, judgement, emotional processing, speech, attention, via interviews/standardised tests
13
Q
Conceptual evolution of neuropsychology from unitary to fluid: who pioneered this approach of symptoms and different components
A
- Initially, brain damage was seen as a unitary phenomenon - yes/no
- Alexander Luria (1973) - advocating for the use of symptoms found from neuropsychological assessment was the essence of the discipline to infer local brain dysfunction, emphasising careful qualitative analysis of symptoms
Breaking down complex mental/behavioural functions into component parts, eg., the drawing test is a multicomponent test
Higher mental functions representing functional systems based on working zones of the cortex - finding sets of tests of different functions, when combined, could discriminate between psychiatric patient vs. normal functioning
14
Q
What did Teuber argue about testing on TBI patients?
A
Teuber (1969)
- advocating for not concluding that normal intelligence results from a TBI patient is immediately indicative of a normal intelligence/healthy brain, as you are conflating “an absence of evidence with evidence of absence [brain dysfunction]”
- Do not average the neuropsych data of a patient, as it can erase any signs of localised cognitive deficits
Have to figure out what their intelligence was pre-injury/disease
15
Q
What did Lezak and Reschly argue about IQ usage in NP testing?
A
Lezak (1988) -
* argued that IQ scores has outlived any usefulness in the field of neuropsychology, as these scores represent so many different conflated/confounded functions
- Specificity deficits in test modules may give the impression of significant intellectual impairment,
Reschly
* “IQ is bound to a myth that one’s intelligence is fixed, predetermined and unitary - this confounds test results and decisions”
* was disastrous for forensic neuropsych, not providing people rehab/compensation because they look like they have normal functioning via IQ
16
Q
What does Lezak consider to be ‘information handling aspects of behaviour’? and what are they?
A
Cognitions
1. Receptive functions, sensation and perception
2. Memory
3. Expressive functions - Apraxia (skilled movement difficulties), aphrasia (speech/comprehension difficulties), constructional disorders
4. Metal activity variables - attention, consciousness, processing and motor speed
16
Q
What refers to the capacity to engage in independent, purposive, self-directed and self-serving behaviour?
What happens when this is damaged?
A
- Executive functions
- No self-initiation or motivation or self-correction, to plan ahead or regulate emotion
17
Q
What case study indicates severe damage to executive functions?
A
- 38 year old hand-surgeon suffered hypoxia -then suffered with frontal functioning: self-regulating, self-correcting and self-initiating behaviours, learning and prospective memory
- Had high average Wexler test scores over years - despite no incentive/motivation to work, truck driver, dressed by others, showed no self-interest/questions in the examination
- Can only complete serial and routine tasks without any judgement
- Cognitive deficits and lifestyle changes demonstrate damage to frontal/executive functions
18
Q
Why is it important to talk to family members?
A
- sometimes patients are unable to conceive of anything being wrong/different in their condition
19
Q
What 3 personality/emotionality variables can occur after disease or TBI?
A
- Direct = emotional dulling and blandness, or mild euphoria, disinhibition (swearing, no control over behaviour) reduced social sensitivity
- Indirect/other = no reactions to experiences of loss, chronic frustration, low tolerance, apathy, radical lifestyle changes, depression and anxiety
- Emotional lability = emotional ups and downs, brief strong affective expression, lost emotional sensitivity
20
Q
What is a case study example of how TBI symptoms could cause new emotional changes?
A
- Case study: middle aged clerk - left side head injury from a car accident,, complained of fatigue despite showing high averages of tests, only had slight problems with verbal fluency in sentence building tasks
- As he could not longer produce fluent speech, draining his energy, and becoming worse of speech when he was tired, becoming discouraged and depressed, struggling with emotional control, more agitated/sullen
21
Q
How do we tell apart questions of cognitive vs. executive function?
A
- Cognitive function questions:
“How much do you know?”
“What can you do?” - Executive function questions:
“Will you do it?”
“If so, when and how will you do it?
22
Q
What are the 2 main rules of a neuropsychological examination procedure?
A
- Treat each patient as an individual - tailor the examination to patients needs, abilities, limitations, think about whether the test performance is representative of the real world
- Think about what you are doing (as many things can go wrong)
23
What's the first step in neuropsych examination?
1. Begin with a basic text battery
2. Choose from the compendium of tests, including: Orientation, attention WM, Perception, Memory, Verbal functions and language, Constriction and motor performance, Concept formation and reasoning, Executive functions
24
What are the key testing issues in neuropsych assessment?
1. Order of test presentation - vary the order of the succeeding tasks considering, task difficulty, fatigue issues, memory issues
2. Task interference for visual/verbal mobility - DO NOT test vocab/verbal fluency in the interval of word list learning tasks, UNLESS you are testing the role of interference of other cognitive tasks, eg., California verbal learning test to see how they handle interference
25
Why do we do 'testing the limits'?
1. for assessing and expanding the patients capacity and skills, beyond the standard procedures,
2. must do the test precisely, then give them further cognitive tests to figure out what cognitive/executive issue they struggled with
Eg., if memory issues, give them other memory tasks, eg., numbers/letters
Eg., if construction, give them a different drawing, allow them to copy it directly
Eg., if visuospatial, do mirror tracing and see if they are able to improve over time
26
What is the issue with practice effects and how is it solved?
repetitive testing allows patients to improve their performance via practice, can implement parallel/similar forms of tests but is limited because of issues with determining if they have the same level of difficulty (inter-form reliability)
27
What do child NP tests often focus on?
behavioural problems and learning disabilities
28
What do adult NP tests focus on?
nowadays, assessment of behavioural change, treatment and rehabilitation are all of major priority
issues from childhood onset and developmental disorders, including
1. ADHD
2. Spina bifida - neural tube defect
3. Hydrocephalus (buildup of cerebrospinal fluid in the brain
4. Premature birth
5. Childhood meningitis
6. Effects of cancer treatment in childhood
29
What 3 ways can neuropsychological assessment can aid with diagnosis?
1. Differentiating between neurological and psychiatric symptoms
2. Finding neurological disorders in non-psychiatric patients
3. Producing behavioural results to help localise the site of an injury/lesion
30
why is diagnosis from neuropsychology declining?
development of advanced and accurate neurological examination has lessened the role of neuropsychology in diagnosis
31
When is neuropsychological data still useful for diagnosis? (4)
1. Alzheimer's / Huntington's disease, to detect slight cognitive changes, even before the onset of psychomotor changes
2. Toxic encephalopathies (brain disease from toxins)
3. Aautoimmune disorders
4. Residual strengths and weaknesses from brain injuries/lesions (which cannot be achieved by looking at brain scans alone)
Brain function can be localised to specific sites but can the behavioural ability of those with BD can significantly vary
32
Why might neurological exams / scans not be enough for diagnosis?
Can NP tests predict, screen and monitor results?
1. Sometimes behavioural predictions from anatomical findings are inconsistent with the actual behaviours and abilities of individual patients revealed in neuropsych assessments eg., patients can perform adequately or superiorly on cognitive tasks
2. Can help predict and inform treatments for those with mood disorders
3. Identify best candidates for surgery, post surgical treatment in patients with intractable epilepsy
4. Can aid in diagnostic screening, identifying who is at risk for a disorder, and who needs further neuropsychological assessment
5. Monitoring neurocognitive and behavioural changes after traumatic brain injuries
33
What info might a NP receive for patient planning and care?
1. Age, handedness, gender
2. Educational background and current employment
3. Nature of work and daily life
4. Pre-injury cognitive abilities
5. Specific nature of injury
6. post-injury symptoms and recovery
7. Daily activity capacity and handedness after injury
8. Cognitive test scores and specific cognitive errors in tests
9. Any reported psychological symptoms, eg,. anxiety/depression
10. Treatment recommendations and communication to patient
11. Family/friends reports
12. Post-treatment outcomes and medication
34
What are the strengths in neuropsychological assessment for patient care?
1. Very precise and sensitive for individual patients with neurological/neuropsychiatric issues
2. Monitoring the neurocognitive and behaviours of TBI patients
3. Whether BD patients need cognitive retraining and evaluating performance of BD patients who have cognitive complaints in attention, monitor the effects of surgery and/or medical treatment and retraining
4. Repeated testing of patients performance can illuminate cognitive repercussions of injury and post-treatment outcomes, eg., after taking medication, eg., especially when behaviour seems to be highly variable, more accurate results of behaviour
35
What is perplexity and why is it important to give very factual information?
1. Many BD patients struggle with decreased self-awareness, emotional functioning and empathy, leading to less ability to comprehend what has changed
2. Perplexity = a high distrust in the self and one’s capabilities, can be debilitating and lead to anxiety, confusion, feeling strange
3. Highly important to communicate to family members of patients, who may be struggling or confused with new levels of dependency, new irritability, arguments, apathy from the BD patient
36
TREATMENT PLANNING AND REMEDICATION
What are the 3 most important things for assessing for treatment? includes:
1. Delineation of problem areas of functioning
2. Evaluation of patient’s strengths and weaknesses
3. needs to be specific, sensitive and accurate, and repeated tests
effectively communicated with other health providers, eg., rehabilitation specialists, speech pathologists, psychiatrists, therapists, occupational therapists
37
What is treatment evaluation?
1. to test whether the treatment producing any long-lasting and significant changes in neurobehavioural symptoms, as they are costly and expend a lot of experts time and labour
2. Applied for patients with lobotomies, radiation treatment, surgery or brain stimulation for Parkinson’s disease
3. can also test the effects of drug medication and side effects, including
HIV - Hypertension- Cancer treatment, Attentional deficit disorder - Multiple sclerosis - Psychiatric disorders
38
How can NP assessments aide in research ?
Normal neuropsychological tests were originally developed for normal cognition
1. To refine the sensitivity, preciseness and reliability of tests to be able to detect subtle changes in behaviour reflective of underlying neuropsychological issues
2. Also informs theories of cognition that are linked to the functional architecture of the brain, eg., brain mapping studies, aging and disease, dementia progression, demographics of mental ability, precise cognitions
39
Neuropsychological assessment takes place in legal proceedings in two main ways - cases of suing for personal injury and criminal cases:
1. Personal injury (bodily injury, loss of function) -
* the neuropsychologist will be asked for a diagnostic opinion of whether the claimant sustained the injury from the case, current status, severity of symptoms, and whether the injuries may prevent returning to the workplace
The request for compensation may be highly influenced by the neuropsychologists report
2. Criminal cases
* will assess whether the defendants actions may have been contributed by brain dysfunction and/or diminished mental capacity, eg., Jack Ruby’s psychomotor epilepsy in killing Lee Harvey Oswald
40
What is malingering in NP tests and is it a major problem?
1. malingering and exaggeration of symptoms, performing deliberately below optimal level in neuropsychological tests though prevalence is unknown
2. most people have dignity above that, may vary demographically, eg., less in BD patients than those screened by defence lawyers
41
Why should a referral always be evaluated?
Examiner needs a clear understanding of why the patient is being seen, may encompass several different questions - which often comes from the referral
1. Referrals might be poorly constructed as they are written often by non-neuropsychological professionals
2. Needs to evaluate the appropriateness of the referral for the wellbeing of the patient,
* referral might ask to test whether the BD patient can return to work, when the patient actually needs testing and rehabilitation options
42
What are the main 2 types of examination questions?
1. Diagnostic questions = enquire what the prognosis/etiology of patients symptoms
2. Descriptive questions = enquire into the characteristics of patients symptoms, behavioural expressions,
* uses serial studies evaluate whether the condition has changed from a previous examination
43
When are diagnostic questions needed + examples?
- when new symptoms emerge without a previous aetiology
- making differential diagnoses
-to distinguish between different conditions based on symptom analysis
1. Neurological vs. psychiatric disturbances
2. Dementia vs. natural age decline
3. Impaired spatial abilities or object recognition in visual agnosia
44
What info is needed in diagnostic questions?
1. Relies on patient history
2. environmental circumstances, interview/tests for normal
3. prior level of functioning
4. risk factors like toxins, substance abuse and family history
5. progression/severity of symptoms, 6. mental attitudes to the symptoms
7. current circumstances
45
After a diagnosis - Why are descriptive questions needed?
1. to assess patient’s capabilities and deficits
2. to answer questions about future vocational/educational planning - back to school/work, driving, working, and everyday executive functioning
3. might focus on specific skills in question, rehabilitation and treatment effectiveness
4. Repeated assessments over time are needed to assess patient condition after the initial assessment (baseline study), asking several questions, documenting disease/injury progression
46
What 5 things does the examiner need to know as background knowledge?
1. Need to have knowledge of neuroanatomy, neuropathy and neurophysiological techniques
2. Have a deep understanding of the interactive nature of cognitive functions and psychiatric symptoms for testing and diagnosis
3. Real-life experience of how to conduct an interview and gather information from family/friends, workplaces, education and medical
4. Ethically responsible for updating one’s knowledge and being aware of biases and what you don't know
47
Why is blind analysis bad and what do we need instead?
1. relying on present scores alone will not give proper insight into patient
2. needs prior ability scores, vocational, educational history,
Social history - present life circumstances - previous/current medical history, Circumstances around the examination, cultural background, signs of dementia,
48
What things does a patient's social history could include?
ideally in a chronologically based history
1. education / work
2. quality and no of education
3. military service
4. current/previous SES
5. academic achievement and of siblings/family
6. marital history, no. spouses, length
7. information from friends/family
8. current living situation
9. legal misdemeanours
49
What 3 factors are important in present life circumstances?
1. Detailed work information: such as how long patient has held down a job, changes in work performance, whether patient enjoys the job, workplace issues
2. Family life: quarrels, anti-social behaviour, acting out adolescents, substance use amongst members, marital discord
3. Sexual problems: new sexual problems can occur with brain disease, or old problems may complicate patient symptoms
50
What should you look for in a medical history?
1. prior exams and records
2. chasms between records and patient's health concerns
3. subtle changes in motor control, sleeping/eating, visual and auditory defects, mental changes
51
What is mainly considered in Lezak's 'Circumstances surrounding the examination'?
1. Patient’s values and needs - which will influence patient’s responses, performance and expectations of the examination
2. Evaluating whether the patient believes what may be LOST or GAINED IN an examination, will influence their perception/behaviour, e.g., gaining money/losing custody
52
What is the issue of referrals and patient reactions?
1. Patient needs to learn of referral sensitively, or may struggle with anxiety, distrust, lack of cooperation, could interfere with test performance
2. Ideally the clinician needs to explain to patient and family
3. Need to include: purpose of referral, nature of examination, any risk factors, patients choice in the matter
53
What happens when a referral is poorly communicated?
What can help?
1. Patient preparation is more easily achieved when NPs work within the same referral sources with other health providers, without direct contact, clinicians send letters to patients instead
2. Without preparation of the referral, patients might think they are being assessed for being crazy
3. Being of examination, clinician should enquire into what the patient has been told, patient questions might not be the same as the ones in the referral, but should be incorporated into the assessment
54
When do we examine a patient in ACUTE CONDITIONS?
1. For sudden/acute conditions = traumas/strokes, within the first few weeks-months,
1. In the first 6-12 weeks, a brief evaluation should be done to understand patient’s mental capacity,
* a full assessment should NOT be done due to the mental capacities often change rapidly from day to day in this time frame
* Early stage patients also often struggle with fatigue, mental sluggishness and awareness of decreased functioning
55
When can a full examination be done after an acute condition?
After 3-6 months, a full examination can be done to evaluate new treatment goals and level of severity of injury/disease
56
When is long term planning done and how does it differ across age?
1. Long term planning and examinations can be undertaken for patients who will remain socially dependent for training and vocation
2. Younger patients might require a full examination while older adults only need a brief one, eg., if they are already retired and/or have a caregiver
57
How does long term planning differ with neurodegenerative conditions?
1. Evolving/degenerative conditions = needing repeated examinations to
* Making a differential diagnosis, esp. when symptoms are psychological
* 12-18 months reexamination is suitable for dementia
* 1-2 years for other diseases with varied rates of deterioration, such as Huntington’s and multiple sclerosis, - aid in rate of decline
* Timing of repeated evaluations takes into consideration evaluation treatment length and whether it would be mentally disruptive to the patient
58
What are the stages of examination planning?
1.Gather initial hypotheses, tests, evaluate referral
2. Preparatory interview = what functions to be studied, level of examination’s complexity, psychosocial and personality factors to explore, patient limitations, fees
* First 15-20 mins = evaluate patients comprehension and mental capacity
* Prepare patient for procedures, obtain consent, clarify confusion/slow patients, can take a whole day depending on fatigue
* Separate interviews with spouses/others to gain additional info
58
What are the 8 interview topics to cover with 'competent patients'?
P N U C F P D P
1. Purpose = Do they know the reasons for the referral, and do they have questions about it?
2. Nature = Do they understand the examination will study cognitive function, e.g., not craziness?
3. Use = Understand who will receive their report & how it will be used
4. Confidentiality = Do they understand their results will be private, except for litigation, legal or insurance purposes?
5. Feedback = Who will report the findings and when?
6. Patient perception = How does the patient feel about taking the tests? Cooporation may be compromised if the patient feels the test makes them childish, crazy, weak or a threat to their job
7. Description = have they been given an explanation of test procedures?
8. Pay = Has the patient been informed about any possible fee/method of payment?
59
What are direct and indirect observations in patient data?
1. Indirect observations = indirect examples of patient data, hospital letters, education performance, artistic productions, grades
2. Direct observations = by the examiner of the patient, either
a) informally, how patient walks, talks, posture, non-verbal behaviour, emotions, reactions to new people, grooming, dressing
b) formally = standardised tests with limited responses
c) non test = checklist
60
What things in an examination shape the examiner's goals?
1. Competency evaluation
2. Brief mental status, or comprehensive functioning tests for younger TBI patients
3. Emotional status relating to neuropathy and functioning
61
What refers to the degree to which the accumulated evidence supports what the test was designed to measure and matches specific interpretations that the test claims to have?
What are 2 caveats?
Validity
1. But many tests measure multiple cognitive functions, leading to different interpretations
2. Findings of validity dependent on what kind of patient, eg., NC, TBI is given the test
61
What refers to issues arise when testing “in a quiet environment may not reveal the problems that patients have with concentration or memory in their natural work or home environment with their numerous distractions”
Ecological validity
62
What refers to the quality of appearing to measure what the test is supposed to measure?
Why is this important in NP?
Face validity!
important when dealing with easily confused or upset patients who may reject tasks that seem nonsensical to them, or be more cooperative with tests that seem relevant
63
How is reliability treated differently in NP examinations?
1. People with BD may be non-existent reliability in their scores due to changes in fluctuation “to daily / hourly—alterations in their level of mental efficiency”
2. Reliability is lowered in test batteries with summed or averaged scores based on a clutch of tests provide no neuropsychologically meaningful information unless it is very low/high
64
What is Sensitivity? What is it good for?
Sensitivity = the proportion of people WITH the target disorder who get a positive result
(HIT)
Good for ruling out disorders, need specific tests to isolate conditions underlying test performance
65
What is specificity?
What is it good for?
1. Specificity is the proportion of people WITHOUT the disorder whose test scores are NORMAL
(correct miss)
2. this proportion is useful for confirming a disorder in a patient based on their test scores, eg., a reading test is passed by normal individuals and almost always failed by those with reading aphasia
66
What is Positive predictive value?
1. Probability of HITS = determines the probability that a person with a positive/ABNORMAL test has a target condition
66
How is positive predictive value calculated?
takes into account both sensitivity (% of hits) and specificity (% normal scores)
Calculates changes from the pretest probability that the person has the target disorder—given the prevalence of the disorder for persons with the relevant characteristics (e.g., age)
67
What is negative predictive value?
1. (P) = CORRECT MISS = determines the probability that a person with NORMAL test scores significances the ABSENCE of the condition
68
What refers to the ratio of the odds of developing a disorder for one group (e.g., experimental group) over the odds of the disorder for the other group (e.g., control)?
The odds ratio
Specifically, it asks: How much more likely it is that someone in the experimental group will develop the outcome as compared to someone who is in the control group?
69
What is relative risk and how does it differ to the odds ratio?
1. Relative risk involves a similar conceptual procedure in which the probability of an event in each group is compared rather than the odds
2. “The odds ratio is the effect of going from “knowing the test negative” to “knowing it's positive”
3. whereas the likelihood ratio + effect of going from an unknown state to knowing the test is +”
70
What are parallel forms?
1. instruments designed for repeated measures,
2. are few and far between
3. risk practice effects, important to public test retest data
71
What are 5 conditions of the time and costs of real and computerised tests?
1. Neuropsych time and labour
2. Patient issues in getting to an examination, fatigue
3. Self-administered and computerised tests do not capture important qualitative observations,
72
What are the pros and cons of computer tests?
1. PRO - Computer tests can do more efficient scoring, adaptive testing, quicker
2. CON - An absence of an examiner might decrease discipline/motivation in the patient
3. CON - Issues with rapid obsolescence and timing issues across computer systems
73
What would be a case of using a non standardised technique?
1. implemented from the literature when no standardised test is suitable for patients symptoms,
2. EXAMPLE - using a non standardised spelling test with
phonetically regular and irregular words instead of a traditional level of spelling test to suit the patients symptoms
74
What is in a neuropsychological battery?
1. A collection of standardized tests designed to assess different cognitive functions, such as attention, memory, language, and executive functions, to help determine the presence and nature of cognitive impairments
2. After the initial battery, the examiner will then drop some tests or choose additional tests as the examination proceeds based on the patient’s strengths, limitations, and specific handicaps and determine modifications to suit the patient’s capabilities
75
How are tests administered, length and types of disorders?
A negative/normal test performance DOES NOT RULE OUT BRAIN PATHOLOGY, but only demonstrates which regions are intact
1. Uniform minimum test batteries have been recommended for several neurological disorders, e.g., multiple sclerosis and Alzheimer's disease
2. a battery of tests will generally take 3-4 hours when given by an experienced examiner and split across 1-2 days depending on the patient
2. For outpatients, one time saving device is to mail a background questionnaire to the patient with instructions to bring it to the examination
76
Why is test selection important?
1. Since the examiner cannot change instruments or procedures in midstream without losing, confounding data
2. but tests specific for the patient’s condition can be added/modified to a research battery
77
What are the advantages of ready-made batteries?
1. are a good starting point especially to new examiners and neuropsychologically inexperienced psychologists
2. extend the scope of the barely minimal neuropsychological examination (IQ batteries, drawing test, and memory batteries, and offer normative data from similar populations across a number of different tests
78
What are the disadvantages of ready-made batteries?
1. involve more testing than necessary, but not enough to answer questions specific to their problems
2. not geared to patients with handicaps, eg., patients with major perceptual or motor disabilities can’t do most of readymade tests
3. Batteries do not render diagnostic opinions
4. Might include questionable or outdated tests to give naive clinicians a sense of complacency - data is never as helpful as patient data
79
What was the case of the 40 year old nursing assistant?
1. Presented with sleep disorder, difficulty learning and remembering
2. Suicide attempt with carbon monoxide, only worked sporadically after this, slowed down mind, disorientation, dependent on family
3. Residual memory impairment from CO poisoning to be assessment
4. Very good verbal and visual memory scores, word recall was bad
Suggested a mild attentional problem, then a visuospatial problem - deviating from initially referral of possible memory problems
5. 2 previous unrelated head injuries
6. New tests for visuospatial deficits were given, resulting in low to defective performance, TBI was offered as conclusive etiology
79
What things contribute to hypothesis testing?
1. Initial examination and referral -
2. Conducting more specific tests
3. Testing the limits
4. Seeking more patient history/current information
5. Changing examination plan, pace, techniques used
6. Sometimes it is better to OBSERVE rather than TEST the patient
Can make several serial hypothesis to find subtle/discrete dysfunction
80
What 2 things happen after the examination?
1. Supporting/rejecting hypothesis, answering diagnosing and descriptive questions and why some questions cannot be answered
2. Two types of reports are often achieved, one to patients/family and other to referral source (and institution eg., hospital)
81
What is the follow up interpretive interview?
1. follow up interview for patients to understand their status and future possibilities and methods to compensate for their issues
2. Feedback is helpful when patient brings closest family member or companions, involving briefly describing the tests taken, patient’s performance, generalising to everyday problems, ascertaining what everyday tasks
3. Allaying anxieties from the patient and offer reassurance to the patient
Counseling is provided in the course of the interpretive interview
4. Offering future strategies, eg “repeat what the other person has said so you comprehend it properly” and to the family member “speak slowly and clearly”
5. Referral sources, physicians, lawyers, rehab teams
