Neuropsychology

Neuropsychologist may assess and help patients with ADHD, Conduct disorder, oppositional defiant disorder, Eating disorder, Anorexia Nervosa, separation anxiety disorder, generalized anxiety disorder, panic disorder, agoraphobia, OCD, and other neuropsychiatric conditions.  

Clinical neuropsychologists assess and treat the cognitive and emotional needs of patients requiring neurosurgery conditions such as brain injury, brain tumors, hydrocephalus, etc.  Neuropsychologist assesses neurocognitive functioning of neurosurgical patients.

As a neuropsychologist one can critically assess changes in patients’ memory, attention, language, and other functions that help determine the course of treatment and rehabilitation and can contribute in clinical neuroscience research on quality of life issues in patients with neurosurgical disease.

Neuropsychological assessments help patients and physicians in multiple ways, including:

• Pinpointing mild or subtle neurocognitive deficit;
• Predicting the course of a disease and recovery rate;
• Assisting in determinations about a patient’s return to school or work, and;
• Helping patients and their families understand the effects of the disease process, including coping techniques, which may aid in diagnosis.

Source: http://www.pennstatehershey.org/web/neurosurgery/patientcare/specialtyservices/neuropsychological

 

Utilization of standard and flexible batteries in clinical evaluation

Dimensional –categorical approach to neuropsychological evaluation approach to neuropsychological evaluation is contingent on a dimensional as opposed to a modular brain model . The idea that the brain is modular is an old one, dating back at least to Gall who believed that different faculties were represented in different regions of the cortex. The opposing view, that the cortex functions as a unified whole, at least with regard to higher mental functions, has always challenged the modular one.  

Fixed batteries in neuropsychological assessment

Halstead- Reitan Neuropsychological Battery

Recent development in the two most frequently utilized fixed neuropsychological batteries , the Halstead –Reitan and the Luria-Nebraska Neuropsychological batteries : In HRB: Development of new summary scores: General Neuropsychological Deficit scale ( GNDS), the Left neuropsychological Deficit scale ( LNDS), & the Right Neuropsychological Deficit scale ( RNDS).

GNDS is a summary scale based on 42 variables from the HRB that characterizes the degree of overall impairment of neuropsychological functioning . this summary score ranges in classification from normal through mild , moderate , and severe degrees of impairment .

Comprehensive Norms for an Extended HRB ( CNEHRB)

Halstead Russel Neuropsychological Evaluation System ( HRNES)

Wechsler Adult Intelligence Scale

WAIS-R

LURIA-NEBRASKA NEUROPSYCHOLOGICAL BATTERY ( LNNB)

The LNNB-1 has undergone changes since 1980. Addition of delayed memory scale, intermediate memory scale

Tests developed by process oriented neuropsychologists utilize tests include the current 60-item version of the Boston Naming Test, Boston Diagnostic Aphasia Examination, the Cancellation test, Delayed Recognition Span Test & non verbal mood scales.

Existing tests that are administered in a manner reflecting the process approach include the WAIS-R as a neuropsychological instrument , Wechsler Memory scale, Hooper Visual Organization test, Rey-Osterreith Complex Figure, Recurrent Series Writing and Multiple Loops.

Neuropsychological Examination of select populations

Child Neuropsychological assessment; tests within cognitive domains of intelligence, achievement, language, visual –spatial and construction, somatosensory, and motor functions, attention , memory and learning and problem solving. Standardized interviews , broadband rating scales, self report inventories.

 Neuropsychological evaluation of the elderly (with dementia)

Minnesota Multiphasic Personality inventory (MMPI), Millon Clinical Multiaxial Inventory, Conner’s Continuous Performance Test

Computer assessment allows for the assessment of performance efficiency, response time, and variability. Automated assessment in the evaluation process. Lack of education, limitation of evaluating cognitive domains such as language and memory, cost, unfamiliarity.

 

Neuropsychological rehabilitation

Modern day cognitive rehabilitation (CR) spans a number of disciplines , including speech pathology, occupational therapy, special education, physical medicine, neurology , cognitive psychology, cognitive neuroscience, rehabilitation psychology and neuropsychology. Rehabilitation has developed as a result of contributions of all these professions and incorporates many different theories and techniques.

Understanding of brain restoration of function

Theory of Phrenology (Franz Gall) 18^th century: gall’s theory was almost completely incorrect, it was perhaps a springboard for those who would later accurately describe localization of brain function.

In the mid-1800s, Paul Broca, the French physician, anatomist, and anthropologist, began his work. He described an intuitive rehabilitation program to restore lost skills in an adult patient who became unable to read aloud. Building on Broca’s work, the great German neuropsychiatrist Carl wernicke was one of the first to conceptualize brain function as a series of regions that were dependent on interconnected neural pathways. This localization and interconnection concept became a fundamental element of clinical psychology and CR.

As the 20^th century dawned, prominent American neuropsychologist Shepherd Franz was using scientific methodology to study motor learning in hemiparesis and effectiveness of therapy in clients with aphasia, making him pioneer in neuropsychological rehabilitation. Like Broca, Franz noticed that his aphasic patients looked like they were learning new skill rather than relearning an old habit. This observation established a precedent for using techniques that focus on learning new skills to compensate for abilities lost or diminished due to brain damage. During and after the two World Wars, Germany & Austria led the way in developing brain injury rehabilitation centers to treat wounded soldiers and German psychologist Kurt Goldstein, Soviet neuropsychologist Alexander Luria,  British neuropsychologist Oliver Zangwill made significant contributions. In 20^th century Yehuda BenYishay (1970), Muriel Lezak ( 1986), Sohlberg and Mateer made siginificant contribution in the field of CR. Neuropsychological rehabilitation centers in US,  CR, neuropsychological rehabilitation interventions, cognitive-didactic treatment approach, functional-experimental approach, systematic CR program: Reitan Evaluation of Hemispheric abilities and Brain Improvement Training (REHABIT) is patient specific & comprises of 3 levels of information processing : (a) attention, concentration, & memory, (b) lateralized processes ( verbal or visuospatial &, (c) higher order abilities such as abstraction and logical analysis. Sohlberg and Mateer’s ( 1989, 2001) attention process training ( APT) series, Robertson’s  (1996) specific cognitive retraining model for addressing executive dysfunction called as the Goal Management Training method. Carter ( 2000) frontal lobe dysfunction, Metzler-baddley & Jones 2010, Children). Memory, visuospatial , language function. Memory Clinic, Emotional dysregulation. Neuropsychological rehabilitation is  a broader field than CR because it encompasses “ amelioration of emotional, psychosocial, & behavioral deficits caused by an insult to the brain” in addition to CR.

Available literature on PubMed, PsychInfo, MEDLINE: Psychotherapy with CR, meditation therapy, catastrophic thinking (e.g., distortion in which patient imagines the worst possible outcome of an event or situation), hypersensitive to one’ error failure to distinguish between normal ordinary error in functioning and more serious errors, are likely caused by brain injury. Psychodynamic approach, disruption of patient’s sense of self ( “ego” identity) : fractured ego identity

[ Phrenology (Oxford dictionary) : The study of shape of the human head, which some people think is a guide to a person’s character]

Use of technology in CR

Memory notebooks

Cognitive prosthetics: smart phones, ipads, PCs, Computerized attention training, Virtual reality programs, telerehabilitation

Incorporation of neuroimaging with neurocognitive techniques, treatment protocol.

A protocol for assessment, psychotherapy and neurorehabilitation for neurosurgical patients may contribute towards holistic neuropsychiatric care provided by the  interdisciplinary team.

The role of psychotherapy and neurorehabilitation is well established in the treatment of brain injured patients. There is need for better understanding of neuropsychological profile of the patients with other intracranial space occupying lesions like brain tumors. There is paucity of literature about the neuropsychological profile of the patients undergoing cranial neurosurgery for brain lesions. The assessment of neuropsychological profile of neurosurgical patients may help in recognizing the subtle changes due to brain lesions, awareness of patient’s emotional distress, designing compensatory strategies and patient’s coping skills, and evolving psychoeducational techniques for neurosurgical patients.

Neurological findings , radiographic findings, neurosurgical plan and neuropsychological assessment will be part of comprehensive presurgical evaluation of the patient. The neuropsychological evaluation will provide essential quantitative and qualitative data about the patient’s neuropsychological and emotional status.

Neuropsychological domains: Effort/motivation,  attention/ concentration, speed of information, processing, motor functioning, verbal functioning, visuospatial functioning,  memory, concept formation, reasoning, executive functioning, awareness, personality composition and psychological distress, estimate of premorbid intelligence.

Sample Tests: California Verbal Learning Test (CVLT) for Effort/ Motivation

                          WAIS-IV, for other domains, except

                         American National Adult Reasoning Test for estimate of premorbid intelligence

Presurgical history

Patients’ impressions of their current neurological status

 Source:

Clinical Psychology: An Introduction,  Author: Alan Carr

Routledge, Taylor & Francis