PSY Week 8: Neuropsych testing

Roles of clinical neuropsych

Child neuropsych

Neuropsych assesment

Basics

Neuropsych tests

occipital: visual processing, dam can result in blindness, poor recall of images, impaired visual scanning

parietal: sensory processing, dam can result in impaired sense, touch, visio-spatial difficulties, apraxia

temporal: auditory, sensory procedures, damage can impair sound discrim, voice recognition, mem comprehension

frontal: EF, dam can impair concentration, attention, abstraction, prob solving, dec making and reasoning

Neuropsychology: study of the brain behaviour relationship, lesions in dif parts of brain lead to dif probs

Sensory motor deficits

Acalculia - inability to perform maths

Agraphia - deficit in writing ability

Akinesia - deficit in motor movement

amnesia - loss of mem

Aphasia - difficulty comm bc of impaired, scrambled speech

Apraxia - movement disorder w/o paralysis

Neuropsych contructs

cognition - intelligence, language, mem & motor

emotion - anx, dep, mood

behaviour - daily activity, aggression, self-monitoring, sleep

management & rehabilitation - behav man, interventions, planning, rehab, oft ch after brain injury

recommendations - for pax, caregivers & teams regarding cog status (ability to return to work), functioning & capacity, what they can or x do

characterizing cognitive impalement - doing assessments, strengths/weaknesses

psychoeducational & counselling - for client, caregivers or teams, more abt education but some do CBT, explore nature of cog difficulties & prognosis/what to expect

provide assessment, treatment & recommendations for pax experiencing mem, learning, attention, lang, reading ... etc probs, also provide treatment w cog, emot & behav models, good for synthesising info

meas of change - monitoring progression & treatment outcomes, e.g. for dementia

psychological therapy - bt mostly for pax w brain injury or dysfunction

Neuropysch settings

Private clinic or practice - of do legal work, provide evidence, brain injury

Forensics & research - areas related to academia

work in multidisciplinary teams - doc, allied health prof (physio, speech therapy ect)

Hospitals - general trauma & medicine, psychiatry, rehab, neurology & neurosurgery, geriatric, pediatric

Assessment vs testing

Assessment process

Usefulness & importance

used when: brain injury (aquired, traumatic), neuropysch condition (MS, Parkinsons, epilepsy), medical (infectious disease, immune or vascular disease), dementia syndromes, psychiatric, learning difficulties & disabilities (Autism, ADHD)

useful bc: provides good profile of pax strengths & weaknesses, aids in cog diagnosis, espec when deficits are subtle, can pick up small changes, tests are in depth, help w treatment, monitor changes and improvements, can predict social, edu & vocational outcomes

testing - just administering a test & assessing results

Assessment - defined as evaluation of brain & NS functioning as its related to behav, much more comprehensive, includes observations, med records, get a whole picture of the person

  1. Referal
  1. Clinical Interview

neuropsych must clarify the referral question, must understand referral question as this dictates your action

start by collecting background info to dev some kind of hyp, get med hist, prev neuroimaging, bloods, psycho-social profile (fam, SES, edu, work), psychiatric history

talk w client on the phone & speak to referral team to get more info, talk to case manager, dev some hyp to plan best assessments

get to know pax, dev rapport, get a timeline of how they believe they've been progressing, figure out what info you're missing, clarify timeline or talk to fam, friends, spouse if client x provide info

Guide for Int

referral q should guide interview, be flexible and bring multiple tests, use what you think is approp, which areas need to meas to answ the referral q

check orientation (know where, who they are, day date etc)

timeline, include functioning, why they are here, getting better or worse, fluctuating, severity

account of cog complaints - ask abt mem, language, attention etc

understand their daily functioning - interfereces w daily activities

edu & occupational history - indication of lvl of functioning across lifespan

med/psychiatric history - med, diagn, major surgeries, injuries, anything that impacts cognition

psychosocial history - current social support, carers, stressors

dev'ment history - learning probs,

current mood, any changes in behaviour, any substance use/abuse

qualitative assessment - how pax present, language, presentation, motor movements, behav, effort, affect

also consider how long you have to test them, is a better time to test them, how urgent is it, whats the best time of day, which factors could impair perf (visual, hearing probs, culture, ESD ect)

Perception & motor Tests

Language tests

Attention & proc speed

Memory

many dif types of neuropsych tests, can be fixed battery of tests (tests used w all pax regardless of referral q, designed to sample cog functioning) or flexible test batteries (tests selected specifically for that context & person, this more comm used

EF

Ecological Approaches

Types of tests

Behav Assessment of Dysexecutive Syndrome (BADS) - meas planning, porb solving, organisation, task prioritisation, for 16-87 years, plan a day at the zoo

Test of Abstraction (TA) - meas EF, displays concrete or rigid thinking (e.g. proverb interpretation,

Controlled Oral Word Association Test (COWAT) - meas verbal fluency, norms aged 6-97, say a letter & name as many things as possible

Trail Making Test (TMT) - tests EF (attention, speed, mental flexibility, connect numbers then rotate between numbers & letters

administering instruments

the order is imp - start w hard ones first, best perf in 1st 30 min, mix it up, verbal, n verb, easy, hard, x want tests interfering w e/o

provide clear guidelines - reduces anx & get to know pax, tell them the order of tests & what to expect, have standard instructions bc pax v sensitive to instructions

take breaks when nec, record all qualitative data (anx effort etc) for the report

judges visual perception

Judgement of Line Orientation Test, draw a clock

Hoopers Visual Organisation Test - visual integration

Finger tapping - meas motor skills & dexterity

Boston Naming Test - pic of something & have to define or describe it

Comprehension & following sets of rules

Production (free speech analysis), repetition (repeat sentences back), reading & writing, semantics (access & concepts), naming

tests perceptions of sound, phonics etc

Digit Span test - attention,

Cancellation tests - meas sustained attention

TMT B - meas divided Attention

TMT A - meas speed coding

assessed the most, usually episodic mem

Word Lists, Logical Memory - meas verbal & learning memory

Rey Complex - tests visual memory, shown figures then must draw them after 30-40 min

Letter number sequencing WM

Planning - tower of London, have x moves to make it from A to B

Abstractions - similarities, proverbs, 10 qusestions

Stroop test - response inhibition

Wisconsin Card Sorting Test - shifting

Rivermead Behaviour Memory test - tests gross mem impairment

tests of everyday attention, ability to multitask

tests that relate to real life probs/activities

Interpreting data - take holistic approach, imagine what they were like before probs, inc history & presentation, try to find simplest explanation, consistency or x between tests

Common Disorders

Overview

Considerations for interpretation - premorbid functioning, differential diagnosis, pax can have dif sympt same injury, time frame from incident, environment factors, qualitative observations, prev assessm results

Assessm processes

maturation is v imp in kids, brain injury may slow or change dev trajectory, uses development models to find context, genetic, environment & fam factors also play imp role

Genetic syndromes - Downs, Huntingtons, Cystic Fibrosis, metabolic syndromes - high BP, obesity, risk of heart probs

  1. interview - need info from multiple contexts (parent, child, teacher)
  1. review medical & edu history

pediatric neuropsych is subspeciality looking at brain/behav rel during dev'ment

Dev'ment disorders - speech/language impairment, ADHD, learning dis, intellectual dis, ASD

acquired neuropsych dis - traumatic brain injury, neurological condition, cerebrovascular disorder, hypoxic-ischemic injury, psychiatric disorder

  1. observations - include emotional/affect functioning
  1. questionnaires - both for parent and child
  1. cog tests - assess attention, EF, mem, lang, spelling, reading, maths etc (e.g. WISC)

useful for identifying kids in low range of functioning, diagnostic tests divide skills into components to isolate areas of difficulty