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PSY Week 8: Neuropsych testing (Neuropsych tests (Types of tests (Behav…
PSY Week 8: Neuropsych testing
Roles of clinical neuropsych
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
Child neuropsych
Common Disorders
Genetic syndromes - Downs, Huntingtons, Cystic Fibrosis, metabolic syndromes - high BP, obesity, risk of heart probs
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
Overview
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
pediatric neuropsych is subspeciality looking at brain/behav rel during dev'ment
Assessm processes
interview - need info from multiple contexts (parent, child, teacher)
review medical & edu history
observations - include emotional/affect functioning
questionnaires - both for parent and child
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
Neuropsych assesment
Assessment vs testing
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
Assessment process
Referal
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
Clinical Interview
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
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
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
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)
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
Basics
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
Neuropsych tests
Perception & motor Tests
judges visual perception
Judgement of Line Orientation Test, draw a clock
Hoopers Visual Organisation Test - visual integration
Finger tapping - meas motor skills & dexterity
Language tests
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
Attention & proc speed
Digit Span test - attention,
Cancellation tests - meas sustained attention
TMT B - meas divided Attention
TMT A - meas speed coding
Memory
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
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
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
Ecological Approaches
Rivermead Behaviour Memory test - tests gross mem impairment
tests of everyday attention, ability to multitask
tests that relate to real life probs/activities
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
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
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
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
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