Chapter 10b.docx

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21 Apr 2012
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Chapter 10b
Neuropsychological Tests, Batteries and Screening Tools
- An essential component of any assessment is an evaluation of a client’s mental status
A conceptual model of brain-behaviour relationships
- Benett has proposed a simplified model of brain-behaviour relationships that is helpful in
organizing the seemingly chaotic profusion of neuropsychological tests
o The conceptualization is a slight expression of the model presented by Reitan and
Wolfson
Each neurological procedure evaluates one or more of the following categories:
Sensory input
Attention and concentration
Learning and memory
Language
Spatial and manipulatory ability
Executive functions
o Logical analysis
o Concept formation
o Reasoning
o Planning
o Flexibility of thinking
Motor output
o Look at FIGURE 10.6
- Tests and procedures of the Halstead Reitan Test Battery
o Category test measures abstract reasoning and concept formation; requires examinee
to find the rule for categorizing pictures of geometric shapes
o Tactual Performance Test Measures kinaesthetic and sensorimotor ability; requires
blindfolded examinee to place books in appropriate cutout on an upright board with
dominant hand, then nondominant hand, then both hands; also tests for incidental
memory of blocks
o Speech Sounds Perception Test measures attention and auditory - visual synthesis;
requires examinee to pick from four choices the written version of taped nonsense
words
o Seashore Rhythm Test Measures attention and auditory perception; requires
examinee to indicate whether paired musical rhythms are same or different
o Finger Tapping Test measures motor speed; requires examinee to tap a telegraph
keylike lever as quickly as possible for 10 seconds
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o Grip strength measures grip strength with dynamometer; requires examinee to
squeeze as hard as possible; separate trials with each hand
o Trail Making, Parts A, B Measures scanning ability, mental flexibility, and speed;
requires examinee to connect numbers (Part A) or numbers and letters in alternating
order (part B) with a pencil line under a pressure of time
o Tactile Form Recognition Measures sensory perceptual ability; requires examinee to
recognize simple shapes (ex: triangle) placed in the palm of the hand
o Sensory Perceptual Form Measures sensory perceptual ability; requires examinee to
recognize simple bilateral sensory tasks (ex: detecting which finger has been touched,
which ear has received a brief sound; assess the visual field)
o Aphasia Screening Test Measures expressive and receptive language abilities; tasks
include naming a pictured item (ex: fork) repeating wrong phases; copying tasks (not a
measure of aphasia) included here for historical reasons
o Supplementary WAIS III, WRAT 3, MMPI 2, memory tests such as Wechsler Memory
Scale III or Rey Auditory Verbal Learning Test
Assessment of Sensory Input
- An individual who does not see stimuli correctly, hear sounds accurately, or process touch
reliably may encounter additional handicaps at higher levels of perception and cognition
Sensory Perceptual Exam
- Reitan and Klove developed procedures for sensory perceptual procedures
o Consists of several methods for delivering unilateral and bilateral stimulation in the
modalities of touch, hearing and vision
For example: the examinee is asked to say which hand has been touched (with
eyes closed) or to report which ear has received a barely audible finger snap, or
to identify which number has been traced on the fingertip.
Especially diagnostic if the examinee consistently makes more errors on one
side of the body than the other
Certain areas of the cerebral cortex are devoted to primary processing of touch,
hearing and vision
An examinee who finds it difficult to process touch in the right hand
may have a lesion in the postcentral gyrus of the left parietal lobe
Difficultly processing sound in the right ear may indicate a lesion in the
superior portion of the left temporal love
Right sided visual defects may indicate brain impairment in the left
occipital lobe
Finger Localization Test
- Is a venerable procedure developed by neurologists to evaluate possible sensory looses caused
by impairment of brain functions
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- Benton has developed a well normed 60 item test of finger location that consists of three parts:
o With the hand visible, identifying single fingers touched by the examined with pointed
end of pencil (10 trials each hand)
o With the hand hidden from view, identifying single fingers touched by the examiner (10
trials each hand)
o With the hand hidden from view, identifying pairs of fingers simultaneously touched by
the examiner (10 trials each hand)
- The method of response is the left of the patient: naming, touching, or pointing to fingers on a
diagram
Measurements of attention and concentration
Test of Everyday Attention
- Is promising measure devised in Great Britain by Robertson Word, Ridgeway and Nimmoo Smith
- Measures the subcomponents of attention , including sustained attention, selective attention,
divided attention, and attentional switching
- The test has three parallel versions and has been well validated with closed head injury clients,
stroke and persons with Alzheimer’s disease
- TEA is highly sensitive to normal age effects in the general population, and is therefore well
suited to geriatric assessment
- TEA allows for subset analysis as a means of identifying an individual’s particular strengths and
weaknesses
Continuous Performance Test
- CPT is not really a single test but rather a family of similar procedures that dates back to path
breaking research of Rosvold, Mirsky, Sarason and others
- These authors devised a measure of sustained attention (also called vigilance)that involved
continuous presentation of letters on a screen
- Errors of commission are noted when the examinee presses the key for a non target stimulus
o Normal subjects make few errors
- CPT tests are sensitive to a wide variety of brain impairing conditions, including hyperactivity,
drug effects, schizophrenia, and overt brain damage, these tests are not a panacea for the
diagnosis of attention deficit disorders
- Children with diagnosed reading disorders showed impaired performance on the CPT
- CPT is ideal for computerized adaptation, and dozens of different version of it have appeared in
the literature
- Sandford and Turner have published a computerized CPT that uses both visual and auditory
stimuli
- Intermediate Visual and Auditory Continuous Performance Test (IVA) is normed on 781 normal
persons ranging from 5 to 90 years of age and screened for attention deficit, learning difficulties,
emotional problems and medication use
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