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Chapter 15

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Ted Petit

Chapter 15 - CT and MRI technology have not made clinical psychologists obsolete - Still many conditions that are not detectable by neuroimaging like early Alzheimers. The client - Usually neuropsychologists call people they're assessing as clients - Can be of any age The neurologist - Neurologist: special type of physician who diagnoses and treats disorders of the nervous system - Disorders of CNS and PNS - Consists of 2-4 years of premedical university training, 4 years med school with M.D. or D.P degree and 3 years of specialty training. - Neurologists looks at neurological structure throughout body. - They diagnose and treat disorders or may recommend surgery, performed by neurosurgeon Radiologist - Made possible because of Wilhelm Conard Rontgen - Xrays: could penetrate solid materials, including human tissue - Rontgen was rewarded for his discovery with the first Nobel Prize in Physics in 1901 - Radiologists are rare. - Not only xrays but radiological examination such as CT or MRIs are analyzed by radiologists who writes a report detailing the findings Clinical neuropsychologist - The branch of neuropsychologist concerned with psychological assessment, management, and rehabilitation of neurological disease and injury. - Different from experimental neuropsychology which focuses on human behaviour arise from brain activity - Cognitive neuropsychology less focused on neural basis and more focused on explaining behaviour in terms of functional brain units regardless of anatomical representation - Usually don't have medical training and typically complete an undergraduate degree in psychology, a master's and doctorate ph.D or Psy.D typically complete an internship as well - Usually first person to assess someone is another professional like optometrist or physician - Ideally after brain injury patient is prompted to see neurologist. Brain imagie is interpreted by radiologist and undergoes behavioural testing from clinical neuropsychologists. - There is a lot of variability in the process Assessment - First assessment is usually series of questions and tests by a neurologist or emergency room physician - Examines reflexes, cranial nerve functioning, muscle tone, gross movements, and perceive stimuli - Neurological exam includes Mini Mental State Exam, or the Modified Mini Mental State Exam. How well people can answer series question designed to briefly examine cognitive functions such as language, orientation to location, attention, mental status - People with dementing illness or nontraumatic neurological impairment may first seek help from the family physician Neuropsychological assessment - Detailed examination of cognitive functions - Consultation consists of personal interview and the performance of a series of tests - Use standardized tests: o Always administered same way and scored same way - 2 general approaches o Use of a fixed battery o Or use of a flexible selection of tests - Many prefer to mix these approaches - First with general cognitive test, then more specific - Together with medical history and neurologist's report, can result in diagnosis, intervention and rehabilitation - Common goal o Neuropsychological assessments provide evidence of cognitive dysfunction o Neuropsychological assessments provide a profile of cognitive function for individual at specific time o As we discovered in the previous chapters, many types of diseases can result in changes in cognitive function o Cognitive profile can provide help to determine reason for cognitive impairment Fixed test batteries - 5 batteries widely used o Halstead-Reitan Battery (HRB) developed in 1930s to examine cognitive change following brain injury 5 core tests: includes category test, tactual performance test, rhythm test, speech sounds perception test, finger tapping test. Often a trail-making test, an aphasia screening test and grip strength test are given Doesn't test memory directly Distinguishes brain damage to non-brain damage. But can be difficult discriminating those with psychiatric illness from brain damage Not used often because ti takes long to administer and not useful for individuals who have motor problems. Strength is its recognition that accurate cognitive profiles rely on assessment of many types of behaviour o Luria-Nebraska Neuropsychological battery (LNNB) Measures receptive and expressive speech, motor, rhythm, tactile, visuospatial, writing, reading, arithmetic and intellectual performance Discriminates braindamge from normal But difficulty discriminating from psychiatric disorders Not sensitive to discriminate among subtle neurological impairments Can't identify laterality of lesions o Wechsler Adult intelligence scale (WAIS-III) One of the most widely used. Not designed as neuropsychological test but for intelligence 2 subtests: verbal (VIQ) and performance (PIQ) Combining PIQ and VIQ = full-scale intelligence quotient (FSIQ) PIQ relies less on previously acquired information than VIQ. PIQ more sensitive to age changes in cognition. Problem in reliability, and validity
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