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Chapter 1

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University of Toronto Scarborough
Zachariah Campbell

CHAPTER 1 What is Clinical Neuropsychology? Clinical Psychology: a division of psychology that specializes in the clinical assessment and treatment of patients with brain injury or neurocognitive defects. It’s considered applied because it deals with assessment, diagnosis, and treatment of those individuals with brain illness or injury as opposed to looking at only brain structures and functions. Other areas within neuropsychology: • Experimental neuropsychology: focuses on brain-behaviour relationships usually using animals as subjects o Describes structures and functions, as opposed to focusing on assessment, diagnosis, and treatment. Historical Background The term ‘neuropsychology; was first used in 1913. During the first time period, it was a combination of psychologists, neurologists, psychiatrists, speech pathologists, and even more. • It eventually became to mean ‘the study of the relationship between the brain and behaviour’. Ancient Hypotheses to Modern Theories of Brain Functioning Neolitihic Period or Stone Age Trephination: oldest known surgical technique in which a small piece of bone is removed from the skull, leaving a hole in the skull; the procedure has been done for medical and religious reasons. • May have been done as a way to relieve pressure caused by brain swelling • Some of the subjects that received the procedure may have exhibit behaviours that were not usually accepted by society at that time. o These may include behaviours that resemble the delusions/hallucinations shown in schizophrenia or behaviours that were secondary to traumatic brain injury (TBI) • Accounts talk about releasing evil spirits from the person’s head by drilling the hole Surgical trephination involved removal of a bony portion of the cranial vault. Successful trephination did show signs of healing. Symbolic trephination involved only the external cortical layer. This occurred mostly in the areas of the frontal and upper parietal regions. • A researcher found that most trephinations occurred after a skull fracture from events such as a blow from a club or a projectile. This was a very crude method as it exposed the brain tissue to various forms of disease and infection. Those that survived probably had residual damage but many did survive. Some even had multiple trephinations. The Egyptians Next evidence came from the Egyptians in the Third Dynasty. They had limited knowledge of brain anatomy. They would preserve all other organs but discard the brain because it was not considered important. • The heart was considered to contain the mind and soul Edwin Smith Surgical Papyrus: described the techniques used various forms of difficulties including brain trauma. There were no indications that actual surgery was performed. • Gave reference to the meninges and the cerebrospinal fluid. • Described how to determine which patients could be successfully treated, which was questionable, and who could not be saved. Similar to modern day triage. • One of the first accounts of brain-behaviour relationships: relationship between certain functions of the brain and overt behaviours. Described within: • Ways to reduce intracranial hemorrhaging • Removal of fragments of bone from the ear canal and blood clots from the sinuses • Prescriptions for head wounds Alexandria, founded after Alexander the Great conquered Egypt. • Herophilus (335-280 BC) and Erasistratus (304-250 BC) were first to propose the brain as the center of reason. They also gave the first accurate and detailed description of the human brain, including ventricles. During this time period, a theory of brain functioning arose (and continued into the Middle Ages). This theory stated that the fluid-filled compartments of the brain were responsible for higher mental, as well as spiritual processes. • The cavities were cells – the lateral ventricles formed the first cell, the third ventricle the second cell, fourth ventricle composed the third cell. o This was the ventricular localization hypothesis. This later became known as the cell doctrine. • We now know that ventricles are the sites that produce and transport cerebrospinal fluid and have no role in higher order brain functioning. Ancient Greeks Heraclitus (540-480 BC)  the mind is an enormous space whose boundaries we could never reach. Pythagoras (582-507 BC)  brain hypothesis: the brain is the source of human thought and behaviour Hippocrates (460-379 BC)  Hippocratic Oath: physicians would do no harm in their quest to appropriately treat their patients • May not have actually been written by Hippocrates Also believed that the brain controlled all sensing and movements. Hippocrates was first to describe contralateral control: the premise that one side of the brain controls the motor and sensory functions of the opposite side of the body. Hippocrates believed that a patient was to be treated as a whole, not as an assemblage of parts. Stressed the benefits of a sound body, a healthy environment, and exercise. He believed in holistic medicine: medical practice that treats the entire patient; involves physical, psychological, and spiritual aspects of healing. • This was the precursor to treatment of mental illness in the 1700s to 1800s, where the main goal was to treat with a combination of therapy and healthy living habits (adequate diet, sleep, exercise). Plato (420-347 BC)  thought the soul was divided into three functions: appetite; reason; and temper (resided in the brain) – brain was closest to the heavens. Also discussed the mind-body question: what is the relationship between the physical body (material) and the spiritual body (immaterial). • Described physical health as the harmony between the mind and body. Aristotle (384-322 BC)  Believed the heart was the main organ of rational thought. Designer of the cardiac hypothesis: heart is the center of rational thought. The Romans Galen (131-201 AD)  Described many of the major brain structures. • He couldn’t dissect humans so he dissected animals and tried to match their brain structure between the two. • He accurately described many organs of the body. • Believed that the functions of the body and brain were based on a balance of bodily fluids or humours (blood, yellow bile, phlegm, black bile). The Middle Ages (500-1400) A rudimentary knowledge of the brain as the organ of thought and emotion. However, proposed structures and functions were inaccurate. There was also a return to superstitious beliefs. During the later part of the Middle Ages, the works of Aristotle were rediscovered and translated. His views were viewed as sacred and any questioning was unacceptable. He believed in heart-centered functioning and nonreliance of scientific methodology. Which was just fine by the church, th Initial move away from the ventricular localization theory began in the 13 century. There was a stagnation of new learning in the Middle Ages. Renaissance Europe (1400-1600) Andrea Vesalius (1514-1564)  published the first accurate book on human anatomy. Completed his work through dissections. Began the history of public dissection. He found fault with the ventricular localization hypothesis and the movement of animal spirits. Rene Descartes (1596-1630)  Believed in complete separation of the mind and body. Felt the mind was immaterial/without substances and the body functioned like a machine. • He came up with dualism: the view that within each person resides two entities, a mind with mental properties and a body with physical properties o He believed that the mental processes resided in the brain – wrong. It now seems that this gland is involved in sleep regulation and melatonin production. Thomas Willis (1621-1675)  was first person in post-Renaissance period to divide the brain into functional parts based on comparative anatomy, theory, and clinical practice. Emanuel Swendenborg (1688-1772)  Concluded that cerebral cortex was the source of understanding, thinking, judging, and willing. Stated that certain functions were represented at different anatomical sites on the cortex. • Saw localization of function as the way to understand the difficulties that came with patients who had different types of pathologies. th 18 Century: Localization Theory Def.: theory that certain abilities are localized to certain areas of the brain. Franz Joseph Gall (1758-1828)  began to write about the thory in 1810. Correlated faculties of the mind with skull features. • His ideas were the starting point of phrenology: inaccurate theory that stated that bumps on the head related to certain abilities residing with the brain; the theory led to belief in reading the bumps and increasing abilities by rubbing he corresponding bumps. Also responsible for the idea that the cortex and its sulci/gyri were functioning parts of the brain. Also stated that the pyramidal tract, leads from the cortex to the spinal cord, implying that the cortex sends information to the spinal cord to command movement of the muscles. Also discovered the role of the corpus callosum i
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