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Chapter 6

Test 2: Chapter 6

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Konstantine Zakzanis

Chapter 6: Neuropsychological Examination Background Data - examiner take into account patient variables when evaluating test performance: sensory and motor status, alertness cycles, medication regimen, etc. - motivation to reach a goal is also important - appreciate patients current medical and neurological status can help guide examiners search for pattern of NP deficits Behavioral Observations - naturalistic observations useful info about how patient functions outside structured examination setting - value of naturalistic observations may be most evident when examination findings alone lead to conclusions that patients are more or less capable than they actually are occur when examiner confounds observed performance with ability - testing: differs from other forms of psychological data gathering elicits behavior samples in standardized, replicable and more or less artificial and restrictive situation - strengths: sameness of test situation for each subject, sameness enables examiner to compare behavior samples btw individuals, over time - weakness: limited to behaviors occasioned by test situation may lack ecological validity, predictive validity - apply examination findings to problems exapolate from limited set of observations to patients behavior in real life situations common feature since impossible to observe subject in every problem area - exapolations likely to be accurate as the observations are pertinent, precise and comprehensive , situations similar and generalizations apt Quantitative and Qualitative Data - each of these classes of data can constitute a self- sufficient data base two different approaches to NP assessment - actuarial system by Ralph Reitan (quantitative method) data base is in numerical, computer processed form - other extreme, clinical approach built upon detailed observations without objective standardization (qualitative) - together, provide observational frames of reference and techniques for taking into account, documenting, and communicating complexity, variability, subtleties of patient behavior - several studies suggest reliance on actuarial evaluation provides best approach to clinical diagnosis inconsistently supported - actuarial predictions not more accurate than clinical ones because (1) only small number of probable outcomes, (2) prediction variables be known and (3) the data from which the formula was derived be relevant to the questions asked - most assessments not undertaken for diagnostic purposes but to describe patients NP status; even for diagnostic purposes, more likely to concern diagnostic discrimination considering broad range of disorders (possibility of more than one condition), diagnosis involves variables unique to individual - actuarial judgments examiners not presented with real patients to have live interaction www.notesolution.comQuantitative Data - scores summary statements about observed behavior - scores obtained for any set of behavior sample that can be categorized according to some principle - scorer evaluates each behavior sample to see how well it fits a predetermined category and then gives it a place on numerical scale - commonly used scale two points, good pass and poor fall; three points, add middle fair - occassionaly, test makers incorporate correction for guessing into scoring system, final score not just simple summation - final test score may misrepresent behavior under examination: (1) based on only one narrowly defined aspect of set of behavior samples, (2) two or more steps removed from original behavior, global aggregate or full scale scores calculated by summing or averaging set of test scores are three to four steps removed from behavior they represent - index scores based on various combinations of scores on two or more tests suffer from same problems as any other summed score too obscure the data - completely different behaviors i.e. writing skills nad visual reaction time can be compared on single numerical scale Test scores - variety of forms; rarely test maker use a RAW score (simple sum of correct answers or minus incorrect ones) - different kinds of scales provide more or less standards for comparing any one score with the scores of the standardization population - most widely used scale based on the standard score - treatment test scores in NP assessment complex more complex, test scores can come from amny different sources - within batteries, scores for each of the individual tests are on the same scale and standardized on the same population so that test scores can be compared directly - on the other hand, no single test battery provides all the info needed for adequate assessment of most patients presenting NP questions - techniques employed in assessment of different aspects of cognitive functioning developed at different times, places, populations, ability and maturity levels, with different scoring and classification systems - taken together, they are unsystemized aggregate of more or less standardizaed tests, experimental techniques and observational aids useful in demonstrating deficits or disturbances in some cognitive function or activity - scores not directly comparable with one another - make comparisons necessary evaluating impairment, disparate test scores must be convertible into one scale with identical units scale can serve as test users lingua franca permitting direct comparison btw many different kinds of measurements - scale most meaningful statistically and that probably serves intermediary function btw different tests best is one derived from normal probability curve and based on standard deviation unit www.notesolution.com
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