L13 Clinical Neuropsychology & Neuropsychological Testing?

參考文獻(xiàn)：Pomerantz, A. (2013). Clinical psychology: science, practice, and culture (3rd ed.). Thousand Oaks, CA: SAGE Publications.

13.1 Clinical Neuropsychology & Assessment

Clinical Neuropsychology

Clinical application of the?relationship between brain?function and behavior.

Clinical neuropsychology is a sub-field of psychology concerned with the applied science of brain-behaviour relationships. Clinical neuropsychologists use this knowledge in the assessment, diagnosis, treatment, and or rehabilitation of patients across the lifespan with neurological, medical, neurodevelopmental and psychiatric conditions, as well as other cognitive and learning disorders.

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Neuropsychological Assessment

? MRI, PET, and CT scans?provide images of the brain?and can highlight areas of?physical abnormality or?concern;

? Neuropsychological?assessment indicates how?those abnormalities?translate to functional?problems for an individual;

? Noninvasive method of assessing cognitive functioning,?skills, and behavior;

? Based on performance on standardized tests shown to?be accurate indicators of brain-behavior links;

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Wide range of uses including: Useful in evaluating head injury, stroke, brain tumor, degenerative diseases, nutritional deficiencies, toxin exposure, prolonged alcohol or drug use, learning disabilities, seizure disorders...

Typical neuropsychological exams evaluate: General Intellectual Functioning, Executive Skills, Attention & Concentration, Language, Learning & Memory, Visual-Spatial Skills, Motor & Sensory Skills, Mood & Personality, etc.

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Test score:

? Test scores are compared?to norms based on?education level and age;

? scores that are different?from norms suggest?“problem areas;”

? Focus on both areas of?strength and areas of?weakness.

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13.2 Specific Assessment Batteries

Full Assessment Batteries

? Long assessments with many subtests

? Halstead-Reitan Neuropsychological Battery (HRB, HRNB)

- For clients 15 years and older

- 5-6 hours to complete

- 8 standardized tests, administered as a whole battery

Eg: Trail making test (order numbers & letters), finger tapping test (index finger, provide motor speed), category test (pattern, organizing), etc.

- Compare to norms and find strengths & weakness.

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Brief Assessments

Typically used as screeners to determine if a longer battery?is needed

Mot used for identified neuropsychological problems

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? Bender Visual-Motor Gestalt Test

- For children ages 3 and older and adults.

- Straightforward copying task

- Series of 9 geometric designs

- Less than 10 minutes to administer

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? Rey-Osterrieth Complex Figure Test

- Drawing/copying task with a more complex figure, often just one figure

- Different colored pencils used at different points

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? Memory component involved too

- 3-60 minutes after the initial administration

- Client asked to generate the image again from memory

13.3 Real-World Application

Neuropsychological?Assessment in Sports

? Common referral among youth and athletes is?- Concussion: A Traumatic Brain Injury (TBI) caused by bump,?blow, or jolt to head that causes the head and brain to move?rapidly back and forth (CDC, 2019)

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Neuropsychological?Assessment in the NFL?(National Football League)

? Large number of?documented?concussions?(about 200+)

? These numbers?are likely?underestimations

? Chronic traumatic encephalopathy (CTE):?Degenerative brain disease associated?with repeated head trauma?- Recent studies found that 110?out of 111?(99%)?former?players who donated brains to science had?CTE

? Many questions remain about CTE?(genetic role, numbers that cause, etc.)

? Repeated trauma triggers progressive degeneration of?brain tissue and build-up of an abnormal?protein called tau

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Sideline Management of Concussions

? Evaluate loss of?consciousness

- Any period of time without?consciousness?

? Evaluate confusion

- Orientation to place, event,?date, day

? “What stadium is this?”

? “Who is the opposing?team?”

? “What day is it?”

? Evaluate amnesia

- Anterograde amnesia: Cannot recall?events immediately after the trauma

? Returning to sideline

? “Repeat ‘girl, dog, green’”?(recall words)

- Retrograde amnesia: Cannot recall?events immediately before the trauma

? “What was the score before the?hit?”

? Evaluate concentration

- “List the days of the week backward?starting with today”

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Formal Assessments

? Formal concussion protocol to determine return to?the game.

? 5-step process?(for football):

1. Rest and recovery: Limited physical and cognitive activity?until return to baseline functioning;

2. Light aerobic activity: Neuropsychological testing may?started at this point; results must indicate return to baseline?(see baseline testing below) to continue;

3. More aerobic activity and strength training, neurocognitive testing is done here if not done in the second step;

4. Football specific activities (with no contact): Move to last?step only if player remains symptoms free;

5. Full football activities.

? After all five steps have been completed, players must?be examined by:

- Team’s doctor

- Independent neuropsychological consultant?works with the team

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? Full neurocognitive and symptom recovery takes longer?in younger athletes

? Baseline testing

- Mandated for NFL teams in?2012

- Complete the baseline testing before the season begins

- Comparison point during the season

ImPACT:

? Validated computerized?system

? Assesses Verbal Memory,?Visual Memory, Visual?Motor Speed, Reaction?Time, Impulse Control,?Symptom Composite

? ImPACT Reliable Change Index

- Indicates whether test score reliably differs from?baseline

- Can be used to track symptoms over time.

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Legal Challenges

? Many legal cases related to head?trauma and CTE involving the NFL

- Lawsuits filed by thousands of?former players and families claiming?that critical information about risks?were withheld

- NFL settled a major suit for $1 billion?in 2016

- Many other lawsuits against the NFL?are currently pending