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Neuropsychological Assessment

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					Neuropsychological
   Assessment
    1) Mental Activity-Attention and
    speed of information processing
   Filtering, focusing, shifting tracking
       Filter and attend to relevant info/stimulus,
        while ignoring the irrelevant
       Ability to shift attention and Focus
         Either being overly focused or too ready to shift
          will cause difficulty (perseverations vs.
          distractibility)
         Attention can be measured by reaction time
    Trails A & B and Digit Span
2) Visuoconstructive Abilities

Accurate construction of objects;
Perceptual, Spatial, Motor

Tests for VC: Bender Gestalt, Block
Design, Object Assembly, HTP, Free
Drawing
                Bender Gestalt

   Bender Gestalt Test (pg 540 for scoring
    sheet) Nine designs to be drawn by
    client. Test is brief, economical, flexible,
    nonverbal, and researched
       Right hemisphere lesions- fragmented and
        lose overall design
       Left hemisphere- duplicate design, but leave
        out details
       This test is to “screen” for severe types of
        brain damage DOES NOT DIAGNOS
How Children may compensate can
  be seen on the Bender Gestalt
   Reproductions maybe accurate but observe
       Length of time (excessive)
       “anchoring” items with a finger
       Reproducing by memory
       Checking and rechecking dots, but being unsure of
        number
       Rotating their paper of the card itself
       Drawing impulsively/quickly and then correcting with
        extreme difficulty
       Expressed dissatisfaction with poor designs after
        repeated attempts to correct them
Children and inadequate reception
          vs expression
   Reception- difficulty in visual perception
       Child report poor designs as accurate


   Expression- difficulty in reproducing what
    is accurately seen
       Recognition that design has been poorly
        reproduced
Block Design and Object Assembly
   Block Design- is more abstract so may
    show clients with a more concrete form of
    problem solving

   Object Assembly-is more concrete, thus
    the same person may do well on it
       3)Memory and Learning
   Sensory, short-term, long term, rehearsal,
    consolidation, recall, recognition and
    forgetting

   Declarative Memory- learning about
    information, objects, and events

   Procedural or implicit memory- automatic,
    habitual responses
    Overview of general intactness of
                memory
   Extent to which cl can acquire and retain
    material
   How quickly material is forgotten
   Extent to which competing information interferes
    with learning
   Degree of specificity or generality of deficit
   Stability or fluctuation of deficit over time
   Distinguish between memory and attention
               Tests of Memory
   Start in the interview
   Weschler Memory Scale
   WAIS-III or WISC-III
       Digit symbol coding, information, (digit span,
        letter-number sequencing-measure attention
        too)
   Rey Auditory Verbal Learning Test- Cl
    repeats back a list of 15 unrelated words
4) Verbal Functions and Academic
              Skills
   Aphasias- impaired speech, writing or
    understanding spoken or written language
   Problems with speech production
   Resulting in poor articulation, loss of
    verbal fluency, word-finding problems,
    poor repetition of words/sentences, poor
    auditory comprehension, reading
    difficulties and impaired writting
      Tests for Verbal Functions
   Information, Comprehension, Similarities,
    Vocabulary, and Arithmetic
   Clinical Interview noting for difficulties
   Controlled Oral Word Association- Cl says
    as many words as possible beginning with
    a certain letter in a fixed amount of time
         5) Executive Functions
   Ability to regulate and direct self behavior
   Initiate, Plan, Act purposefully, and
    Effective performance
   Frontal lobe damage is most typically the
    difficulty and can be impaired while other
    cognitive functioning remains intact
   Interview, behavioral observations, look
    for detail in description of activities, family
    members ( due to lack of awareness)
      What to look for in assessing
         executive functions
   Does patient initiate activity?
   Are there unusual social behaviors?
    Are these behaviors pre or post morbid if there
    is an injury?
   Look at planning abilities when cl organize
    Bender Gestalt, Bock Design, Stories on TAT.
    Do they have difficulty attending to stimuli
    while simultaneously performing another task
    (freedom from distractibility on WISC/WAIS)
         6) Motor Performance
   Expected difference between the
    dominant hand and the nondominant
    hand should be 10%. Differences of 20%
    or more infer lesions contralateral to the
    side of weakness or slowing. (Use with
    Caution)
   Finger Tapping Test
              7) Emotional Status
   Are Cognitive difficulties the cause or result of
    emotional problems?
       Concentration (Anxiety, Depression)
       Impulsivity (Anxiety, ADHD)
       Processing speed- (depression)
       Retention and Retreval (Anxiety)
       Paranoia, aggressiveness, and irritability can effect
        test results
       Limited self-awareness, impulsivity, concreteness, and
        poor social awareness could be due to frontal lobe
        damage
       LD can lead to depression and anxiety
Assessing LD and ADHD


    See Worksheet

				
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