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What Is Neuropsychological Testing?

One of the primary components of any post-brain injury treatment is neuropsychological testing.  It is also tends to be the least understood of the injury evaluations.  This post will aim to clarify what is, and is not, neuropsychological testing.

Neuropsychological testing is designed to assess all of the cognitive (thinking) skills that can be impacted by an injury and the areas that may influence these cognitive skills.  It is administered by a licensed neuropsychologist or their assistant and tends to last for several hours.  It provides a “snap-shot” view of the patient’s current cognitive functioning to help guide treatment.  Testing will generally include the following domains: memory, attention, executive functioning (reasoning, problem-solving, processing speed and mental flexibility), visual-spatial, language, orientation, basic motor dexterity and mood.  Areas such as academic achievement and personality functioning may also be assessed. By knowing cognitive strengths and weaknesses, the neuropsychologist is able to direct cognitive rehabilitation and advise other rehabilitation specialties as to how cognitive skills may impact their therapies. For instance, it is important for a physical therapist to know the severity of a patient’s attention deficits as this will effect the patient’s safety when walking in the community.

There are a few misconceptions patients have about neuropsychological testing.  The first misconception that patients often have is believing that a neuropsychological evaluation is the same as school-based testing.  In school-based testing, getting 90% of answers correct will get you an “A”, 80% a “B” and so forth.  In a neuropsychological evaluation, scoring is based on how individuals of similar age and gender (and on some tests, race and education) to the patient generally do on these same tests.  Patient results are not scored based on a school grade system but in comparison to how people who are akin to the patient generally score on these tests.  As such, the neuropsychologist does not expect a 70 year-old patient to perform at the same level as a 20 year-old.  The real question is how does that 70 year-old patient perform in comparison to other 70 year-olds?  It is possible that answering 60% of the questions correctly on a particular neuropsychological test may be a perfectly normal result while in school-based testing this score would be a failure.

The second misconception that patients often have is believing that the tests will show how smart (or not smart) the patient is.  After a severe brain injury, neuropsychologists often use parts of intellectual evaluations but tend to look at them very differently.  Rather than being interested in an overall intellectual score, a neuropsychologist is interested in how the patient performs on each of the individual test sections.  For instance, how did the patient perform on visual attention as opposed to visual reasoning? Furthermore, as more severe brain injuries often effect one part of the brain more than another, a general intellectual score may not provide much useful information.  For example, if someone is severely injured on the left side of the brain, he or she may do poorly on verbally-based skills but perfectly well on visually-based skills.  It would illogical to just take the average of the performances and call this a “true” marker of overall functioning.  It is better to consider the verbal and visual skill levels separately.

Hopefully this post helps clarify neuropsychological testing!

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org

English Premier League Concussion Protocol

The English Premier League, one of the top leagues of professional soccer, recently set up new protocols to manage concussions.  Under the new rules, all players will be given baseline neuropsychological testing prior to the season, much as the NFL, NHL and NASCAR already does.  Any player who has received a concussion, or is suspected of having received a concussion, is automatically removed from the game and cannot return.  The decision whether the player has received a concussion will be solely up to the team doctor, rather than allowing players or coaches to make the call.

These new rules follow on the heels of the World Cup, at which Alvaro Pereira of Uruguay and Christoph Kramer of Germany both continued to play after receiving a concussion.  Former United States National Team member and current television analyst Taylor Twellman brings up the concern that a neutral doctor would be a better choice of evaluator than a team doctor, as the team doctor may feel pressure to allow a star player to return.  Though his point is valid, this is certainly a step in the right direction for the health and well-being of soccer players.  Moreover, as the English Premier League tends to be a trendsetter for other leagues, this may bode well for the further implementation of concussion protocols in leagues around the world.  After all, a concussion is just another word for brain injury and the better injured players are cared for the less likely their injuries will lead to permanent brain damage.

http://www.nytimes.com/2014/08/07/sports/soccer/premier-league-concussion-protocol-could-force-injured-players-from-games.html?_r=0

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org

NCAA and Brain Injury

The National Collegiate Athletic Association (NCAA) has agreed to a $70 million settlement which provides for testing to assess whether past and current college athletes have suffered a brain injury in a wide range of sports.  Athletes with brain injuries can individually sue for damages due to their brain injury on the basis of results from testing though the settlement amount does not specifically involve a sum to pay athletes with injuries.

http://espn.go.com/college-sports/story/_/id/11279710/ncaa-settles-head-injury-lawsuit-create-70-million-fund

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org

 

Personal Health Devices

Many people use personal health devices such as reading glasses, hearing aides and c-pap machines in their daily lives. For some odd reason, these items are often left at home when patients comes to rehabilitation.

Patients are asked to read written directions and hear verbal instructions in therapies. Realistically, they will need their reading glasses and hearing aides on a daily basis to reach their maximum rehabilitation success. After an injury, patients need their sleep even more than prior so it vital that they continue use of their c-pap machines. These are just a few examples of how personal health devices are important in rehabilitation.

Personal health devices should be considered like soap and toothpaste. Just as you would not forget soap and toothpaste when coming for rehabilitation you also need to remember all personal health devices.

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org

Free Family Caregiver Kit

Families of brain injury survivors face a great deal of stress in many areas of life.  One of those stressors is the sudden need to manage their loved one’s personal life, such as managing their finances and making their medical decisions.  Columnist Dear Abby and the United States government has teamed together to offer a free Family Caregiver Kit.  This kit contains nine publications addressing a wide range of important issues such as finances, power of attorney and medicine safety.  The kit can be ordered for free (or alternatively, the publications can be downloaded for free) via this link:

http://promotions.usa.gov/dearabby.html

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org

Mood and Awareness

It can be scary when a brain injury survivor lacks sufficient awareness of the full effect an injury has had upon his or her life.   It can be all too easy for a survivor in such a circumstance to engage in what could potentially be extremely risky behavior. For instance, if a survivor does not realize that he can no longer walk, he may attempt to get up from his wheelchair anyway to walk to the bathroom. This could lead to a terrible fall. Similarly, a survivor who is not aware that she now suffers from severe memory deficits may turn on a curling iron for her hair and forget to turn it off. This could lead to a fire. When survivors gain in awareness of their situations post-injury, families understandably feel much more at ease as these risky behaviors can only decline.

However, there is one downside to such improved awareness. When a survivor first becomes significantly aware of his or her deficits, he or she often experiences a marked decline in mood. The survivor is suddenly aware of the severity and implications of the injury. It is depressing to realize that life has changed, in some cases irrevocably, and that success over these new challenges can only come after many trials and tribulations. It is important that the loved ones of brain injury survivors understand that this decline in mood is natural and expected. This is the time when a psychologist, counselor or psychotherapist can step in and help the survivor adjust to his or her new situation. With therapy and support, most brain injury survivors will see an improvement in mood after this initial decline due to increased situational awareness.

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org

It Takes Awhile

Many brain injury survivors become frustrated with the slow rate at which a brain injury heals.  They are used to the comparably more rapid pace seen in the healing of broken bones, cuts and other like injuries.  However, it is normal for a serious brain injury to require a much longer period of time before significant progress towards full healing is made.  I was reminded of this fact this past Sunday while watching the qualifying for the Indianapolis 500.  Former winner Dario Franchitti was interviewed by the hosts and was asked about how he’s been feeling since his horrific crash in a race on October 6.  He said that his concussion (brain injury) was almost completely healed.  After nine months his injury is not completely healed, but is almost healed.  This serves as a reminder that even world class athletes with access to the best medical care available have to patiently wait for healing after a brain injury.

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org

Book Recommendation For Working With Soldiers/Veterans

In recent years, public awareness has been growing of the increasing presence of brain injuries in combat soldiers and veterans. Many doctors and therapists are now working with these soldiers and veterans but often do not fully grasp how this population may differ from other patient populations.

 
The military is in no way simply a nine to five job. For many soldiers and veterans it encompasses much of their life and identity. Under combat deployment, there are no days off from work. The soldier is on duty 24-7 without a true break or rest. Due to the demands and risks of the military, soldiers are part of a culture that is very different from that of the civilian world. For instance, it’s relatively common for an employee at a store to question a supervisor’s directives and perhaps even lodge a complaint with management. This process may last for several days and either see action taken or not. In combat, a soldier is not in a position to question a direct order. Life and death decisions have to be made moment by moment. The immediacy of danger also leads soldiers to develop intense and special bonds with one another. The loss of a fellow solider in combat may be felt as strongly as the loss of a family member. Since being a soldier so often encompasses so much of the individual’s life and identity, being dismissed from the military due to an injury is not like being fired from a job. The effects of emotions such as grief and anger felt resulting from losses suffered in the course of a veteran’s service are often experienced on an entirely separate level of magnitude.

 

Below is a list of a few books that may help doctors and therapists to better understand this population:

Hidden Battles on Unseen Fronts: Stories of American Soldiers with Traumatic Brain Injury and PTSD by Patricia Driscoll and Celia Straus

On Combat: The Psychology and Physiology of Deadly Conflict in War and Peace and On Killing: The Psychological Risks of Learning To Kill in War and Society by Lt. Colonel Dave Grossman

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org

Medication Safety

Prior to their injuries, many brain injury survivors were in good health. As such, these individuals rarely had to devote significant attention to  the taking of  medication. After suffering a brain injury though, survivors are often faced with many new health conditions that require integration of a strict medication schedule into their daily life.

 
Taking medication is more than just “popping a pill.” The difference between proper and improper medication allocation adherence can literally be a life or death matter. The Institute for Safe Medication Practices has a wonderful, short brochure on medication safety that can benefit anyone taking medication. Click on the link below to access the brochure:

 

http://www.ismp.org/Newsletters/consumer/alerts/Brochure.asp

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org

Goodbye, Kent

As much as patients learn from their d0ctors and therapists, their doctors and therapists learn from them.    Many brain injury survivors have given generously of their time and energy in order to help further research and understanding of brain injuries.  Kent Cochrane, known in research literature by his initials “KC”, participated in many studies which allowed researchers to learn a great deal about memory.  Mr. Cochrane is one of the best known survivors to have volunteered as a research subject and fields related to the study of brain injury have greatly benefited from his generosity.  Mr. Cochrane recently passed away but his legacy will live on.

http://www.ctvnews.ca/health/famed-canadian-amnesiac-kent-cochrane-dies-at-62-1.1756363

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org