Monthly Archives: August 2014

What Is Neuropsychological Testing?

One of the primary components of any treatment strategy engaged in the aftermath of a brain injury is neuropsychological testing.  It also tends to be the least understood of the various post-injury evaluations.  This entry 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 outside factors (such as fine motor speed) that may influence these cognitive skills.  It will be administered by a licensed neuropsychologist or a neuropsychologist’s assistant and tends to last for several hours.  It provides a “snap-shot” view of the patient’s current cognitive functioning in order 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 understanding, language capacity, orientation, basic motor dexterity and mood.  Areas such as academic achievement and personality functioning may also be assessed. By attaining familiarity with the patient’s cognitive strengths and weaknesses, the neuropsychologist is able to more effectively direct cognitive rehabilitation and to advise staff tasked with addressing other rehabilitation specialties as to how cognitive skills may impact the patient’s participation in those 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 that patients will often have regarding neuropsychological testing.  One misconception that patients commonly face is believing that the way in which results of neuropsychological evaluations are compiled can be considered as roughly equivalent to what they remember of school-based testing.  In school-based testing, scoring is used as an entirely objective measure.  Getting 90% of answers correct earns an “A”, 80% a “B” and so forth.  In a neuropsychological evaluation, scoring is approached from a much more subjective and nuanced perspective.  Neuropsychological evaluation scoring is instead based upon how individuals of similar age and gender (and on some tests, race and education) to the patient generally do on the 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 such 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 is a perfectly normal result for the particular subject being tested.  Under the school-based testing method though, such a score could only represent a failure.
Another misconception  sometimes held by patients involves believing that the tests will show how smart (or not smart) the patient is.  After a severe brain injury, neuropsychologists often use portions of more widely-utilized intellectual evaluations but will tend to look at them very differently than those usually assessing the same results.  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 assessments as opposed to those for 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.  One typical illustration of this dynamic involves a survivor severely injured on the left side of the brain. As a result of this specific injury, he or she may do poorly on those sections assessing verbally-based skills but do perfectly well when required to rely solely on visually-based skills.  It would be illogical to simply take the average of the performances on these wholly distinct sections of the test and call that a “true” marker of overall functioning.  It is clearly better then to consider the verbal and visual skill levels separately.

 
Hopefully this post helped somewhat to 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 in professional soccer, recently enacted new protocols designed to help manage the effects of concussions suffered by its players.  Under the new rules, all players will be given baseline neuropsychological testing for later comparison prior to each season, in much the same way that the NFL, the NHL and NASCAR already do.  Any player who has received a concussion  (or is even sufficiently suspected of having received a concussion) will be automatically removed from the remainder of a given game.  The decision whether or not the player has received a concussion will be solely up to the team doctor, rather than allowing coaches or players themselves to make that all too crucial 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 concussions.  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 to make these evaluations than a team doctor, as the team doctor may feel pressure from the organization under which he’s employed to allow a star player to return.  Though his point is valid, this nonetheless still doubtlessly represents a much-needed step in the right direction as concerns the health and well-being of professional soccer players.  Moreover, as the English Premier League tends to be a trendsetter for other leagues, this likely bodes 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 that these injured players are cared for, the less likely it is that 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 pay a $70 million settlement which provides for testing in order to assess whether past and current college athletes have suffered brain injuries throughout the course of their participation in a wide range of sports.  Athletes with brain injuries can individually sue for damages due to their brain injuries on the basis of the results from this testing, but the settlement amount itself does not specifically involve any dedicated 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