Tag Archives: testing

What Language Do You Speak?

There is an interesting phenomenon often observed in brain injury survivors who were fluently bilingual prior to their injuries.  Namely, in survivors who have post-injury language deficits, the first (native) languages tend to return more quickly and fully than their second languages.  This is true even in survivors who were fully fluent in their second language and used the second language in their every day lives.  As TLC is located in Texas, our staff tends to see this most often with Spanish-English bilingual patients.  Many of these patients with language difficulties find it easier to name objects or follow directions when given in Spanish than in English, while prior to their injuries, they were comfortable using both languages.

The return of the first language prior to the second language can have a number of practical consequences.  Many survivors become frustrated at their inability to speak their second language with the same skills as in the past.  Being bilingual is often a point of pride and may have previously allowed the survivor to engage in activities (such as import-export business transactions) that the average person could not.  This may even prevent them from returning to jobs where their second language was the language of their everyday business transactions.  Moreover, if the survivor was previously the primary translator for the family, this may cause difficulties in the ability for the family to access the outside world.  For example, the survivor may have previously been the point person to get information from the school regarding their child’s performance as the survivor could fluently speak to school officials in English while the rest of the family struggled in English.  If the survivor is now unable to converse fluently in English, the family may have significant problems interacting with the school.

There are practical therapy concerns when a survivor struggles with their second language, if the second language is the main language of the community.  In America, English is obviously the dominant language.  As such, most evaluations are conducted in English.  There are a limited number of health care professionals who are comfortable conducting evaluations in another language.  However, if the survivor’s first language is not English and the survivor is significantly stronger in their first language, that first language will need to be the language used in the evaluations so as to get the most accurate measurements of the survivor’s skills.  The same is true in therapy.  If a survivor understands therapy directions significantly better in their first language, then therapy should be conducted in the survivor’s first language.    Additionally, therapists should always inquire as to which language is used in the home.  If the survivor’s first language is different than the language used at home (e.g. someone who spoke Spanish and English married a spouse who only speaks English), then that second language will need extra focus or alternative methods of communication (e.g. pictures) may need to be used.  At TLC, we have a number of staff that are bilingual in Spanish-English and have a contract with a translation service is other help is needed.  Overall, rehabilitation professionals must be aware of survivors’ language skills and adjust their evaluations and therapy accordingly.

Learn about brain injury treatment services at the Transitional Learning Center! Visit us at: http://tlcrehab.org/



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