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Neuropsychological Assessment

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

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Neuropsychological Assessment

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  1. Neuropsychological Assessment

  2. 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

  3. 2) Visuoconstructive Abilities Accurate construction of objects; Perceptual, Spatial, Motor Tests for VC: Bender Gestalt, Block Design, Object Assembly, HTP, Free Drawing

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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)

  14. 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)

  15. 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

  16. 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

  17. Assessing LD and ADHDSee Worksheet

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