Neuropsychological Testing

7/29/2019 Neuropsychological Testing

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NeuropsychologicalFunctions and Testing

Dr. S. Balasubramanian, MPT, PhD

Associate Professor, SCPTRC, Mangalore

Dr.S.Balasubramanian, MPT,PhD

NeuropsychologyNeuropsychologyDefinition:

Neuropsychology is defined as the study of therelation between brain function and behaviour.

Although the study draws information from manydisciplines such as anatomy, biology, biophysics,pharmacology and physiology, its central focus is

the development of a science of human behaviourbased on the function of the human brain.

Clinical NeuropsychologyClinical Neuropsychology

Clinical neuropsychology is a specialty

profession that focuses on brain functioning.

A clinical neuropsychologist is a licensed

psychologist with expertise in how behavior

and skills are related to brain structures and

systems.


In clinical neuropsychology, brain

function is evaluated by objectively

testing memory and thinking skills.

A very detailed assessment of abilities is

done, and the pattern of strengths andweaknesses is used in important health

care areas, such as diagnosis and

treatment planning.



The clinical neuropsychologist conducts

the evaluation and makes

recommendations.He or she may also provide treatment,

such as cognitive rehabilitation, behavior

management, or psychotherapy.



NPE is an essential element in

development of a treatment protocol in

patients with brain injury.

The neuropsychological examinationserves as an expansion of the basic

mental status examination and it employsstandardized measures to quantify a

performance at a given time.



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These tests employ a variety of normative

databases to evaluate performancerelative to the entire population.

The distribution of test scores are

grouped by sex, age, education or other

relevant criteria, provide a reference forinterpreting the test performance of

specific patients.


Goals of NPEGoals of NPE

The assessment aims to diagnose thepresence of cortical damage ordysfunction and to provide an accurateand unbiased estimate of a personscognitive capacity.

NPE is used to facilitate patient care andrehabilitation. Serial assessment canprovide information about the rate ofrecovery and the potential for resuming aprevious life-style.


Goals of NPEGoals of NPE

NPE can identify the presence of milddisturbances in cases in which otherdiagnostic studies have produced equivocalresults.

To identify unusual brain organization thatmay occur in left hander or in people withchildhood brain injury.

This information is valuable to the surgeon,who would not wish to remove primaryspeech zones inadvertently during surgeryand such information is obtained only from

behavioural measures.Dr.S.Balasubramanian, MPT,PhD

NPE is most useful for the followingNPE is most useful for the following

purposespurposes Adjunct diagnostic work-up

Establish baseline for known illness orinjury

Evaluate medication efficacy/toxicity

Evaluate early dementia

Evaluate competency, independence andreturn to work/school issues

Provide recommendations forpsychosocial interventions.


NPE is of limited value in theNPE is of limited value in the

following casesfollowing cases The patient is severely compromised such

as in advanced dementia or early in

recovery from brain injury

The patient has other serious medicalcomplications or psychiatric disorders.

Patients are exceptional, educationally and

culturally

The examiner exhibits bias or is not fully

qualified.


A typical NPE will involveA typical NPE will involve

assessment of the followingassessment of the following

General intellect

Higher level executive skills

(e.g., sequencing, reasoning, problem solving) Attention and concentration

Learning and memory

Language

Visualspatial skills (e.g., perception)

Mood and personality



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AttentionAttention

Attention is the ability to select and to

attend to a specific stimulus while

simultaneously suppressing extraneous

stimuli


3 different types of attentional3 different types of attentional

mechanismsmechanisms1. One in the parietal cortex that enhances

spatial attention2. One in the visual and posterior

temporal cortex that selects object

features

3. One in the inferior temporal region that

selects objects themselves


AttentionAttention

Many different processes work together

to process information

These processes include alertness or

arousal, the ability to select stimuli, theability to span attention, the ability to shift

attention and information processing


Attention DeficitsAttention Deficits

Attention deficits include:

- Distractibility

- Perseveration (inability to shift locus)

- Decreased concentration (Concentration

means ability to sustain attention over

extended periods of time)

- Increased confusion

- Impulsivity, persistence on irrelevant cues


Attention DeficitsAttention Deficits

Attention deficits contribute to decreased

performance on neuropsychological tests,

those involved with memory and learning

Standardized assessment may include:- Stroop color and word test

- Symbol digit modalities test

[Both of these tests assess the patients

ability to shift locus of attention]


Standardized Assessment ToolsStandardized Assessment Tools

The Bay area functional performance

evaluation

The cognitive behaviour rating scales

The dementia rating scales

The severe impairment battery

The neurobehavioural cognitive status

examination.



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Stroop Color & Word TestStroop Color & Word Test

Developed by psychologists Made up of three stimuli sheets

Takes only a few minutes to administer

and score

In the first test sheet names of colors are

written in black. This is to make certainthat the patient is able to read



In the second test sheet, four Xs are printedin different colors to make certain that he or

she is able to identify all the colors utilizedin the test.

In the third stimulus page, columns of wordsare printed in different colors.

The color in which the word is typed innever matches the word printed.

The patient is asked to identify the color ofword and to ignore the word that is printed.



3 scores are obtained; the color score,

the word score and the color-word score

Scoring consists of the number of words

read in 45 seconds

Normal scores for patients between ages16 and 44 are provided


Bay Area Functional PerformanceBay Area Functional Performance

EvaluationEvaluation Developed in 1977 and revised in1987

Assesses daily functional performance ofpatients with psychiatric diagnoses

The psychiatric patients behaviour isquantified in how they relate to objectsand to other people in their environment

It comprises 2 subsets

1. The task oriented assessment

2. The social interaction scale



EvaluationEvaluationTOA is made up of five tasks:

1. Sorting by different categories

2. Money and marketing

3. Drawing a house plan

4. Block design

5. Drawing a person



EvaluationEvaluation The skills assessed through these 5 tasks

include the cognitive skills of memory for

instructions, organization of time and

materials, attention span and ability toabstract.

Performance components include thepatients ability to complete the task, their

efficiency and errors.



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EvaluationEvaluation

The affective component includesmotivation, frustration tolerance, abehavioural impression and self-

confidence.

Patients are rated on a scale from 1 to 4

points, 1 being marked dysfunctional and

4 functional or appropriate.



EvaluationEvaluation On the SIS, the clinician rates the behaviour

of the patient in five specified social

situations, ranging from one on one to anunstructured group. The components of social behaviour

assessed include response to authority,verbal communication, psychomotorbehaviour, ability to work with others in agroup, social behaviour, group participationand independence.

The patients are rated on a five-point ratingscale


Cognitive Behaviour Rating ScaleCognitive Behaviour Rating Scale

This comprises 116 items in the areas of

language deficit, apraxia, disorientation,attention, depression, abstract reasoning,

motor execution and memory.

Scores are obtained from observation by

a reliable person, in some instances a

family member.


Cognitive Behaviour Rating ScaleCognitive Behaviour Rating Scale

The patient is rated on a five-point scale

from 1(ability is very low) to 5 (ability isvery high).

A profile of the patients functioning in all

areas is graphed so that strengths and

weakness may be identified.

It takes 15-20 minutes.


Dementia Rating ScaleDementia Rating Scale

It was designed to measure decline inneurologic, behavioural and cognitivefunctions.

It is composed of 36 tasks with fivesubscales:

a. Attention

b. Initiation and perseveration

c. Construction

d. Conceptualization

e. Memory


Dementia Rating ScaleDementia Rating Scale

Stimulus items are familiar to most patients.

The test is designed in a hierarchic manner,in that patients passing the first item in eachsubscale are given credit for the remindertasks in the subscale and therefore do notneed to complete them.

Total possible score is 144.

A score of 123 is cutoff score.

Norms are based on healthy persons aged65 to 81.



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Severe Impairment BatterySevere Impairment Battery

Developed to assess cognitive skills in

patients who are unable to completestandard neuropsychological tests.

The tasks provided were taken from a

wide variety of low-level tasks that

address the behavioural and cognitivedeficits.

There are 57 questions, with a total score

of 0 to 133 points.


Severe Impairment BatterySevere Impairment Battery

It takes approximately 20 minutes to

complete It is made up of one-step commands that

are presented verbally along with

gestures.

The subtests include: attention,

orientation, language, memory, social skills,

visuo-perceptional ability and

constructional ability.


Neurobehavioural Cognitive StatusNeurobehavioural Cognitive Status

ExaminationExamination It is a quick screening test of cognitive ability

in the areas of language, constructions,memory, calculations, reasoning,consciousness, orientation and attention.

There are two sections.

The first part is the status profile whichconsists of areas of level of consciousness,orientation, attention, language, visualconstruction, visual memory, calculation andverbal reasoning.



ExaminationExamination There is also process section in which

information related to clinicalobservations is compiled including affect,

response time, the ability to concentrate,

emotional status and copying.

Most sections of the test begin with a

more demanding screen of the area being

assessed.



ExaminationExamination If the patient passes this item, the skill is

considered intact.

Both the status profile and process

feature are standardized. Scores should be analyzed together.


OrientationOrientation

Orientation generally encompasses the

knowledge of person, place, time and

situation.

It is an integration of attention, memoryand perception.

Orientation to person includes an

awareness of self - i.e. knowing who you

are and having information about yourself,

including social role.



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OrientationOrientation

Orientation to place allows a person to

have knowledge of where he or she is andhow he or she may move about in the

environment.

Temporal orientation is broken down into

several areas, including awareness ofpublic time (clocks, calendars) cued time

(time of day, the seasons).


Assessment tools for OrientationAssessment tools for Orientation

Bay Area Functional Performance Evaluation

Cognitive Assessment of Minnesota

Cognitive Behaviour Rating Scale

Short Portable Mental Status Questionnaire

Mini-mental State Exam

Middlesex Elderly Assessment of Mental State

Neurobehavioural Cognitive Status Examination

Severe Impairment Battery

Loewenstein Occupational Therapy CognitiveAssessment


Cognitive Assessment of MinnesotaCognitive Assessment of Minnesota

It was developed by a Occupational

therapist to assess a broad range ofcognitive abilities in persons with brain

damage

It was developed as a screening tool,

rather than a diagnostic tool

The test consists of the manual score

sheet and some common objects ,such as

paper, a pencil, blocks and a toothbrushDr.S.Balasubramanian, MPT,PhD

Cognitive Assessment ofCognitive Assessment of

MinnesotaMinnesota It takes approximately 40 minutes to

administer

Subtests include: Orientation, memory,visual neglect, following directions,attention, matching ,object identification,visual and auditory memory, sequencing,recall, recognition, money skills, mathskills, foresight, planning, safety, judgement,concrete problem solving and abstractreasoning.


Cognitive Assessment ofCognitive Assessment of

MinnesotaMinnesota This test appropriate for patients with

CVA

Not appropriate for patients with severe

perceptual deficits, visual acuity deficitsand aphasia

Scores range from no impairment to

severe impairment

Norms were developed from 18 years to

70 years


Short Portable Mental StatusShort Portable Mental Status

QuestionnaireQuestionnaire It was developed in 1975 to provide a

short, easily scored assessment of

cognitive functioning

It consists of 10 items, includingorientation, current events and serial

mathematic calculations

As with other mental status examinations,

it does not assess visuospatial skills,

constructional skills and abstraction



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Short Portable Mental StatusShort Portable Mental Status

QuestionnaireQuestionnaire

It is not timed The assessment was standardized on 997

elderly adults aged 65 and older

Scores indicate intact, mildly impaired,

moderately impaired or severely impaired

performance.


MiniMini-- Mental State ExamMental State Exam

It was devised in 1975

It was developed to be used withpsychiatric, neurologic and generalmedical patients

The assessment is not timed

It assesses orientation, the ability to

follow verbal and written directions,

attention, recall, language, reading, writing

and copying.


MiniMini-- Mental State ExamMental State Exam

It has two sections, one assessing verbal

responses and the other assessing the

ability to follow written and verbal

commands

In the second section, the subject is asked

to copy a design, write a sentence and

follow written directions.


Middlesex Elderly Assessment ofMiddlesex Elderly Assessment of

Mental StateMental State It was developed to screen for global

impairment of cognitive skills in the elderly

It is intended to show whether any areas ofthe brain are not functioning as effectively aspossible and whether these problems needfurther investigation

The subtests include orientation, memory,comprehension, verbal fluency, arithmetic,perceptual functions and motorperseveration


Middlesex Elderly Assessment ofMiddlesex Elderly Assessment of

Mental StateMental State The test takes approximately 10 minutes

to administer and score

The maximum score possible is 12

Scores of 8 or 9 suggest borderlineperformance and scores of 7 or below

indicate that a more detailed assessment

is needed


Loewenstein Occupational TherapyLoewenstein Occupational Therapy

Cognitive AssessmentCognitive Assessment It comprises of 20 subtests in 4 areas:

orientation, perception, visuomotororganization and thinking operations

It was developed in 1974 It takes about 45 minutes

It was normed on 55 adult subjects aged20 to 70 and 240 children aged 6 to 12

In addition to the standard procedure, itcontains a procedure for patients withaphasia



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MemoryMemory

To understand about memory the

knowledge about anatomy of the

temporal lobes is imperative.


Subdivisions of the Temporal CortexSubdivisions of the Temporal Cortex

The temporal lobe comprises all the

tissues that lie below the sylvian fissureand anterior to the occipital and parietal

cortex.

Lateral surface of temporal lobe can be

divided into auditory (41,42 and 22) andventral visual stream (20,21 and 37).

The visual regions are referred to as

infero-temporal cortex.


Subdivisions of the Temporal CortexSubdivisions of the Temporal Cortex

The sylvian fissure contains insula which

includes gustatory cortex as well asauditory association areas.

The superior temporal sulcus which is

multimodal, receiving input from auditory,

visual and somatic regions, frontal and

parietal and the paralimbic cortex.

The medial temporal region includes the

hippocampus amygdala and uncus.Dr.S.Balasubramanian, MPT,PhD

Connections of the temporalConnections of the temporal

cortexcortex Afferent projections are from the sensory

systems and efferent projections to theparietal and frontal association regions,

limbic system and basalganglia.

a. Hierarchical pathway from the primary

and secondary auditory and visual areas,

ending in the temporal pole. The visual

projection from the ventral stream of

visual processing.


Connections of the temporalConnections of the temporal

cortexcortexb. The second is a series of parallel

projections from the visual and auditoryassociation areas into the polymodalregions of the superior temporal sulcus.

c. The third is a projection from theauditory and visual association areas intothe medial temporal regions.

d. Finally, the fourth is a series of parallelprojections from the association areas tothe frontal lobe.


Temporal lobe FunctionsTemporal lobe Functions

1. Hierarchical pathway is responsible for

stimulus recognition i.e., processing of

auditory input and visual object

recognition.2. The polymodal pathway is for stimulus

categorization.

3. The medial temporal projection is for

long-term memory.



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Temporal lobe FunctionsTemporal lobe Functions

4. The frontal lobe projection is for variousaspects of movement control, short-term memory and affect.

5. Cross modal matching: The process of

matching visual and auditory information

which is done by superior temporal

sulcus.


Symptoms of temporal lobe lesionsSymptoms of temporal lobe lesions

1. Disturbance of auditory sensation andperception

2. Disturbance of visual perception

3. Disturbance of selective attention of

auditory and visual input.

4. Impaired organization and categorization

of verbal material


Symptoms of temporal lobe lesionsSymptoms of temporal lobe lesions

5. Disturbance of language comprehension

6. Impaired long term memory

7. Altered personality and affective

behaviour

8. Altered sexual behaviour


MemoryMemory -- DefinitionDefinition

The ability to take in, store and retrieve

information.

The ability to learn new information and

to retrieve previously learned

information.

Stored perceptional experiences that can

be brought to consciousness to alter

future thought and behaviour.


Memory ProblemsMemory Problems

Amnesia is a word often used to describe

memory deficits.

Retrograde amnesia is difficulty in

remembering events that took placebefore the onset of amnesia. This is

usually in relation to events that tookplace more recent to the onset of

amnesia.


Memory ProblemsMemory Problems

Antegrade amnesia is difficulty learning andremembering new information since theonset of amnesia.

Lesions of the left temporal lobe result inimpaired recall of verbal material, such asshort stories and word lists, whetherpresented visually or orally.

Lesions of the right temporal lobe result inimpaired recall of non-verbal material, suchas geometric designs, faces and tunes.



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Assessment of MemoryAssessment of Memory

Sl.

No.

Test Component Assessed

1. Autobiographica lMemoryInterview

Personal, Retrograde memory

2. Contextual Memory test Recall and meta-memory

3 . Continuous v isua l memory test Visua l memory

4. Doors and People Recall and recognition, Visual a nd

auditory, delayed memory

5. Rey complex figure test Visual memory

6. Rivermead Behavioural Memory

test

Recall and recognition, visual and

auditory, functional tasks


Autobiographical InterviewAutobiographical Interview

AMI is an assessment of a patients

remote personal memory, which may beaffected with retrograde amnesia.

The test was developed for patients from

18 years to old age.

The patient is asked to recall 3 incidents

from childhood, adulthood and his or her

current life.


Autobiographical InterviewAutobiographical Interview

Scores are given for full and partial recall.

Memories are validated by talking with

friends or relatives.

It can be used in disorders such as TBI,

encephalitis, dementia and psychiatricdisorders.


Contextual Memory testContextual Memory test

Developed by an occupational therapist

to assess awareness of memory deficits.

It is used in conditions, including CVA, TBI,

dementia, depression, schizophrenia and

other neurologic disorders.

It assesses a patients meta-memory or

awareness of his or her memory

capabilities, recognition, recall and

strategy use.Dr.S.Balasubramanian, MPT,PhD


This is a manual test which consists of 2large presentation cards, 40 recognitioncards and a scoring booklet.

First, the patient is presented with a cardon which are 20 line drawings.

He is asked to study the card and try toremember as many items as possible.

In the second part of the test, the patientis provided with the context in which thepictures are related.



The patient is asked to recall items fromeach part of the test.

If he is unable to recall, recognition cardsmay be used.

Delayed recall may also be assessed afterapproximately 20 minutes.

Prior to the presentation of the recognitioncard, the patient is asked a series ofquestions about his perception of memoryand awareness of strategies utilized toremember.



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Recall scores (Immediate, delayed, total)

Awareness score (prediction, estimation, aresponse to general questioning in whichpoint values are assigned to some of the

responses).

Strategy used (the effect of context, total

strategy score, order of recall)


Doors and PeopleDoors and People

The test was designed to assess visual andverbal memory through recall andrecognition.

This consists of 4 people photographs, 12

door photographs and 4 simple drawings

(shapes).


Continuous visual memory testContinuous visual memory test

Is an assessment of visual memory.

It comprises 3 subtests:

- An acquisition task

- A delayed recognition task

- A visual discrimination task

The acquisition task assesses recognitionmemory by asking the patient to discriminatebetween new and repeated stimuli of complex

designs.


Continuous visual memory testContinuous visual memory test

This is repeated in the delayed recognitiontask.

In the visual discrimination task, patient isasked to perceive and discriminate amongstimuli so that visual discrimination deficitscan be distinguished from visual memorydeficits.

The test consists of 137 stimulus cards and ascoring form.

45 50 minutes to perform. Norms available on persons from 18 to 91

years.Dr.S.Balasubramanian, MPT,PhD

Rey complex figure testRey complex figure test

Was first devised by Rey in 1941 toinvestigate perceptional organization , visualspatial constructional ability and visualmemory.

It also assesses several other cognitiveprocesses, including organization andproblem solving.

The test consists of a 16 page test bookletto cover the copy, immediate recall, delayedrecall and recognition subtests.


Rey complex figure testRey complex figure test

The patient is first asked to copy the

stimulus onto the test manual.

The patient is then asked to recall the

figure in the non-cued recall section, aftera 3 minute recall from which he or she

must identify aspects recognized from thecomplex figure.



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Rivermead Behavioural MemoryRivermead Behavioural Memory

testtest It was developed to assess problems with

everyday memory and to provide amonitor for changes in memory with

intervention.

Subtests include recall of name and

appointment, recognition of faces andobjects recently seen, remembering a

route, remembering a story and

recognition.



test test The patient is given a score of two, one

or zero, based on his or her responses. For both the screening and profile scores,

the total score is computed and the

patient falls either above the cutoff for

normal memory or below for variouslevels of impairment.



test test The score can be adjusted for aphasic

patients with the verbal sections deletedfrom the total score.

The score may also be modified for

patients with perceptual problems by

deleting the immediate and delayed route,

orientation, date and faces.

Applicable from 16 to 7o years.


Executive functioning


Executive functioningExecutive functioning

Definition:

Higher level cognitive skill group that

includes goal setting, organization, self

monitoring (or reasoning), problemsolving, decision making, divergent

thinking (abstract thinking) andjudgment.


Problem solvingProblem solving

Problem solving includes the abilities to

recognize errors, generate solutions,

select and implement a solution and judge

the effectiveness of the solutionimplemented.



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organizationorganization

Organization is the ability to sequenceand plan occupations by deducing therelationship between objects.


JudgmentJudgment

Judgment is the ability to anticipateconsequences


Decision makingDecision making

Decision making is the ability to select

appropriate response by inhibiting the

other unwanted responses.

Prefrontal cortex is primarily responsiblefor these executive functions.


NeuroanatomyNeuroanatomy

Anterior to the primary motor cortex liesSMA on the medial aspect and Premotorarea on the lateral surface (area 6).

Anterior to these areas lie frontal eye fieldarea (area 8 and 8 A) on the lateral aspectand Brocas area on the medial aspect (area44).

Anterior to these areas lie prefrontal cortexon the dorsolateral aspect (area 9 and 46)and orbital on the venteromedial aspect

(area 47).Dr.S.Balasubramanian, MPT,PhD

NeurophysiologyNeurophysiology

The motor cortex is responsible formaking movements.

The premotor cortex selects movements.

The prefrontal cortex controls thecognitive processes so that appropriatemovements are selected at the correcttime and place.

This selection is controlled by internalrecord of (old experiences) existingsensory information.



1. Control of fine movements: Area 4

2. Movement programming: Premotor and

dorsolateral area

3. Movement repetitions: Premotor

4. Movement sequences: SMA



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5. Voluntary eye gaze: Frontal eye field area6. Speech (motor): Brocas area7. Divergent thinking: Orbital8. Social behaviour, sexual behaviour, mood or

affect, olfactory discrimination: Orbitalarea

9. Problem solving, decision making, goalsetting, reasoning (self monitoring),judgment, temporal memory, organizationand associative learning: Dorsolateralprefrontal area.


AssessmentAssessment

Many of the executive functions can beassessed through observation of the patient

during functional occupations. Apart from the standardized tests, there are

some informal assessments and sequencingcards.

The examiner should know whether thepatient is aware of planning problems, howmany steps in an occupation he or she isable to sequence and how he or she handleschange, and whether he or she is able toproblem solve.


Sl.

No


1. Allen Cognitive Level Test Ability to learn new

information

2. Allen Cognit ive Level Test

Problem solving

Problem solving and

ability to learn new

information

3. Bay Area Functional

Performance Evaluation

Ability to abstract and

ability to delete errors

4. Cognitive Assessment of

Minnesota

Following directions,

foresight an d planning,

concrete problem solving,

abstract thinkingDr.S.Balasubramanian, MPT,PhD

Sl.

No.


5. Cognitive Behaviour

Rating scale

Abstract thinking

6. Cognitive Performance

Test

Information Processing

7. Mini mental State

Exam

Following directions

8. Neurobehavioural

Cognitive State

Examination

Reasoning


Sl.

No.


9. Rey Complex Figure

test

Organization and Problem

solving

10. Short Category Test Problem solving and

abstract thinking

11. Wisconsin card sorting

Test

Abstract thinking, problem

solving, the ability to shift

cognitive strategies

12. Ravens Progressive

Matrices

Ability to formulate

constructs


Allen Cognitive Level TestAllen Cognitive Level Test

Developed in 1973

Quick assessment of a patient's ability toperform visuomotor tasks.

The patient is asked to perform severaldifferent types of stitches on a leatherlacing sample, including a running stitch,whip stitch and single cordovan stitch.

The test utilizes a 5 point scale andmeasures patients abilities in levels 2through 6



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Allen Cognitive Level TestAllen Cognitive Level Test

Problem solvingProblem solving Developed in 1991

Assesses more specifically the skills ofdeduction, planning and problem solving

The examiner asks the patient toreplicate the lacing stitches by firstlooking at the completed stitches

If the patient is unable to do the stitchesby looking at them, then verbalinstructions are given and thendemonstration may be provided


Cognitive Performance TestCognitive Performance Test

Developed to assess the functional levelof patients with Alzheimers disease and isin a standardized ADL format

It utilizes Allens cognitive levels, with thefocus of the assessment being on theinformation processing deficits incommon functional occupations

The assessment utilizes the ADL tasks ofdressing, shopping, making toast, using thetelephone washing and travelling.


Example of a test item is the patient is

asked to choose what he or she wouldwear if he or she were to go on a cold,

rainy day.

The patient must choose from an array of

mens and womens clothing, including

raincoats, a sheer scarf, a straw hat and a

rain scarf


Short Category TestShort Category Test

Comprises of 100 test items, divided into

five test booklets

Takes 15 30 minutes to administer

The tests assess the persons ability to

solve problems, handle abstract conceptformation and deal with situations in

everyday life


Wisconsin Card Sorting TestWisconsin Card Sorting Test

Developed to assess executive functioning

in terms of abstract reasoning and the

ability to shift cognitive strategies and to

problem solve as conditions or theenvironment changes

The patient is asked to sort the cards

The patient is not told how to sort the

cards but must conclude this based on

the examiners responses


The patient first sorts by color, then form,

then number

It is not timed.

Takes 20 30 minutes to administer

No. of errors, perseverative errors can be

converted to standard scores



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Ravens Progressive MatricesRavens Progressive Matrices

A set of 3 tests are used to measure the

ability to form constructs 3 tests are Standard Progressive Matrices

(SPM), Colored Progressive Matrices and

Advance Progressive Matrices (APM).

SPM consists of 60 stimuli, divided in to

five sets that progressively assess the

patients ability to discern relationships

among the stimuli.


APM has 48 problems an dis more

complex than the SPM This is beneficial in assessing patientsjudgement

SPM was designed to assess a wide range

of mental abilities without influence of

educational, cultural and physical abilities.


Language


Components of a soundComponents of a sound--basedbased

LanguageLanguage Phonemes: Fundamental sound units

whose combination produces morphemes

Morphemes: The smallest meaningful

units of a word, whose combination

creates a word.

Syntax: The admissible combinations of

words in phrases and sentences (called

grammer)


Components of a soundComponents of a sound--basedbased

LanguageLanguage Lexicon: The collection of all words in a

given language

Semantics: The meanings that correspond

to all lexical items and all possiblesentences

Prosody: The vocal intonation that canmodify the literal meaning of words andsentences.

Discourse: The linking sentences suchthat they constitute a narration


AphasiaAphasia

It refers to a disorder of language

apparent in speech, writing (agraphia) orreading (alexia).



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Fluent (Sensory) aphasiaFluent (Sensory) aphasiaSl.

No.

Aphasia Type of speech

production

Type of Language

errors

1. Wernickies

aphasia(sensory

aphasia)

Fluent Speech

without articulatorydisorders

Anomias or

paraphasias,poor

comprehension,

poor repetition

2. Transcortical

sensory

aphasia

(isolation

syndrome)

Fluent speech

without articulatory

disorders, good

repetition,can

repeat and

understand but

cannot speak

spontaneously

Paraphasia,poor

comprehension,

anomia


Fluent (Sensory) aphasiaFluent (Sensory) aphasia

Sl.

No.

Aphasia Type of Speech

production

Type of

Language

errors

3. Conduction aphasia Fluent

speech, can

name objects,

understand

speech, but

they cannot

repeat words

Poor

repetition,

fairly good

comprehensi

on

4. Anomic apahasia Fluent

speech with

articulatory

disorders

Anomia,

difficulties in

finding nouns


NonNon Fluent (Motor) aphasiaFluent (Motor) aphasia

Sl.

No.


production

Type of language errors

1. Brocas

aphasia

Non-fluent,

laborious

articulation

Speechlessness with

recurring utterances,

or syndrome of

phonetic

disintegration, poor

repetition

2. Transcortical

motor

apahsia

Non-fluent,but

good repetition

Uncompleted

sentences and

anomias, but naming

is better than

spontaneous speech


NonNon Fluent (Motor) aphasiaFluent (Motor) aphasia

Sl.

No.


production

Type of language

errors

3. Global aphasia Laborious

articulation

Speechlessness

with recurring

utterances, poor

comprehension,

poor repetition


Pure aphasiaPure aphasia

Sl.

No.


production

Type of language

errors

1. Alexia

without

agraphia

Normal Poor reading

2. Agraphia Normal Poor writing

3. Word

deafness

Normal Poor

comprehension

and poor

repetition


Aphasia Test BatteriesAphasia Test Batteries

1. Boston Diagnostic Aphasia Test

2. Functional Communicative Profile

3. Neuro-sensory Center Comprehensive

Examination for Aphasia

4. Porch Index for Differential Diagnosis of

Aphasia

5. Wepman Jones Language Modalities

Test for Aphasia



19/19

3/23/20

Aphasia Screening TestsAphasia Screening Tests

1. Halstead Wepman Aphasia ScreeningTest

2. Token Test


Documents

Neuropsychological Testing