Neuropsychology The field of neuropsychology has had a very important growth over the past several decades.

The growth has been reflective in a). increases in membership in professional neuropsychological associations; b). the number of training programs that offer neuropsychology courses; and c). the many papers, books, and journals now published on neuropsychological topics.

The number of jobs available to clinical neuropsychologists is no longer unlimited, and the clinical services offered by neuropsychologists will need to be provided at lower costs and higher effectiveness.

What is Neuropsychology?

Simply defined, it is the study of the relation between the brain function and behavior.

It deals with understanding, assessment, and treatment of behaviors directly related to the functioning of the brain.

Neuropsychological assessment is a noninvasive method of describing brain functioning based on a patients’ performance on standardized tests that have been shown to be accurate and sensitive indicators of brain-behavior relationships.

Roles of Neuropsychologists. Neuropsychologists often called on by neurologists or other

physicians to help establish or rule out particular diagnosis. They make predictions regarding prognosis for recovery. Intervention and Rehabilitation Evaluation of patients with mental disorders to help predict the course

of illness as well as to help tailor treatment strategies of patients’ strength and weaknesses.

History of NeuropsychologyAs in most areas of psychology, the historical

roots of neuropsychology extend as far back in time as we are inclined to look. Several theories have emerged to form conceptualization of what is now Neuropsychology.

Localization of function – is a concept examined within the last century but assumed to be true for sometime. It considers that certain areas of the brain are

strictly responsible for certain functions of the brain

Obtained greater credibility with Broca’s surgery and finding area motor speech.

History of Neuropsychology As stated above, historically

this concept was held to be true with little empirical evidence. As such, Phrenology used this in a similar but unempirical manner.

Certain individual measured intelligence and personality by noting the bumps and indentations of the skull. Thus, the size of a given area determines the psychological capacity of the individual.

History of Neuropsychology Localization of function was generalized to the rest

of the brain and how it functions.

However, Lashley in the late 1920 and early 1930 Discovered that behavioral consequences of

experimentally induced lesions on the brains of rats were a result of the amount of tissue damage versus location, leading to Law of Mass Potential or Equipontentiality

Equipotentiality – (Flourens & Lashley) Higher intellectual functioning is mediated by the brain as a whole, and any brain injury will impair these higher functions. Yet there is the ability of one area of the cortex to substitute for the damaged area.

History of Neuropsychology Functional Model – (Jackson & Luria) Areas of the brain

interact with each other to produce behavior. Behavior “is conceived of as being the result of several functions or systems of the brain areas, rather than the result of unitary or discrete brain areas. A disruption at any stage is sufficient to immobilize a given functional system.

PROBLEMS WITH THE FIRST TWO:Why lesions created unexpected effects?

Why small lesions created greater deficits than expected?

Structure and Function of the brainThe brain consists of two hemispheres. Left hemisphere: controls right side of body; language function, logical

inference, and detail analysis in almost all right-handed individuals. Right Hemisphere: control left side of body; visual-spatial skills, creativity,

musical activities, and the perception of direction.Each cerebral hemisphere has four lobes. Frontal lobes are executive functions such as formulating, planning, and

carrying out goal-directed initiatives. Also, emotional modulation – the ability to monitor and control one’s emotional state.

Temporal lobes mediate linguistic expressions, reception, and analysis. Also involved in auditory processing of tones, sounds, rhythms, and meanings that are non language in nature.

Parietal lobes are related to tactile and kinesthetic perception, understanding, spatial perception, and some language understanding and processing.

Occipital lobes are mainly oriented towards visual processing and some aspects of visually mediated memory. Motor coordination, as well as the control of equilibrium and muscle tone, is associated with the cerebellum.

F P O T

Frontal Parietal

Occipital

Temporal

Causes of brain damage

a). Trauma – incidents producing these injuries range from automobile accidents to falls off ladders. Head trauma is the leading cause of death and disability in young Americans. Major effects of head traumas:

Concussions result in momentary disruptions of brain functions although permanent damage is uncommon. JARRING OF THE BRAIN

Contusions refers to cases in which the brain has been shifted from its normal position and pressed against the skull. As a result brain tissue is bruised.

Lacerations involve actual ruptures and destruction of brain tissue. Often caused by bullets or flying objects.

b). Tumors – Brain tumors may grow outside the brain, within the brain, or result from metastatic cells spread by body fluids from some other organ of the body, such as the lung or breast.

Cont.. Causes of Brain Damage

c). Degenerative Disease – Characterized by degeneralization of neurons in the central nervous system. Common degenerative disease include Huntington’s chorea, Parkinson’s disease, Alzheimer’s disease and other dementias. Eventually patients in these categories show severe disturbances in many behavioral areas, including motor, speech, language, memory, and judgment difficulties.

d). Nutritional Deficiencies Korsakoff’s psychosis- resulting from nutritional problems

brought about by poor eating habits common in longtime alcoholics.

Pellagra (niacin/ Vitamin B3 deficiency), and Beriberi ( thiamine/ Vitamin B1 deficiency).

e). Toxic Disorder – A variety of metals, toxins, gases, and even plants can be absorbed through the skin resulting in a toxic or poisonous effect that produces brain damage.

Cont.. Causes of Brain Damage

f). Chronic Alcohol Abuse – several regions of the brain seem especially vulnerable to damage from chronic exposure of alcohol.

g). Cerebral vascular Accidents Stroke is defined as a blockage or rupture of cerebral blood

vessels. A blood clot blocks the vessel that feeds a particular area of the brain resulting in:

Aphasia - the partial or total inability to produce and understand speech as a result of brain damage caused by injury or disease.

Apraxia – inability to perform certain voluntary movements. Agnosia – disturbed sensory perception.

The exact symptoms that occur depend on the site of the accident and its severity. In very serious cases the outcome might be death; those who survive show paralysis, speech problems, memory and judgment difficulties, and so on.

Consequences and symptoms of neurological damage Brain injury or trauma can produce a variety of cognitive and behavioral

symptoms. Several common symptoms associated with neurological damage are in the list that follows.

1. Impaired orientation – name the day of the week

2. Impaired memory – inability to learn and retain new information

3. Impaired intellectual functions – general knowledge may be affected

4. Impaired judgment – trouble making decisions

5. Shallow and labile affects – laughs or weeps too easily and inappropriate

6. Loss of emotional and mental resilience – stress results in emotional reaction

7. Frontal lobe syndrome – poor social judgment, apathy and indifference

Methods of AssessmentMajor approaches Standard battery approach – evaluates patients for all basic neurological

abilities, accumulating a standard database for all patients over time, and allowing for the identification of important patterns of score.

Flexible approach – each assessment is tailored to the individual patient, with the neuropsychologist choosing tests based on her or his hypotheses about the case.

Interpretation of Neuropsychological Test Results Patient’s level of performance may be interpreted in the context of normative

data. For example, does a patient’s score fall significantly below the mean score for the appropriate reference group.

Calculating difference scores between two tests for a patient ; certain levels of difference suggest impairment.

Pathognomonic signs of brain damage (e.g., failing to draw the left side of a picture) may be noted and interpreted.

Pattern analysis of scores may be undertaken; certainly patterns of scores on tests have been reliably associated with specific neurological injuries.

A number of statistical formulas that weight test scores differentially may be available for certain diagnostic decisions.

Methods of Assessment

Neurodiagnostic Procedure Spinal taps, x-rays, electroencephalograms, computerized axial

tomography scans, positron emission tomography scans, and the more recent nuclear magnetic resonance imaging (NMR or MRI) technique.

Testing Areas of cognitive Functioning Intellectual functioning – WAIS-III and subtests from WAIS-R-NI Abstract reasoning – WAIS-III or WCST Memory – WMS-III, Benton Visual Retention Test, and Rey-

Osterrieth Complex Figure Test Visual – Perception Processing – WAIS-III, Judgment of Line

Orientation Test Language Functioning – Receptive Speech Scale of the Lubria –

Nebraska

Methods of Assessment

Test Batteries Halstead- Reitan Battery is used to provide information about the

probable localization of lesions and whether they appear to be of gradual or sudden onset. It also suggests something about specific psychological deficit that a therapist should note. The scale is used with people 15 years and older.

Luria-Nebraska Battery shows substantial agreement with results obtained from the Halstead – Reitan method. The main advantage of the Luria – Nebraska is that it only takes 2.5 hours to complete, compared with the 6 hours often required to complete the Halstead – Reitan battery.

Variables That Affect Performance on Neurological Tests A number of patient variables may influence neurological test

scores. Because test scores differ according to the biological sex, age, and educational level of the patient, appropriate norms should be used in interpretation.

Intervention and Rehabilitation Rehabilitation is becoming one of the major functions of

neuropsychologists. Their role is to coordinate the cognitive and behavioral treatment of patients who have shown cognitive and behavioral impairment as a result of brain dysfunction or injury.

First, a thorough assessment of the patient’s strengths and deficits is conducted.

A program of rehabilitation is then developed that will be maximally beneficial to the patient, given her or his deficit, as well as one that will be efficient in the sense of requiring a minimum amount of staff time and supervision.

Neuropsychologist and the rehabilitation team are present when rehabilitation is accomplished by having the patient “relearn,” via developmentally older and intact functional systems, the development of new functional systems, or changing the environment to ensure the best quality of life possible.

The future for neuropsychologyTraining Ph. D. from a graduate program with a specialty track in neuropsychology. Genetic psychology core Generic clinical core Neurosciences and basic human and animal neuropsychology Specific clinical neuropsychological training Skills should be acquired through coursework, supervised experience, and a

required 2 year residency/ postdoctoral training. At the end of their rigorous training they should be able to demonstrate advanced

skill in neuropsychological assessment, treatment, and consultation and should be eligible for board certification in clinical neuropsychology by the American Board of Professional Psychology.

Future Many challenges lie ahead for the field, including the need for more sophisticated

and more economical assessment and rehabilitative techniques, as well as a tightening in the job market as a result of managed care.