临床与咨询心理学导论 13 - Neuropsychology
L13 Clinical Neuropsychology & Neuropsychological Testing
参考文献：Pomerantz, A. (2013). Clinical psychology: science, practice, and culture (3rd ed.). Thousand Oaks, CA: SAGE Publications.
13.1 Clinical Neuropsychology & Assessment
Clinical Neuropsychology
Clinical application of the relationship between brain function and behavior.
Clinical neuropsychology is a sub-field of psychology concerned with the applied science of brain-behaviour relationships. Clinical neuropsychologists use this knowledge in the assessment, diagnosis, treatment, and or rehabilitation of patients across the lifespan with neurological, medical, neurodevelopmental and psychiatric conditions, as well as other cognitive and learning disorders.
Neuropsychological Assessment
• MRI, PET, and CT scans provide images of the brain and can highlight areas of physical abnormality or concern;
• Neuropsychological assessment indicates how those abnormalities translate to functional problems for an individual;
• Noninvasive method of assessing cognitive functioning, skills, and behavior;
• Based on performance on standardized tests shown to be accurate indicators of brain-behavior links;
Wide range of uses including: Useful in evaluating head injury, stroke, brain tumor, degenerative diseases, nutritional deficiencies, toxin exposure, prolonged alcohol or drug use, learning disabilities, seizure disorders...
Typical neuropsychological exams evaluate: General Intellectual Functioning, Executive Skills, Attention & Concentration, Language, Learning & Memory, Visual-Spatial Skills, Motor & Sensory Skills, Mood & Personality, etc.
Test score:
• Test scores are compared to norms based on education level and age;
• scores that are different from norms suggest “problem areas;”
• Focus on both areas of strength and areas of weakness.
13.2 Specific Assessment Batteries
Full Assessment Batteries
• Long assessments with many subtests
• Halstead-Reitan Neuropsychological Battery (HRB, HRNB)
- For clients 15 years and older
- 5-6 hours to complete
- 8 standardized tests, administered as a whole battery
Eg: Trail making test (order numbers & letters), finger tapping test (index finger, provide motor speed), category test (pattern, organizing), etc.
- Compare to norms and find strengths & weakness.
Brief Assessments
Typically used as screeners to determine if a longer battery is needed
Mot used for identified neuropsychological problems
• Bender Visual-Motor Gestalt Test
- For children ages 3 and older and adults.
- Straightforward copying task
- Series of 9 geometric designs
- Less than 10 minutes to administer
• Rey-Osterrieth Complex Figure Test
- Drawing/copying task with a more complex figure, often just one figure
- Different colored pencils used at different points
• Memory component involved too
- 3-60 minutes after the initial administration
- Client asked to generate the image again from memory
13.3 Real-World Application
Neuropsychological Assessment in Sports
• Common referral among youth and athletes is - Concussion: A Traumatic Brain Injury (TBI) caused by bump, blow, or jolt to head that causes the head and brain to move rapidly back and forth (CDC, 2019)
Neuropsychological Assessment in the NFL (National Football League)
• Large number of documented concussions (about 200+)
• These numbers are likely underestimations
• Chronic traumatic encephalopathy (CTE): Degenerative brain disease associated with repeated head trauma - Recent studies found that 110 out of 111 (99%) former players who donated brains to science had CTE
• Many questions remain about CTE (genetic role, numbers that cause, etc.)
• Repeated trauma triggers progressive degeneration of brain tissue and build-up of an abnormal protein called tau
Sideline Management of Concussions
• Evaluate loss of consciousness
- Any period of time without consciousness?
• Evaluate confusion
- Orientation to place, event, date, day
• “What stadium is this?”
• “Who is the opposing team?”
• “What day is it?”
• Evaluate amnesia
- Anterograde amnesia: Cannot recall events immediately after the trauma
• Returning to sideline
• “Repeat ‘girl, dog, green’” (recall words)
- Retrograde amnesia: Cannot recall events immediately before the trauma
• “What was the score before the hit?”
• Evaluate concentration
- “List the days of the week backward starting with today”
Formal Assessments
• Formal concussion protocol to determine return to the game.
• 5-step process (for football):
1. Rest and recovery: Limited physical and cognitive activity until return to baseline functioning;
2. Light aerobic activity: Neuropsychological testing may started at this point; results must indicate return to baseline (see baseline testing below) to continue;
3. More aerobic activity and strength training, neurocognitive testing is done here if not done in the second step;
4. Football specific activities (with no contact): Move to last step only if player remains symptoms free;
5. Full football activities.
• After all five steps have been completed, players must be examined by:
- Team’s doctor
- Independent neuropsychological consultant works with the team
• Full neurocognitive and symptom recovery takes longer in younger athletes
• Baseline testing
- Mandated for NFL teams in 2012
- Complete the baseline testing before the season begins
- Comparison point during the season
ImPACT:
• Validated computerized system
• Assesses Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time, Impulse Control, Symptom Composite
• ImPACT Reliable Change Index
- Indicates whether test score reliably differs from baseline
- Can be used to track symptoms over time.
Legal Challenges
• Many legal cases related to head trauma and CTE involving the NFL
- Lawsuits filed by thousands of former players and families claiming that critical information about risks were withheld
- NFL settled a major suit for $1 billion in 2016
- Many other lawsuits against the NFL are currently pending
