Adult cognitive disorders Neuropsych assessment post brain injury

Recall falls to 60-75% after

10 second delay with interference. Decrement is much worse after interference for brain injured population

100% recall after

30 second delay

Advantage of RBANS

4 versions of test. Tracks recovery during rehab and progression of neuro disorders. Downward extension to 12 yrs old. Available in spanish

MOCA normative score

> or = 26/30

Auditory perception

Acuity, auditory discrimination, inattention, yes/no questions, nonverbal aud perception

Neuropsych assessment rationale

Admin by neuropsychologist but SLP makes recommendations or conducts therapy

Extinction example

Am I touching your R hand or L hand or both?

Which type of memory loss is most detrimental to rehab?

Anterograde

Pts post TBI have more difficulty with

Anterograde memory

Nonverbal tasks-controversy

Are they really nonverbal? For most have to use expressive language to answer

When someone you're going to assess produced unintelligible speech you should

Ask if they wear dentures

CLQT personal facts

Asks 4 questions about pt. Assesses episodic memory and language

CLQT mazes

Assesses executive functions, attention, visual perceptual skills

What is the advantage of the SCATBI?

Assesses high level of functioning

What is advantage of BTHI?

Assesses low level of functioning

CLQT cognitive domains

Attention, memory, executive function, language, visuospatial skills

CLQT yields severity ratings for

Attention, memory, executive function, language, visuospatial skills

Orientation

Awareness of self in relation to surroundings. Person, place, time, event

CLQT severity ratings

Based on norms for 2 age ranges. WNL, mild, moderate, severe

Orientation deficits are most frequent symptom of

Brain disease

BTHI

Brief test of head injury. Useful for pts with severe TBI.

Selective attention tasks

Cancellation tasks. Cross out all the letter "k"'s

RIPA-2 scoring system

Combination of numeric scores and diacritical descriptors for quantitative and qualitative information

Psychological functioning of pt

Compare mental health before injury to now. Any change as a result of injury?

Intact attention is necessary for both

Concentration and mental tracking activities

CLQT symbol trails

Connect starting with smallest shape to next biggest.. then move up to alternating between different shapes

Requirements for orientation

Consistent and reliable integration of attention, perception, and memory.

Flexible assessment provides

Consistent baseline measures as well as ongoing pt specific reassessment

CLQT

Criterion referenced instrument. Can be administered at bedside. Generally takes 30-40 min.

CLQT symbol cancellation

Cross out symbols that match target. Assesses visual attention, scanning, inhibition, response shifting

Spatial orientation

Distance estimations, mental transformations in space, topographical organization/localization, extra personal orientation

1 of the questions you should ask before beginning a cognitive linguistic assessment is

Do you wear glasses?

Assessment of alertness

During initial interview, caregiver reports, EMR

Dysphonias post TBI may be due to

Extubation

In neuro typical adults, recall is 100% after a 10 second delay with interference

False

Most common deficits in orientation

For time and place. Require continuity of awareness

Recovery of communicative function

General marked resolution of linguistic deficits (30-60 days), spontaneous recovery (1 yr), pragmatic comm deficits (convo turns)

Overall cognitive assessment

Generative cognitive/intellectual abilities. Broad measures of intellectual ability (WAIS-R)

CLQT target population

H/o neurological dysfunction, English and spanish speaking, ages 18-89, pt must be able to manipulate pen, verbal responses required for 4 tasks

RBANS assesses

Immediate memory, visuospatial, language, attention, delayed memory

Retention span

Immediate or short term (delayed)

Language assessment

Impairments depend on site, extent, severity of damage

Visual scanning

Important for reading/writing and telling time. Can do visual search or counting dots

Visual agnosia

Inability to recognize familiar objects. Unable to connect sensory info and past experience. Unable to understand object fx

Tactile perception

Inattention to touch, extinction, recognition/discrimination

Pts with TBI as communicators

Ineffective even though speech and language skills per se are relatively unimpaired

Sustained attention tests

Involve presentation of stimuli over period of time with instructions to indicate when given target stimulus is perceived. Ex. Tap hand every time you hear letter "a"

Why is orientation to time most challenging?

It requires continuity of awareness. Have to be present in the moment

Advantage of SCATBI

Items progress in difficulty to levels that some neuro typical adults do not typically master

Anterograde memory

Learning new information

BTHI scoring system

Linguistic and gestural communicativeness

Flexible assessment

Measures selected based on presenting problem. Can be mixed model (combo of standard battery and additional measures)

Most common deficit post TBI

Memory deficits

CLQT generative naming

Name as many animals as you can in 1 minute, as many words with letter "f"

Controlled Oral Word Association

Name as many words as you can in 60 seconds that start with letters F,A,S

Is there a gold standard for neuropsych tests?

No

Areas of cognitive function assessed

Orientation (most basic), language, attention, memory, visuospatial, visuomotor, executive function (most specific). Psychological functioning

BTHI areas of assessment

Orientation, attention, follow commands, organization, naming, reading, memory, visual spatial

Verbal learning and memory assessment

Paragraph recall and word list learning

SCATBI assesses

Perception and discrimination, orientation, organization, recall, reasoning

CLQT subtests

Personal facts, symbol cancellation, confrontation naming, clock drawing, story retell, symbol trails, word fluency, design memory, mazes, design generation

Standard (fixed battery)

Pre determined set of tests to assess variety of abilities. Need wide range of tests for comprehensive eval

What is missing from CLQT

Problem solving

Post TBI language impairments

Problem with pragmatics and word retrieval

What type of memory is critical for accomplishing tasks throughout the day?

Prospective

Benton Word Fluency Test

Pt asked to say aloud as many words beginning with certain letter and tester records

CLQT design generation

Pt produces up to 13 unique designs following specific rules. Assesses executive functions and memory

CLQT story retelling

Pt required to repeat story and respond with yes/no questions about story. 18 key elements, 6 follow up questions

How do TBI language and pragmatics compare to aphasia?

Pt with aphasia will have language impairment but pragmatics intact. Use compensatory strategies and residual skills to comm effectively in social contexts

Thurstone Word Fluency Test

Pts asked to write as many words beginning with "s" in 5 minutes

Attention TBI

Pure attention deficits appear as distractibility or impaired ability for focused behavior.

Visual memory

Recall (show designs then pt draws from memory) and recognition (view designs then select target from large array)

Retrograde memory

Recalling old information

RBANS

Repeatable battery for assessment of neuropsych status.

Nonverbal learning and memory

Reproduce figure from memory after delay, recognize figure from array

CLQT clock drawing

Requires integrated cognitive functioning. Memory, executive function, language, visuospatial skills

Impact of delay and interference

Retention span testing (delay may not make a difference). Interference will affect ability to recall

CLQT +

Revised version of CLQT. Added semantic comprehension component

RIPA-2

Ross Info Processing Assessment. Assesses memory, orientation, problem solving, word fluency, auditory comprehension

MOCA

Screening tool. Exec function, naming, memory, attention, language, abstraction, delayed recall, orientation.

CLQT design memory

Show design then identify it from larger array. Have to have pt look at design for full 20 seconds

Speech deficits after TBI

Spastic dysarthria most common, followed by ataxic and flaccid. Dysphonias and dysfluencies are rare

Tactile recognition

Sterognosis-inability to recognize object by touch alone (Ex. Reach into bag with object unknown cannot guess the object)

Divided attention tasks

Subject must retain info in memory while performing mental operations on the information. 2 types of tasks

Selective attention-stroop test

Subject perceives conflicting colors and color names. Can be asked to state color of ink, alternate between ink and actual color, etc

A cancellation task is assessing

Sustained attention

Alternating attention tasks

Sustained attention tests in which response requirements periodically change. Ex. Take 100 subtract by 7 then add 3. Ex. trail making

Post assessment of pt with TBI

Team meeting, reality orientation, goal setting

Retrospective memory

Test for personal information

Word Fluency Tasks

Thurstone word fluency and benton word fluency test

Prospective memory

Use of object (hide object then later ask where it is) and use of instruction (when timer goes off do this)

Halstead-Reitan Battery

Used to be most popular and the gold standard but not used anymore

Neuropsych screening

Used when pt can't tolerate full battery. SLP can administer. May over rely on certain faculties (verbal processing)

CLQT confrontation naming

Verbally name 10 simple drawings of common items. Assesses for presence of anomia

Assessing perception

Visual inattention (neglect, extinction) and cancellation tasks

Variety of assessment measures-Most common

Woodcock-Johnson test of cognitive abilities, Raven's coloured matrices, Wisconsin card sort

Can pts with brain injury still recover after spontaneous recovery?

Yes