clinical psychology

1. METHODS OFMETHODS OF
NEUROLOGICALNEUROLOGICAL
ASSESSMENTASSESSMENT
Lecture 42Lecture 42

2. WHAT IS A NEUROLOGICALWHAT IS A NEUROLOGICAL
ASSESSMENT?ASSESSMENT?
 Neurological assessment was traditionally carriedNeurological assessment was traditionally carried
out to assess the extent of impairment to a particularout to assess the extent of impairment to a particular
skill and to attempt to locate an area of the brainskill and to attempt to locate an area of the brain
which may have been damaged after brain injury orwhich may have been damaged after brain injury or
neurological illness .neurological illness .
 Miller outlined three broad goals of neurologicalMiller outlined three broad goals of neurological
assessment.assessment.
 Firstly, diagnosis, to determine the nature of theFirstly, diagnosis, to determine the nature of the
underlying problem.underlying problem.
 Secondly, to understand the nature of any brainSecondly, to understand the nature of any brain
injury or resulting cognitive problem and its impactinjury or resulting cognitive problem and its impact
on the individual,on the individual,
 And lastly, assessments may be undertaken toAnd lastly, assessments may be undertaken to
measure change in functioning over time.measure change in functioning over time.

3. DefinitionDefinition
 ““Neuropsychology is the study of brain-Neuropsychology is the study of brain-
behavior relationships”.behavior relationships”.

4.  Assessment may be carried for aAssessment may be carried for a variety of reasonsvariety of reasons,,
such as: Clinical evaluation, to understand the patternsuch as: Clinical evaluation, to understand the pattern
of cognitive strengths as well as any difficulties aof cognitive strengths as well as any difficulties a
person may have, and to aid decision making for useperson may have, and to aid decision making for use
in a medical or rehabilitation environment.in a medical or rehabilitation environment.
 The objectives of neuropsychological assessment inThe objectives of neuropsychological assessment in
clinical practice are to assess and diagnoseclinical practice are to assess and diagnose
disturbances of mentation and behavior and to relatedisturbances of mentation and behavior and to relate
these findings to their neurological implications and tothese findings to their neurological implications and to
the issues of clinical treatment and prognosis.the issues of clinical treatment and prognosis.
 The clinical neuro-psychologist offers a variety ofThe clinical neuro-psychologist offers a variety of
services, including the assessment of theservices, including the assessment of the
psychological-behavioral effects of real or suspectedpsychological-behavioral effects of real or suspected
brain lesions, the diagnosis of organic brainbrain lesions, the diagnosis of organic brain
conditions, and the planning and implementation ofconditions, and the planning and implementation of
rehabilitation programs for brain injured patients.rehabilitation programs for brain injured patients.

5. Historically, the field of neuropsychology evolved from aHistorically, the field of neuropsychology evolved from a
lesion localization model.lesion localization model.
 The neuropsychologist endeavors to assess differentThe neuropsychologist endeavors to assess different
domains of functioning (e.g., attention, memory,domains of functioning (e.g., attention, memory,
problem solving) in order to generate a profile ofproblem solving) in order to generate a profile of
strengths and weaknesses that can inform treatmentstrengths and weaknesses that can inform treatment
planning and adaptation in daily life.planning and adaptation in daily life.
 A neuropsychological assessment typically evaluatesA neuropsychological assessment typically evaluates
multiple areas of functioning. Such as:multiple areas of functioning. Such as:
• Sensory perceptual and motor functions,Sensory perceptual and motor functions,
Attention, Memory,Attention, Memory,
• Auditory and visual processing, Language,Auditory and visual processing, Language,
• Concept formation and problem solving,Concept formation and problem solving,
• Planning and organization, Speed of Processing,Planning and organization, Speed of Processing,
• Intelligence, Academic skills,Intelligence, Academic skills,
• Behavior, emotions, and personalityBehavior, emotions, and personality

6. WHAT INFORMATION DOES THEWHAT INFORMATION DOES THE
NEUROPSYCHOLOGICAL ASSESSMENTNEUROPSYCHOLOGICAL ASSESSMENT
PROVIDE?PROVIDE?
 A comprehensive assessment can yield information toA comprehensive assessment can yield information to
assist in distinguishing one disorder from another asassist in distinguishing one disorder from another as
well as better clarifying its nature.well as better clarifying its nature.
 In addition, based on knowledge of brain-behaviorIn addition, based on knowledge of brain-behavior
relationships, evidence for dysfunction in one region ofrelationships, evidence for dysfunction in one region of
the brain may tell us something about other difficultiesthe brain may tell us something about other difficulties
that might be present.that might be present.
 In this regard, knowing more about theIn this regard, knowing more about the individual’sindividual’s
strengths and weaknessesstrengths and weaknesses can assist in interpretingcan assist in interpreting
their behaviors and guiding program/treatmenttheir behaviors and guiding program/treatment
planning.planning.
 Finally, a written report should be provided followingFinally, a written report should be provided following
completion of the assessment that can be shared withcompletion of the assessment that can be shared with
those involved in the individual’s care.those involved in the individual’s care.

7. APPROACHES TO THE NEUROLOGICALAPPROACHES TO THE NEUROLOGICAL
EVALUATIONEVALUATION
 Neuropsychologist make inferences regarding anNeuropsychologist make inferences regarding an
individual’s neurological functioning based onindividual’s neurological functioning based on
measures of behavior (neuropsychological testmeasures of behavior (neuropsychological test
performance).performance).
 Another very important conceptual issue in theAnother very important conceptual issue in the
neuropsychological examination has to do with theneuropsychological examination has to do with the
pre-morbid level of functioningpre-morbid level of functioning..
 Lezak (1976) discusses 2 methodsLezak (1976) discusses 2 methods
The first is based on the assumption that certain wellThe first is based on the assumption that certain well
established abilities, such as vocabulary skills andestablished abilities, such as vocabulary skills and
fund of general information, are frequently preservedfund of general information, are frequently preserved
in individuals with brain injury, while other skills arein individuals with brain injury, while other skills are
impaired.impaired.

8.  The second method assumes that theThe second method assumes that the
individual’s best current performance “providesindividual’s best current performance “provides
the closest approximation to his original abilitythe closest approximation to his original ability
level;” hence the clinician simply looks for thelevel;” hence the clinician simply looks for the
highest scores or set of scores.highest scores or set of scores.
 Again, caution is warranted, since someAgain, caution is warranted, since some
patients are so severely impaired that all testpatients are so severely impaired that all test
scores are depressed.scores are depressed.
 Lezak warns that a single high test score on aLezak warns that a single high test score on a
memory task may not be a good estimate ofmemory task may not be a good estimate of
pre-morbid level of functioning, since memorypre-morbid level of functioning, since memory
is the least reliable indicator of generalis the least reliable indicator of general
intellectual ability of all intellectual functions.intellectual ability of all intellectual functions.

9. Other MethodologicalOther Methodological
ApproachesApproaches
 There are several other methodologicalThere are several other methodological
approaches that neuropsychologists use inapproaches that neuropsychologists use in
evaluating and interpreting a given patient’sevaluating and interpreting a given patient’s
performance. No single approach is itselfperformance. No single approach is itself
satisfactory, but when they are used in concertsatisfactory, but when they are used in concert
each approach supplements the other.each approach supplements the other.
 The more common approaches are:The more common approaches are:
Level Of Performance, Pattern Analysis, Patho-Level Of Performance, Pattern Analysis, Patho-
gnomonic Signs, and Right-left Differences.gnomonic Signs, and Right-left Differences.
Each is described more fully below.Each is described more fully below.

10. LEVEL OF PERFORMANCELEVEL OF PERFORMANCE
 In the level of performance approach, the patient isIn the level of performance approach, the patient is
administered tests that are sensitive to cerebraladministered tests that are sensitive to cerebral
impairment.impairment.
 The patient’s scores on such tests are compared toThe patient’s scores on such tests are compared to
normative levels.normative levels.
 In the past, many psychologists used theIn the past, many psychologists used the BenderBender
GestaltGestalt as a single measure of organicity.as a single measure of organicity.
 It is by no means sufficient, because it provides justIt is by no means sufficient, because it provides just
one bit of data about the patient.one bit of data about the patient.
 Another problem with the level of performanceAnother problem with the level of performance
approach particularly when a single test is used is thatapproach particularly when a single test is used is that
a patient may do well on this test despite havinga patient may do well on this test despite having
significant deficits in other areas of higher corticalsignificant deficits in other areas of higher cortical
functioning.functioning.

11. PATTERN ANALYSISPATTERN ANALYSIS::
 Pattern analysis means that the patient is givenPattern analysis means that the patient is given
a battery of tests with known association toa battery of tests with known association to
higher cortical functioning; and thehigher cortical functioning; and the
neuropsychologist then looks at the pattern ofneuropsychologist then looks at the pattern of
test performance—on which tests did thetest performance—on which tests did the
patient perform relatively poorly, and on whichpatient perform relatively poorly, and on which
tests did the patient perform well?tests did the patient perform well?
 The problem with pattern analysis approach isThe problem with pattern analysis approach is
that a person could have a low score on athat a person could have a low score on a
given test for numerous reasons, and thegiven test for numerous reasons, and the
simple presence of the low score does notsimple presence of the low score does not

12. RIGHT-LEFT DIFFERENCES:RIGHT-LEFT DIFFERENCES:
 To use the right-left difference approach, the clinicianTo use the right-left difference approach, the clinician
examines the test scores of patient on the tasks thatexamines the test scores of patient on the tasks that
require performance or participation of both sides of therequire performance or participation of both sides of the
body.body.
 A number of tests on the Halstead Battery involve havingA number of tests on the Halstead Battery involve having
the patient perform a given task with his or her dominantthe patient perform a given task with his or her dominant
hand and then perform the same task with the non-hand and then perform the same task with the non-
dominant hand.dominant hand.
 For example, to give another example on theFor example, to give another example on the TactualTactual
Performance TestPerformance Test, a right handed patient who takes a, a right handed patient who takes a
significantly longer time for block placement with the leftsignificantly longer time for block placement with the left
hand than for the right might suggest a lesion in thehand than for the right might suggest a lesion in the
parietal area of the right hemisphere.parietal area of the right hemisphere.
 One problem with this approach is that measuring right-leftOne problem with this approach is that measuring right-left
differences typically means measuring motor and sensory-differences typically means measuring motor and sensory-
motor deficit, so the number of tests in this category ismotor deficit, so the number of tests in this category is
limited.limited.

13. PATHOGNOMONIC SIGNS:PATHOGNOMONIC SIGNS:
 A pathognomonic sign is a problem that a patientA pathognomonic sign is a problem that a patient
manifests that is an absolute indication of organicmanifests that is an absolute indication of organic
brain disorder. A pathognomonic sign is present thebrain disorder. A pathognomonic sign is present the
patient is, by definition, suffering from an organicpatient is, by definition, suffering from an organic
neurological disorder.neurological disorder.
 Examples of pathognomonic signs are visual fieldExamples of pathognomonic signs are visual field
deficits, spatial inattention or neglect, aprexia anddeficits, spatial inattention or neglect, aprexia and
alexia.alexia.
 The major advantage of the pathognomonic signThe major advantage of the pathognomonic sign
approach is that if the sign is present, the patientapproach is that if the sign is present, the patient
definitely has organic impairment.definitely has organic impairment.
 The major disadvantage, however, is that absoluteThe major disadvantage, however, is that absolute
pathognomonic signs are seen rather infrequently onpathognomonic signs are seen rather infrequently on
neuropsychological evaluation.neuropsychological evaluation.

14. USES OF CLINICAL NEURO-USES OF CLINICAL NEURO-
PSYCHOLOGICAL ASSESSMENT:PSYCHOLOGICAL ASSESSMENT:
1. DIAGNOSTIC CLARIFICATION1. DIAGNOSTIC CLARIFICATION
In confusing or complex cases, neuropsychologicalIn confusing or complex cases, neuropsychological
assessment can be useful for testing out the relativeassessment can be useful for testing out the relative
contributions ofcontributions of
• neurological conditions (e.g., cellular degeneration,neurological conditions (e.g., cellular degeneration,
neuro-chemical disruption),neuro-chemical disruption),
• emotional states (e.g., anxiety, depression), andemotional states (e.g., anxiety, depression), and
• psychiatric illnesses (e.g., personality disorder,psychiatric illnesses (e.g., personality disorder,
psychoses).psychoses).
 Neuro-psychological assessment can be used to helpNeuro-psychological assessment can be used to help
localize brain damage.localize brain damage.

15. 2. MEASURING CHANGE:2. MEASURING CHANGE:
Repeat assessment can be valuable in chartingRepeat assessment can be valuable in charting
progress (e.g., recovery from cerebrovascularprogress (e.g., recovery from cerebrovascular
accident or closed head injury) as well as foraccident or closed head injury) as well as for
recognizing a decline in mental statusrecognizing a decline in mental status
(e.g., following the course of various dementias,(e.g., following the course of various dementias,
identifying unexpected declines in patients undergoingidentifying unexpected declines in patients undergoing
various treatments or during the process of recovery).various treatments or during the process of recovery).
3. EVALUATING COGNITIVE AND3. EVALUATING COGNITIVE AND
FUNCTIONAL STATUS:FUNCTIONAL STATUS:
Neuropsychological testing is able to delineate anNeuropsychological testing is able to delineate an
individual's pattern of cognitive strengths andindividual's pattern of cognitive strengths and
weaknesses relative to his or her own ability as well asweaknesses relative to his or her own ability as well as
compared to normative samples of age-matchedcompared to normative samples of age-matched
peers (Ideally, norms should be matched for age,peers (Ideally, norms should be matched for age,
education, gender, and race if each variable has beeneducation, gender, and race if each variable has been
shown to affect test performance).shown to affect test performance).

16. Applications Of Neuro-psychologicalApplications Of Neuro-psychological
Assessment:Assessment:
1. VOCATIONAL INTERVENTIONS:1. VOCATIONAL INTERVENTIONS:
With the input of the neuropsychologist, a patient'sWith the input of the neuropsychologist, a patient's
ability to rejoin the work force can be evaluated andability to rejoin the work force can be evaluated and
efforts toward re-entry can be facilitated (e.g., developefforts toward re-entry can be facilitated (e.g., develop
specific routines that are tailored to the patient'sspecific routines that are tailored to the patient's
existing strengths and that anticipate the impact of hisexisting strengths and that anticipate the impact of his
or her limitations).or her limitations).
Aspects of neuropsychological testing can beAspects of neuropsychological testing can be
integrated with organizational psychology in order tointegrated with organizational psychology in order to
enhance the quality of vocational assessment.enhance the quality of vocational assessment.

17. 2. ACADEMIC INTERVENTIONS:2. ACADEMIC INTERVENTIONS:
As with vocational interventions, results of aAs with vocational interventions, results of a
neuropsychological assessment may be used to planneuropsychological assessment may be used to plan
a special educational program to better meet thea special educational program to better meet the
needs of an individual. This may be useful withneeds of an individual. This may be useful with
developmental disorders as well as with patientsdevelopmental disorders as well as with patients
recovering from illness or injury.recovering from illness or injury.
3. FAMILY INTERVENTIONS:3. FAMILY INTERVENTIONS:
Accurate knowledge about a patient's functional statusAccurate knowledge about a patient's functional status
may assist him or her to adjust their role within amay assist him or her to adjust their role within a
family system. Neuropsychological information mayfamily system. Neuropsychological information may
enable family members to recognize the need forenable family members to recognize the need for
changes and accommodations within theirchanges and accommodations within their
relationships, highlight the need for environmentalrelationships, highlight the need for environmental
changes to accommodate patient deficits, and providechanges to accommodate patient deficits, and provide
an opportunity for emotional processing and eventualan opportunity for emotional processing and eventual
acceptance of the patient's limitations.acceptance of the patient's limitations.

18. 4. COMPETENCY ISSUES:4. COMPETENCY ISSUES:
Neuropsychological status plays an importantNeuropsychological status plays an important
role in determining a patient's overallrole in determining a patient's overall
competency.competency.
Questions typically involve one's ability toQuestions typically involve one's ability to
exercise rational judgment, make competentexercise rational judgment, make competent
decisions, and live in an independent fashion.decisions, and live in an independent fashion.
In addition to cognitive status, assessment ofIn addition to cognitive status, assessment of
the patient's awareness of their limitations isthe patient's awareness of their limitations is
also important in establishing ability foralso important in establishing ability for
independent functioning.independent functioning.

19. Methods of Neuro-PsychologicalMethods of Neuro-Psychological
Assessment:Assessment:
1. MEDICAL HISTORY:1. MEDICAL HISTORY:
All relevant medical records, especially resultsAll relevant medical records, especially results
of neurological examination, imaging studies,of neurological examination, imaging studies,
and electrophysiological (EEG) results.and electrophysiological (EEG) results.
2. CLINICAL INTERVIEW:2. CLINICAL INTERVIEW:
Includes review of cognitive, sensorimotor, andIncludes review of cognitive, sensorimotor, and
neurovegetative complaints as well as medical,neurovegetative complaints as well as medical,
psychiatric, and substance abuse history.psychiatric, and substance abuse history.
Family members may be interviewed whenFamily members may be interviewed when
necessary.necessary.

20. 3. PSYCHOMETRIC TESTS:3. PSYCHOMETRIC TESTS:
These may be "paper and pencil" tasks orThese may be "paper and pencil" tasks or
measures requiring performance of a relevantmeasures requiring performance of a relevant
skill (e.g., assembly of blocks or puzzles,skill (e.g., assembly of blocks or puzzles,
reaction time tasks).reaction time tasks).
Major cognitive domains typically assessedMajor cognitive domains typically assessed
include:include:
Attention, Memory, Intelligence, Visual-Spatial-Attention, Memory, Intelligence, Visual-Spatial-
Perceptual functions, Psychosensory andPerceptual functions, Psychosensory and
Motor abilities, "Executive" or "Frontal Lobe"Motor abilities, "Executive" or "Frontal Lobe"
functions, and Personality or Emotionalfunctions, and Personality or Emotional
Functioning.Functioning.

21. 4. INTERPRETATION OF RESULTS:4. INTERPRETATION OF RESULTS:
Deficit patterns occurring across neuropsychologicalDeficit patterns occurring across neuropsychological
tests can be suggestive of various sites of cerebraltests can be suggestive of various sites of cerebral
dysfunction and neurological processes underlying thedysfunction and neurological processes underlying the
deficit pattern.deficit pattern.
An effort is made by the neuropsychologist to integrateAn effort is made by the neuropsychologist to integrate
test data, history, clinical interview, behavioraltest data, history, clinical interview, behavioral
observations, and available laboratory and radiologicalobservations, and available laboratory and radiological
evidence into one cohesive summary report thatevidence into one cohesive summary report that
arrives at a neurobehavioral diagnosis, discusses thearrives at a neurobehavioral diagnosis, discusses the
neurological implications (e.g., localization, course,neurological implications (e.g., localization, course,
prognosis), and can be used in the process ofprognosis), and can be used in the process of
treatment planning.treatment planning.

22. INTERPRETATION OF NEURO-INTERPRETATION OF NEURO-
PSYCHOLOGICAL TEST RESULTS:PSYCHOLOGICAL TEST RESULTS:
 First, a patient’sFirst, a patient’s level of performancelevel of performance may bemay be
interpreted in the context of normative data.interpreted in the context of normative data.
 Second, some calculate difference scores betweenSecond, some calculate difference scores between
two tests for a patient; certain level of differencetwo tests for a patient; certain level of difference
suggests impairment.suggests impairment.
 Third,Third, pathognomonic analysispathognomonic analysis of scores on tests hasof scores on tests has
been reliably associated with specific neurologicalbeen reliably associated with specific neurological
injuries or impairments.injuries or impairments.
 Finally, a number of statistical formulas that weightFinally, a number of statistical formulas that weight
test scores differently may be available for certaintest scores differently may be available for certain
diagnostic decisions.diagnostic decisions.

23. NEURODIAGNOSTIC PROCEDURESNEURODIAGNOSTIC PROCEDURES
 The medical field has a variety of neurodiagnosticThe medical field has a variety of neurodiagnostic
procedures. they include the tradition neurologicalprocedures. they include the tradition neurological
examination performed by the neurologist, spinal taps,examination performed by the neurologist, spinal taps,
X rays, electroencephalograms (EEGs), computerizedX rays, electroencephalograms (EEGs), computerized
axial tomography (CAT) scans, positron emissionaxial tomography (CAT) scans, positron emission
tomography (PET) scans, and the more recent nucleartomography (PET) scans, and the more recent nuclear
magnetic resonance imaging (NMR or MRI) technique.magnetic resonance imaging (NMR or MRI) technique.
 Many of these neurodiagnostic procedures are quiteMany of these neurodiagnostic procedures are quite
expensive, and some are invasive. Therefore, it mayexpensive, and some are invasive. Therefore, it may
be helpful to use neuropsychological tests asbe helpful to use neuropsychological tests as
screening measures, the results of which may indicatescreening measures, the results of which may indicate
whether more expensive neurodiagnostic tests arewhether more expensive neurodiagnostic tests are
indicated.indicated.

24. TESTING AREAS OF COGNITIVETESTING AREAS OF COGNITIVE
FUNCTIOINGFUNCTIOING
A. INTELLECTUAL FUNCTIONING:A. INTELLECTUAL FUNCTIONING:
A number of techniques have been used over toA number of techniques have been used over to
assess levels of intellectual functioning.assess levels of intellectual functioning.
 To estimate level of intellectual ability, manyTo estimate level of intellectual ability, many
neuropsychologists use the WAIS -3 and subtestsneuropsychologists use the WAIS -3 and subtests
from a modified version of the WAIS-R called thefrom a modified version of the WAIS-R called the
WAIS-R-NI (Kaplan, 1991).WAIS-R-NI (Kaplan, 1991).
 The modifications include, for example, changes inThe modifications include, for example, changes in
administration (such as allowing the patient toadministration (such as allowing the patient to
continue on a subtest despite consecutive incorrectcontinue on a subtest despite consecutive incorrect
answers) and additional subtest items.answers) and additional subtest items.
 Because of these modifications, it is believed that theBecause of these modifications, it is believed that the
WAIS-R-NI provides more information regarding theWAIS-R-NI provides more information regarding the
patient's cognitive strategies.patient's cognitive strategies.

25. B. ABSTRACT REASONING:B. ABSTRACT REASONING:
Some of the more commonly used tests to assessSome of the more commonly used tests to assess
abstract reasoning abilities include the Similaritiesabstract reasoning abilities include the Similarities
subtest of the WAIS-3 and the Wisconsin Card Sortingsubtest of the WAIS-3 and the Wisconsin Card Sorting
Test, or WCST (Heaton, 1981).Test, or WCST (Heaton, 1981).
The Similarities subtest requires the patient to produceThe Similarities subtest requires the patient to produce
a description of how 2 objects are alike. The WCSTa description of how 2 objects are alike. The WCST
consists of decks of cards that differ according to theconsists of decks of cards that differ according to the
shapes imprinted, the colors of the shapes, and theshapes imprinted, the colors of the shapes, and the
number of shapes on each card.number of shapes on each card.
The patient is asked to place each card under theThe patient is asked to place each card under the
appropriate stimulus card according to a principleappropriate stimulus card according to a principle
(same color, same shapes, same number of shapes)(same color, same shapes, same number of shapes)
deduced from the examiner's feedback ('that's right'deduced from the examiner's feedback ('that's right'
and 'that's wrong').and 'that's wrong').

26. C. MEMORY:C. MEMORY:
Brain injury is often marked by memory loss. To testBrain injury is often marked by memory loss. To test
for such loss, Wechsler (1945) developed thefor such loss, Wechsler (1945) developed the
Wechsler Memory Scale, or WMS. The WechslerWechsler Memory Scale, or WMS. The Wechsler
Memory Scale-3 is the most recent revision of theMemory Scale-3 is the most recent revision of the
WMS.WMS.
 WMS-3 subtest scores are combined into 8 primaryWMS-3 subtest scores are combined into 8 primary
indexes that assess a range of memory functioning:indexes that assess a range of memory functioning:
Auditory Immediate, Visual Immediate, ImmediateAuditory Immediate, Visual Immediate, Immediate
Memory, Auditory Delayed, Visual Delayed, AuditoryMemory, Auditory Delayed, Visual Delayed, Auditory
Recognition Delayed, General Memory and WorkingRecognition Delayed, General Memory and Working
Memory.Memory.
 Four supplementary Auditory Process Composites canFour supplementary Auditory Process Composites can
also be calculated. These are used to assess memoryalso be calculated. These are used to assess memory
processes when stimuli are presented auditorily.processes when stimuli are presented auditorily.

27. D. VISUAL-PERCEPTUAL PROCESSING:D. VISUAL-PERCEPTUAL PROCESSING:
Visual-spatial skills are necessary for a broad range ofVisual-spatial skills are necessary for a broad range of
activities, including reading a map, parallel parking aactivities, including reading a map, parallel parking a
car, a throwing a baseball from the outfield to a base.car, a throwing a baseball from the outfield to a base.
In addition to theIn addition to the Rey-Osterrieth Complex FigureRey-Osterrieth Complex Figure
TestTest, many neuropsychologists seeking to assess, many neuropsychologists seeking to assess
visual-spatial skills examine performance on certainvisual-spatial skills examine performance on certain
WAIS-3 subtests, such as theWAIS-3 subtests, such as the Block Design subtestBlock Design subtest..
Several specialized tests of these skills are alsoSeveral specialized tests of these skills are also
available. For example, the judgment ofavailable. For example, the judgment of LineLine
Orientation TestOrientation Test requires examinees to indicate therequires examinees to indicate the
pair of lines on a response card that 'match' the 2 linespair of lines on a response card that 'match' the 2 lines
on the stimulus card.on the stimulus card.

28. E. LANGUAGE FUNCTIONING:E. LANGUAGE FUNCTIONING:
Various forms of brain injury or trauma can affectVarious forms of brain injury or trauma can affect
either the production or comprehension of language.either the production or comprehension of language.
Tests that require patients to repeat words, phrases,Tests that require patients to repeat words, phrases,
and sentences can assess articulation difficulties andand sentences can assess articulation difficulties and
paraphasias (word substitutions); naming tests canparaphasias (word substitutions); naming tests can
help diagnose anomias (impaired naming).help diagnose anomias (impaired naming).
Language comprehension can be assessed using theLanguage comprehension can be assessed using the
Receptive Speech Scale of the Luria-Nebraska. ThisReceptive Speech Scale of the Luria-Nebraska. This
subtest requires patients to respond to verbalsubtest requires patients to respond to verbal
commands. Speech and language pathologists do ancommands. Speech and language pathologists do an
excellent job of comprehensively assessing languageexcellent job of comprehensively assessing language
dysfunction, and the neuropsychologist may choose todysfunction, and the neuropsychologist may choose to
refer patients to these health professionals if arefer patients to these health professionals if a
screening test indicates suspected problems inscreening test indicates suspected problems in
language production or comprehension.language production or comprehension.