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3/23/2012

Neuropsychology

Neuropsychological Functions and Testing

Dr. S. Balasubramanian, MPT, PhD Associate Professor, SCPTRC, Mangalore


Dr.S.Balasubramanian, MPT,PhD

Definition: Neuropsychology is defined as the study of the relation between brain function and behaviour. Although the study draws information from many disciplines such as anatomy, biology, biophysics, pharmacology and physiology, its central focus is the development of a science of human behaviour based on the function of the human brain.

Clinical Neuropsychology Clinical 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 and weaknesses is used in important health care areas, such as diagnosis and treatment planning.

Dr.S.Balasubramanian, MPT,PhD

Clinical Neuropsychology
The clinical neuropsychologist conducts the evaluation and makes recommendations. He or she may also provide treatment, such as cognitive rehabilitation, behavior management, or psychotherapy.

Clinical Neuropsychology
NPE is an essential element in development of a treatment protocol in patients with brain injury. The neuropsychological examination serves as an expansion of the basic mental status examination and it employs standardized measures to quantify a performance at a given time.

Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

3/23/2012

Clinical Neuropsychology
These tests employ a variety of normative databases to evaluate performance relative to the entire population. The distribution of test scores are grouped by sex, age, education or other relevant criteria, provide a reference for interpreting the test performance of specific patients.

Goals of NPE
The assessment aims to diagnose the presence of cortical damage or dysfunction and to provide an accurate and unbiased estimate of a persons cognitive capacity. NPE is used to facilitate patient care and rehabilitation. Serial assessment can provide information about the rate of recovery and the potential for resuming a previous life-style.
Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

Goals of NPE
NPE can identify the presence of mild disturbances in cases in which other diagnostic studies have produced equivocal results. To identify unusual brain organization that may occur in left hander or in people with childhood brain injury. This information is valuable to the surgeon, who would not wish to remove primary speech zones inadvertently during surgery and such information is obtained only from behavioural measures.
Dr.S.Balasubramanian, MPT,PhD

NPE is most useful for the following purposes


Adjunct diagnostic work-up Establish baseline for known illness or injury Evaluate medication efficacy/toxicity Evaluate early dementia Evaluate competency, independence and return to work/school issues Provide recommendations for psychosocial interventions.
Dr.S.Balasubramanian, MPT,PhD

NPE is of limited value in the following cases


The patient is severely compromised such as in advanced dementia or early in recovery from brain injury The patient has other serious medical complications or psychiatric disorders. Patients are exceptional, educationally and culturally The examiner exhibits bias or is not fully qualified.
Dr.S.Balasubramanian, MPT,PhD

A typical NPE will involve assessment 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
Dr.S.Balasubramanian, MPT,PhD

3/23/2012

Attention

3 different types of attentional mechanisms


One in the parietal cortex that enhances spatial attention 2. One in the visual and posterior temporal cortex that selects object features 3. One in the inferior temporal region that selects objects themselves
1.

Attention is the ability to select and to attend to a specific stimulus while simultaneously suppressing extraneous stimuli

Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

Attention
Many different processes work together to process information These processes include alertness or arousal, the ability to select stimuli, the ability to span attention, the ability to shift attention and information processing

Attention 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
Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

Attention 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]
Dr.S.Balasubramanian, MPT,PhD

Standardized 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.

Dr.S.Balasubramanian, MPT,PhD

3/23/2012

Stroop 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 certain that the patient is able to read
Dr.S.Balasubramanian, MPT,PhD

Stroop Color & Word Test


In the second test sheet, four Xs are printed in different colors to make certain that he or she is able to identify all the colors utilized in the test. In the third stimulus page, columns of words are printed in different colors. The color in which the word is typed in never matches the word printed. The patient is asked to identify the color of word and to ignore the word that is printed.
Dr.S.Balasubramanian, MPT,PhD

Stroop Color & Word Test


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 ages 16 and 44 are provided

Bay Area Functional Performance Evaluation


Developed in 1977 and revised in1987 Assesses daily functional performance of patients with psychiatric diagnoses The psychiatric patients behaviour is quantified in how they relate to objects and to other people in their environment It comprises 2 subsets 1. The task oriented assessment 2. The social interaction scale
Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

Bay Area Functional Performance Evaluation


TOA 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

Bay Area Functional Performance Evaluation


The skills assessed through these 5 tasks include the cognitive skills of memory for instructions, organization of time and materials, attention span and ability to abstract. Performance components include the patients ability to complete the task, their efficiency and errors.

Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

3/23/2012

Bay Area Functional Performance Evaluation


The affective component includes motivation, frustration tolerance, a behavioural impression and selfconfidence. Patients are rated on a scale from 1 to 4 points, 1 being marked dysfunctional and 4 functional or appropriate.

Bay Area Functional Performance Evaluation


On the SIS, the clinician rates the behaviour of the patient in five specified social situations, ranging from one on one to an unstructured group. The components of social behaviour assessed include response to authority, verbal communication, psychomotor behaviour, ability to work with others in a group, social behaviour, group participation and independence. The patients are rated on a five-point rating scale
Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

Cognitive 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 Scale


The patient is rated on a five-point scale from 1(ability is very low) to 5 (ability is very 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.

Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

Dementia Rating Scale


It was designed to measure decline in neurologic, behavioural and cognitive functions. It is composed of 36 tasks with five subscales: a. Attention b. Initiation and perseveration c. Construction d. Conceptualization e. Memory
Dr.S.Balasubramanian, MPT,PhD

Dementia 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 each subscale are given credit for the reminder tasks in the subscale and therefore do not need to complete them. Total possible score is 144. A score of 123 is cutoff score. Norms are based on healthy persons aged 65 to 81.
Dr.S.Balasubramanian, MPT,PhD

3/23/2012

Severe Impairment Battery


Developed to assess cognitive skills in patients who are unable to complete standard neuropsychological tests. The tasks provided were taken from a wide variety of low-level tasks that address the behavioural and cognitive deficits. There are 57 questions, with a total score of 0 to 133 points.
Dr.S.Balasubramanian, MPT,PhD

Severe 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.
Dr.S.Balasubramanian, MPT,PhD

Neurobehavioural Cognitive Status Examination


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 which consists of areas of level of consciousness, orientation, attention, language, visual construction, visual memory, calculation and verbal reasoning.
Dr.S.Balasubramanian, MPT,PhD

Neurobehavioural Cognitive Status Examination


There is also process section in which information related to clinical observations 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.

Dr.S.Balasubramanian, MPT,PhD

Neurobehavioural Cognitive Status Examination


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.

Orientation
Orientation generally encompasses the knowledge of person, place, time and situation. It is an integration of attention, memory and perception. Orientation to person includes an awareness of self - i.e. knowing who you are and having information about yourself, including social role.
Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

3/23/2012

Orientation
Orientation to place allows a person to have knowledge of where he or she is and how he or she may move about in the environment. Temporal orientation is broken down into several areas, including awareness of public time (clocks, calendars) cued time (time of day, the seasons).

Assessment 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 Cognitive Assessment
Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

Cognitive Assessment of Minnesota


It was developed by a Occupational therapist to assess a broad range of cognitive 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 toothbrush
Dr.S.Balasubramanian, MPT,PhD

Cognitive Assessment of Minnesota


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, math skills, foresight, planning, safety, judgement, concrete problem solving and abstract reasoning.
Dr.S.Balasubramanian, MPT,PhD

Cognitive Assessment of Minnesota


This test appropriate for patients with CVA Not appropriate for patients with severe perceptual deficits, visual acuity deficits and aphasia Scores range from no impairment to severe impairment Norms were developed from 18 years to 70 years
Dr.S.Balasubramanian, MPT,PhD

Short Portable Mental Status Questionnaire


It was developed in 1975 to provide a short, easily scored assessment of cognitive functioning It consists of 10 items, including orientation, current events and serial mathematic calculations As with other mental status examinations, it does not assess visuospatial skills, constructional skills and abstraction
Dr.S.Balasubramanian, MPT,PhD

3/23/2012

Short Portable Mental Status Questionnaire


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 Exam


It was devised in 1975 It was developed to be used with psychiatric, neurologic and general medical patients The assessment is not timed It assesses orientation, the ability to follow verbal and written directions, attention, recall, language, reading, writing and copying.
Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

MiniMini- Mental 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 of Mental State


It was developed to screen for global impairment of cognitive skills in the elderly It is intended to show whether any areas of the brain are not functioning as effectively as possible and whether these problems need further investigation The subtests include orientation, memory, comprehension, verbal fluency, arithmetic, perceptual functions and motor perseveration
Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

Middlesex Elderly Assessment of Mental State


The test takes approximately 10 minutes to administer and score The maximum score possible is 12 Scores of 8 or 9 suggest borderline performance and scores of 7 or below indicate that a more detailed assessment is needed

Loewenstein Occupational Therapy Cognitive Assessment


It comprises of 20 subtests in 4 areas: orientation, perception, visuomotor organization and thinking operations It was developed in 1974 It takes about 45 minutes It was normed on 55 adult subjects aged 20 to 70 and 240 children aged 6 to 12 In addition to the standard procedure, it contains a procedure for patients with aphasia
Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

3/23/2012

Memory

Subdivisions of the Temporal Cortex


The temporal lobe comprises all the tissues that lie below the sylvian fissure and anterior to the occipital and parietal cortex. Lateral surface of temporal lobe can be divided into auditory (41,42 and 22) and ventral visual stream (20,21 and 37). The visual regions are referred to as infero-temporal cortex.
Dr.S.Balasubramanian, MPT,PhD

To understand about memory the knowledge about anatomy of the temporal lobes is imperative.

Dr.S.Balasubramanian, MPT,PhD

Subdivisions of the Temporal Cortex


The sylvian fissure contains insula which includes gustatory cortex as well as auditory 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 temporal cortex


Afferent projections are from the sensory systems and efferent projections to the parietal 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.
Dr.S.Balasubramanian, MPT,PhD

Connections of the temporal cortex


b. The second is a series of parallel projections from the visual and auditory association areas into the polymodal regions of the superior temporal sulcus. c. The third is a projection from the auditory and visual association areas into the medial temporal regions. d. Finally, the fourth is a series of parallel projections from the association areas to the frontal lobe.
Dr.S.Balasubramanian, MPT,PhD

Temporal lobe Functions


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.
1.

Dr.S.Balasubramanian, MPT,PhD

3/23/2012

Temporal lobe Functions


The frontal lobe projection is for various aspects of movement control, shortterm memory and affect. 5. Cross modal matching: The process of matching visual and auditory information which is done by superior temporal sulcus.
4.

Symptoms of temporal lobe lesions


Disturbance of auditory sensation and perception 2. Disturbance of visual perception 3. Disturbance of selective attention of auditory and visual input. 4. Impaired organization and categorization of verbal material
1.
Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

Symptoms of temporal lobe lesions


5. Disturbance of language comprehension 6. Impaired long term memory 7. Altered personality and affective behaviour 8. Altered sexual behaviour

Memory - Definition
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.

Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

Memory Problems
Amnesia is a word often used to describe memory deficits. Retrograde amnesia is difficulty in remembering events that took place before the onset of amnesia. This is usually in relation to events that took place more recent to the onset of amnesia.

Memory Problems
Antegrade amnesia is difficulty learning and remembering new information since the onset of amnesia. Lesions of the left temporal lobe result in impaired recall of verbal material, such as short stories and word lists, whether presented visually or orally. Lesions of the right temporal lobe result in impaired recall of non-verbal material, such as geometric designs, faces and tunes.
Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

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3/23/2012

Assessment of Memory
Sl. Test No. 1. Autobiographical Memory Interview Contextual Memory test Continuous visual memory test Doors and People Component Assessed Personal, Retrograde memory

Autobiographical Interview
AMI is an assessment of a patients remote personal memory, which may be affected 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.

2. 3. 4.

Recall and meta-memory Visual memory Recall and recognition, Visual and auditory, delayed memory Visual memory Recall and recognition, visual and auditory, functional tasks
Dr.S.Balasubramanian, MPT,PhD

5. 6.

Rey complex figure test Rivermead Behavioural Memory test

Dr.S.Balasubramanian, MPT,PhD

Autobiographical 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 psychiatric disorders.

Contextual 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

Dr.S.Balasubramanian, MPT,PhD

Contextual Memory test


This is a manual test which consists of 2 large presentation cards, 40 recognition cards and a scoring booklet. First, the patient is presented with a card on which are 20 line drawings. He is asked to study the card and try to remember as many items as possible. In the second part of the test, the patient is provided with the context in which the pictures are related.
Dr.S.Balasubramanian, MPT,PhD

Contextual Memory test


The patient is asked to recall items from each part of the test. If he is unable to recall, recognition cards may be used. Delayed recall may also be assessed after approximately 20 minutes. Prior to the presentation of the recognition card, the patient is asked a series of questions about his perception of memory and awareness of strategies utilized to remember.
Dr.S.Balasubramanian, MPT,PhD

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3/23/2012

Contextual Memory test


Recall scores (Immediate, delayed, total) Awareness score (prediction, estimation, a response to general questioning in which point values are assigned to some of the responses). Strategy used (the effect of context, total strategy score, order of recall)

Doors and People


The test was designed to assess visual and verbal memory through recall and recognition. This consists of 4 people photographs, 12 door photographs and 4 simple drawings (shapes).

Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

Continuous 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 recognition memory by asking the patient to discriminate between new and repeated stimuli of complex designs.
Dr.S.Balasubramanian, MPT,PhD

Continuous visual memory test


This is repeated in the delayed recognition task. In the visual discrimination task, patient is asked to perceive and discriminate among stimuli so that visual discrimination deficits can be distinguished from visual memory deficits. The test consists of 137 stimulus cards and a scoring form. 45 50 minutes to perform. Norms available on persons from 18 to 91 years.
Dr.S.Balasubramanian, MPT,PhD

Rey complex figure test


Was first devised by Rey in 1941 to investigate perceptional organization , visual spatial constructional ability and visual memory. It also assesses several other cognitive processes, including organization and problem solving. The test consists of a 16 page test booklet to cover the copy, immediate recall, delayed recall and recognition subtests.
Dr.S.Balasubramanian, MPT,PhD

Rey 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, after a 3 minute recall from which he or she must identify aspects recognized from the complex figure.

Dr.S.Balasubramanian, MPT,PhD

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Rivermead Behavioural Memory test


It was developed to assess problems with everyday memory and to provide a monitor for changes in memory with intervention. Subtests include recall of name and appointment, recognition of faces and objects recently seen, remembering a route, remembering a story and recognition.
Dr.S.Balasubramanian, MPT,PhD

Rivermead Behavioural Memory 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 various levels of impairment.

Dr.S.Balasubramanian, MPT,PhD

Rivermead Behavioural Memory test


The score can be adjusted for aphasic patients with the verbal sections deleted from 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

Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

Executive functioning
Definition: Higher level cognitive skill group that includes goal setting, organization, self monitoring (or reasoning), problem solving, decision making, divergent thinking (abstract thinking) and judgment.

Problem solving
Problem solving includes the abilities to recognize errors, generate solutions, select and implement a solution and judge the effectiveness of the solution implemented.

Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

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organization
Organization is the ability to sequence and plan occupations by deducing the relationship between objects.

Judgment
Judgment is the ability to anticipate consequences

Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

Decision making
Decision making is the ability to select appropriate response by inhibiting the other unwanted responses. Prefrontal cortex is primarily responsible for these executive functions.

Neuroanatomy
Anterior to the primary motor cortex lies SMA on the medial aspect and Premotor area on the lateral surface (area 6). Anterior to these areas lie frontal eye field area (area 8 and 8 A) on the lateral aspect and Brocas area on the medial aspect (area 44). Anterior to these areas lie prefrontal cortex on the dorsolateral aspect (area 9 and 46) and orbital on the venteromedial aspect (area 47).
Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

Neurophysiology
The motor cortex is responsible for making movements. The premotor cortex selects movements. The prefrontal cortex controls the cognitive processes so that appropriate movements are selected at the correct time and place. This selection is controlled by internal record of (old experiences) existing sensory information.
Dr.S.Balasubramanian, MPT,PhD

Neurophysiology
Control of fine movements: Area 4 2. Movement programming: Premotor and dorsolateral area 3. Movement repetitions: Premotor 4. Movement sequences: SMA
1.

Dr.S.Balasubramanian, MPT,PhD

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Neurophysiology
5. Voluntary eye gaze: Frontal eye field area 6. Speech (motor): Brocas area 7. Divergent thinking: Orbital 8. Social behaviour, sexual behaviour, mood or affect, olfactory discrimination: Orbital area 9. Problem solving, decision making, goal setting, reasoning (self monitoring), judgment, temporal memory, organization and associative learning: Dorsolateral prefrontal area.
Dr.S.Balasubramanian, MPT,PhD

Assessment
Many of the executive functions can be assessed through observation of the patient during functional occupations. Apart from the standardized tests, there are some informal assessments and sequencing cards. The examiner should know whether the patient is aware of planning problems, how many steps in an occupation he or she is able to sequence and how he or she handles change, and whether he or she is able to problem solve.
Dr.S.Balasubramanian, MPT,PhD

Sl. No 1.

Test

Component Assessed

Sl. No. 5.

Test

Component Assessed

2.

Allen Cognitive Level Test Ability to learn new information Allen Cognitive Level Test Problem solving and Problem solving ability to learn new information Bay Area Functional Performance Evaluation Cognitive Assessment of Minnesota Ability to abstract and ability to delete errors Following directions, foresight an d planning, concrete problem solving, abstract thinking Dr.S.Balasubramanian, MPT,PhD

Cognitive Behaviour Rating scale Cognitive Performance Test Mini mental State Exam Neurobehavioural Cognitive State Examination

Abstract thinking Information Processing Following directions Reasoning

6.

7.

3.

8.

4.

Dr.S.Balasubramanian, MPT,PhD

Allen Cognitive Level Test


Sl. No. 9. Test Component Assessed

10.

Rey Complex Figure test Short Category Test Wisconsin card sorting Test Ravens Progressive Matrices

11.

Organization and Problem solving Problem solving and abstract thinking Abstract thinking, problem solving, the ability to shift cognitive strategies Ability to formulate constructs
Dr.S.Balasubramanian, MPT,PhD

12.

Developed in 1973 Quick assessment of a patient's ability to perform visuomotor tasks. The patient is asked to perform several different types of stitches on a leather lacing sample, including a running stitch, whip stitch and single cordovan stitch. The test utilizes a 5 point scale and measures patients abilities in levels 2 through 6
Dr.S.Balasubramanian, MPT,PhD

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Allen Cognitive Level Test Problem solving


Developed in 1991 Assesses more specifically the skills of deduction, planning and problem solving The examiner asks the patient to replicate the lacing stitches by first looking at the completed stitches If the patient is unable to do the stitches by looking at them, then verbal instructions are given and then demonstration may be provided
Dr.S.Balasubramanian, MPT,PhD

Cognitive Performance Test


Developed to assess the functional level of patients with Alzheimers disease and is in a standardized ADL format It utilizes Allens cognitive levels, with the focus of the assessment being on the information processing deficits in common functional occupations The assessment utilizes the ADL tasks of dressing, shopping, making toast, using the telephone washing and travelling.
Dr.S.Balasubramanian, MPT,PhD

Short Category Test


Example of a test item is the patient is asked to choose what he or she would wear 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 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 concept formation and deal with situations in everyday life

Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

Wisconsin 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 the environment 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
Dr.S.Balasubramanian, MPT,PhD

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

Dr.S.Balasubramanian, MPT,PhD

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Ravens 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.
Dr.S.Balasubramanian, MPT,PhD

APM has 48 problems an dis more complex than the SPM This is beneficial in assessing patients judgement SPM was designed to assess a wide range of mental abilities without influence of educational, cultural and physical abilities.

Dr.S.Balasubramanian, MPT,PhD

Components of a sound-based soundLanguage


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)

Language

Dr.S.Balasubramanian, MPT,PhD

Dr.S.Balasubramanian, MPT,PhD

Components of a sound-based soundLanguage


Lexicon: The collection of all words in a given language Semantics: The meanings that correspond to all lexical items and all possible sentences Prosody: The vocal intonation that can modify the literal meaning of words and sentences. Discourse: The linking sentences such that they constitute a narration
Dr.S.Balasubramanian, MPT,PhD

Aphasia

It refers to a disorder of language apparent in speech, writing (agraphia) or reading (alexia).

Dr.S.Balasubramanian, MPT,PhD

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Fluent (Sensory) aphasia


Sl. No. 1. Aphasia Type of speech production Type of Language errors

Fluent (Sensory) aphasia


Sl. No. Aphasia Type of Speech production Type of Language errors

Wernickies aphasia (sensory aphasia)

2.

Fluent Speech Anomias or without articulatory paraphasias, disorders poor comprehension, poor repetition Paraphasia, poor Transcortical Fluent speech sensory without articulatory comprehension, anomia aphasia disorders, good (isolation repetition, can syndrome) repeat and understand but cannot speak spontaneously Dr.S.Balasubramanian, MPT,PhD

3.

Conduction aphasia

4.

Anomic apahasia

Fluent Poor speech, can repetition, name objects, fairly good understand comprehensi speech, but on they cannot repeat words Fluent Anomia, speech with difficulties in articulatory finding nouns disorders Dr.S.Balasubramanian, MPT,PhD

Non Fluent (Motor) aphasia


Sl. No. 1. Aphasia Type of speech production Type of language errors

Non Fluent (Motor) aphasia


Sl. No. Aphasia Type of speech production Type of language errors

Brocas aphasia

Non-fluent, laborious articulation

Speechlessness with recurring utterances, or syndrome of phonetic disintegration, poor repetition

3.

Global aphasia

Laborious articulation

Speechlessness with recurring utterances, poor comprehension, poor repetition

2.

Transcortical Non-fluent, but Uncompleted motor good repetition sentences and apahsia anomias, but naming is better than spontaneous speech
Dr.S.Balasubramanian, MPT,PhD Dr.S.Balasubramanian, MPT,PhD

Pure aphasia
Sl. No. 1. Aphasia Type of speech production Type of language errors

Aphasia Test Batteries


Boston Diagnostic Aphasia Test 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
1. 2.
Dr.S.Balasubramanian, MPT,PhD

Alexia without agraphia Agraphia Word deafness

Normal

Poor reading

2.

Normal Normal

Poor writing Poor comprehension and poor repetition


Dr.S.Balasubramanian, MPT,PhD

3.

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3/23/2012

Aphasia Screening Tests


Halstead Wepman Aphasia Screening Test 2. Token Test
1.

Dr.S.Balasubramanian, MPT,PhD

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