Compare and Contrast the Various Methods of Investigation Employed

By Neuropsychologists.

Student: Alan Cummins Student ID: 1165236

Course: BA Psychology

Module: Physiological Psychology PSY185

Lecturer: Dr. Lee Richardson

There is a wealth of techniques used in the investigation of neurological problems.

None however are universal or can give a complete picture in relation to the medical

condition being diagnosed. Neuropsychologists rely on a wide range of techniques used

in conjunction with each other to form an understanding of the issues for a given patient.

Many diseases such as epilepsy, movement disorders and spinal cord disorders stem from

abnormalities in the brain. The neuropsychologist along with other clinicians must

ascertain the possible primary causes and solutions to ease the patient suffering. Many

factors are involved in determining the correct investigation technique ranging from

previous history, suitability of patient for the technique, cost and availability of the

research facilities. This essay will discuss some of the various techniques used in

neurophysiology ranging from those involving neural imaging through to

neuropsychological assessment.

Primary investigations made by neuropsychologists typically involve an

assessment of the history of the patient. Pertinent issues such as mental state of the

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patient, pattern of sleep, difficulties in speech and writing, previous illnesses, social and

family history are all addressed in order to guide the neuropsychologist in determining

both the right method of treatment but also in selection of the correct method of

investigation. Clinical examination is a secondary method of investigation that is

undertaken. This pertains to sensory modalities (tactile, kinaesthetic, visual and auditory),

motor strength, speed, and dexterity, memory, concentration and general alertness and

emotional well-being among a large selection of primary investigation methods. Once the

background to the case and the current overall mental and physical health of the patient

has been ascertained specific relevant and valuable neuropsychological tests can be

carried out.

There is a large range of tests available for the prognosis and assessment of a

patient’s neurological problem. These techniques are used to describe and identify any

changes in psychological functioning, most importantly in determining whether the

changes are related to neurological disease, psychiatric conditions or non-neurological

conditions, formulating and developing a prognosis and providing a workable

rehabilitation plan that works for both the patient and their care-givers. Only through

measurement of the decline or incline of the associated symptoms can the

neuropsychologist determine whether significant brain injury has occurred and if aid is

required or successful once underway. Several different batteries of tests are used to

measure many of the modalities as listed above. These include the HRB (Halstead-Reitan

Battery), LNNB (Luria-Nebraska neuropsychological battery), Hayling and Brixton

Tests, Del-Kaplan Test Batteries, the WAIS (Weshsler Adult Intelligent Scale, for

varying age groups) and combinations thereof as can be seen in the Boston process

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approach. All these tests measure scientifically the nature of any problematic functional

damage in the brain and make a comparison against a large set of previous subjects drawn

from the population. Areas such as reading, writing, mathematical skill, memory, tactile

and intellectual are all tested to cover the main cognitive processes of the brain. The

manner in which they can be compared and contrasted to the general population and also

importantly to patients with previous neurological issues however differs. HRB and

LNNB can be used to compare against a standard, whereas the Boston approach produces

results that are difficult to compare against normals. Patient suitability is an important

factor in these tests as they require the attention and focus of the patient involved. HRB

can be long and tedious for some patients (young, elderly or those generally with short

attention span) whereas LNNB is relatively speaking brief. The Boston approach battery

and LNNB can be tailored and made relevant to the problem at hand while it is more

difficult in relation to the HRB. Essentially it is difficult to tie results to the real world i.e.

how do the results carry into regular daily functioning. These tests all suffer from cultural

and bilingual skew. As most of these investigation techniques were formed under the

western tradition further work is required in order to ensure that the comparative

sampling of the population is widened to include all possible cases. Similarly further data

is required from both young and old patients to allow for comparative study. Statistical

techniques for data interpretation play a vital role in the validity and uses of all the

techniques mentioned and as such vary in terms of difficulty of application. LNNB

requires a trained technician whereas HRB or Kaplan test makes less demands of the

tester. Such batteries of test still have relevance and are used alongside more recently

introduced techniques of brain imaging.

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 Alongside the techniques used above brain scanning techniques are common in

investigating and assessing brain injuries. All involve the use of high resolution imaging

techniques but differ in the granularity and specificity of their results. Measurement and

monitoring techniques such as Electroencephalography (EEG), Electromyography

(EMG) and Auditory Brainstem Response (ABR) are used to measure

electrophysiological patterns of the brain as a form of intra-operative neurophysiology

monitoring but can also be used in determining neural damage in relation to many areas

including as part of polysomnography in studying sleep or. Alongside these monitoring

techniques visualisation of brain structures plays a vital role. Some of the many

techniques include traditional X-ray, angiography (visualisation of blood vessel flow with

the use of contrast media), computer aided tomography (CAT), radioactive imaging

techniques, advancing angiography, such as single photon emission tomography (SPECT)

and positron emission tomography (PET), visualisation techniques involving magnetic

resonance (MRI), fluorescent magnetic resonance imaging (fMRI),

magnetoencephalography (MEG) and newer techniques such as diffuse optical imaging

(DOT) and hemoencephalography (HEG) which use infrared light and measurement of

absorption. Techniques such as X-ray, angiography, CAT and MRI give increasingly

high resolution imagery of the structure of the brain with MRI being the most flexible in

its ability to take cross-sectional images in any plane. However it is often necessary to

measure and track the brain as it works. EEG, PET, SPECT, fMRI and MEG all watch

for increases in various measurable brain activity whether that be electrical, oxygen /

glucose metabolism, blood flow or neural activity respectively. For example MEG is

more flexible than EEG for measurement of brain activity in that it doesn’t depend on

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head geometry to record a valid dataset. Also EEG is not sensitive enough to pick up on

specific areas as compared to fMRI or MEG. The techniques required to measure cause

problems for some of the methods listed, PET, for example, dues to its use of radiation

doses that have short half-lives requires careful planning and recalibration of the

machines involved as the dose reduces in strength. Angiograms are somewhat invasive

and involve considerable discomfort to the patient, X-rays are a health-risk to pregnant

women and techniques involving MRI are of danger to those with pacemakers or metallic

implants, CAT scans involve use of X-rays and therefore has inherent risks associated

with radiation so should be used sparingly while PET (it has relatively low doses of

radiation as compared to X-ray, CT and general background radiation) and EEG are non-

invasive and safe for a wide cross-section of society. Each method has extrinsic factors

that may make them unsuitable for a patient including those who suffer from

claustrophobia which makes MRI extremely uncomfortable. Each method makes use of

differing chemical and structural properties of the brain to measure visual functioning and

structure. A combination of the cost, availability, resolution of image required either

spatially or temporally, form or function of the brain under investigation and state of the

patient is used in determining the most suitably informative method of investigation.

These methods of investigation all produce images of brain function or structure and most

recently have been used in a multi-modal way to provide a clear picture of the

functioning of the brain. MRI, fMRI and MEG are a good example of this multi-modal

approach. MRI measures structure, fMRI overlays brain activity on this structure and

MEG can give a fine-grained indication of which part of the brain is currently active.

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 As has been discussed there is a wide range of techniques available for use by

the modern neuropsychologist. A combination of techniques allows for the best

assessment of the patients needs and for the scientific understanding of the human mind

and its relationship to specific cognitive processes and behaviours. Patients require

assessment, prognosis and a plan of action to improve, whether that is via intrusive

medical, medicinal or psychological solutions.

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