28 Neuropsychological Assessment.pdf - PRINTED BY Abigail Garces <[email protected]> Printing is for personal private use only No part of this book may be

28 Neuropsychological Assessment.pdf - PRINTED BY Abigail...

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PRINTED BY: Abigail Garces <[email protected]>. Printing is for personal, private use only. No part of this book may be reproduced or transmitted without publisher's prior permission. Violators will be prosecuted. 28 28 Neuropsychological Neuropsychological Assessment Assessment PORTRAIT Lingering Effects of Brain Trauma Driving home from work one afternoon, R.L., a 32-year-old nurse and mother of four, stopped at a red light. The vehicle traveling behind rear-ended her car. R.L.’s head snapped back and struck the headrest, then the side window as she bounced forward. She blacked out for a few minutes, but by the time the emergency vehi cles arrived, she was conscious—albeit disoriented and dysphasic—and experi encing severe pain in her back and neck from the whiplash. Several vertebrae were damaged. R.L. spent about a week in the hospital. Neither a CT nor an MRI scan identi fied any cerebral injury. Nonetheless, evidence of closed-head trauma (dia grammed in Figure 26.4 ) was abundant. An accomplished musician, R.L. could still play the piano well from memory, but she could no longer read music. Her oral lan guage skills remained impaired, and she was completely unable to read. R.L.’s difficulties did not abate, and she had spells of apraxia. For example, she often found herself unable to figure out how to put on her makeup; she would stare at her lipstick with no idea how to use it. When she came to us a year after the ac cident, R.L. was depressed because the neurologists could find no reason for her continuing impairments. As described in Section 16.3 , perhaps the most commonly observed trait of frontal-lobe patients is difficulty in using environmental feedback to regulate or change their behavior. One manifestation is response inhibition:, patients with frontal-lobe lesions consistently perseverate on responses in various test situa tions, particularly those in which the solution demands change. The Wisconsin Card-Sorting Test exemplifies the predicament of a patient with frontal damage. A subject is given a deck of cards containing multiple copies of those represent ed here. Presented with a row of four cards selected from among them, the sub
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PRINTED BY: Abigail Garces <[email protected]>. Printing is for personal, private use only. No part of this book may be reproduced or transmitted without publisher's prior permission. Violators will be prosecuted. 28.1 The Changing Face of Neu ropsychological Assessment Neuropsychological assessment is rooted in neurology and psychiatry. One of its pioneers was Kurt Goldstein, a clinician who was expert in neurology, psy- chology, and psychiatry. After World War II, Goldstein and others pushed the development of psychological assessments for neurological patients, and espe- cially returning veterans, leading to a divergence of psychological assessment from traditional medicine by the late 1940s. The first neuropsychological tests were designed to identify people with cerebral dysfunction attributable to or-
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