Stories of Neuro-Psychological Assess of Voices with Brain Injury
The following are stories of real life survivors of brain injury. Clicking on the titles will take you to their actual story.
So in that period of time in between three weeks and three months, the only treatment you were getting when you weren’t an in -patient was this marital counseling?: “Marital counseling and then until I got my neuropsychological evaluation. That’s when they came up with the cognitive rehab plan.” When was the neuropsych done?: “I did it in February and I got my results the beginning of April.” That’s a long time to wait for diagnosis.: “It is, yep.”
While its value in a Mild TBI is a bit more suspect, core to evaluating deficits and areas that need further therapy after a severe brain injury is an assessment by a neuropsychologist. Neuropsychologists are not medical doctors, but doctors of psychology who have completed intensive post doctoral work in brain function and pathology. You’™ve had a neuropsych evaluation. Your first one was when?: “January of ’06.” What were the findings?: “There were several categories of neurocognitive deficits and short-term memory. They do a lot of different types of tests, the Wais III the MMPI-2 and they did puzzles where they blindfold you and you have to take like a round piece of wood and then on a board find the round spot and then place in there.” When asked if he were to tell someone what to expect regarding the neuro-psychological testing he responded with: “I would tell them to make sure that it’™s a full-day test. We actually had somebody on our team HI-Level Facebook site recently say that they were going to get some neuropsychological testing and then go (after) and get their shunt checked. I said I’™ve done seven neuropsych evaluations and not one of them was less than a day. Most of them are a day and a half. So she came back and said you’re right, they only did the MMPI-2 which is more of a litigation play toy for lawyers and nurse case managers or whoever, insurance companies.
The first major step towards recovery for Helena was the neuropsychologist. She explains: “That was a very, very good experience. He spent time with me beforehand. I went through this four or five hours over two days of testing, and then he, after they’d done all the correcting, then he sat down with me again and gave me the evaluation of what, where he thought I was.I couldn’t do pictures of little squares and triangles in one place, and then you’re supposed to tell the difference between the first one and the second one, and I just couldn’t work that out, and I also couldn’t, I couldn’t, so any of those visual things. (The testing did make her nauseous.)There was a lot of focus and concentration. I had to take a half-hour nap in the middle of it all, because that concentration of energy and focus was probably one of the biggest things that happened to me in the course of my rehab, was that, you know, I’d work for an hour and I’d have to sleep for two hours.”
When asked; “Has the neuropsychologist explained anything to you about where the location of your injuries were, with respect to the things you could continue to do and those things that you couldn’t?” She responds with: “Because it was on the right side and it was this occipital â€“parietal thing, I tried to do a lot of research about what does that happen and what does it mean when it’s on the right side, and he said that, that the, that the deficits would be in language, in concentration, in trying to work out puzzles, and also trying to go, I could not go at the speed that I had.”
Neuropsychology is the field of psychology that primarily assesses brain dysfunction. One of the fundamental tools that neuropsychologists use for this assessment is the administration of a battery of primarily pen and paper tests, to determine strengths and weaknesses of a particular person. Included in these batteries are traditional tests of IQ along with many measures that test the performance of the brain beyond just thinking and cognitive tasks. A neuropsychomotrist is the assistant to the neuropsychologist, the person who administers these tests.
We don’t see a lot of survivors who got neuropsychological therapy, so tell us about your neuropsych therapy.: “That’s probably what helped me the best. I still, 26 plus years after, I try to contact my neuropsych once a year, just socially and say hi. I send him Christmas cards. I know when I started it, I didn’t trust him, and I was afraid that the neuropsych was to evaluate me if I needed to go to an asylum or not. nd it took a while, a month, and then I started realizing that my neuropsychologist was on my side and that he was doing everything he could to help me.And I could actually make lists with my neuropsychologist and say, this is where I want to be, this is what I want to do, and he’d help me, help guide me. I don’t know how to describe what he did. Maybe he helped me find, he helped me, he helped me find avenues that I could go into, to reach the goals that I wanted, maybe? So in the beginning with neuropsychology, I don’t remember. I know that at one point and that I could review them, review my journals at any time to see what I had done right and wrong in the past. I kept those journals for almost 20 years and that’s how I created my book.
Tell me about the neuropsych assessment he did? : “He actually took her into a room with an associate do all the testing. And then Dr. Theye sat with us and he interviewed her first which was really cute because he likes riddles, and he asked her about some riddles. And she understood some of the jokes a little bit if they’re point-blank obvious and some of them she was going on and it was just, like, duh. You know, you could’ve, we just couldn’t believe that we didn’t figure this out for yourself.”
Among the problems in relying on neuropsych testing to identify executive functioning problems is that the testing is done in a laboratory, where distractions, stress and choices have to be made. Yet, it is the ability to function as an adult in face of the real world challenges that defines whether the brains â€œ chief executiveâ€ is working. Thus, almost all neuropsychological testing is said to lack â€œecological validity.â€ It is for this reason that the best neuropsychologists use the test results as only the framework for an assessment, which should be based upon the changes the brain injured survivor is having in the real world. The best way to assess those changes is through clinical interviews, of the injured person, but most importantly his or her spouse, parents, co-workers.
Has she had a neuropsychological evaluation?: “No, no.” Has she not recovered enough to make that meaningful?: “I don’t know that much about them so I can’t say.” Nobody’s suggested it or nobody’s going to pay for it?: “We’re by ourselves. We have nobody. We don’t have a doctor. We have nobody, you know, it’s just me basically.”
Let’s take that apart. First why do you think it’s too much to give to someone during a neuropsychological evaluation?: “They should probably in most every instance be broken up into a few like sessions, a couple sessions because it’s already really hard to process smaller amounts of information correctly and then when you dump a ton of information even a regular person it’s going to be kind of hard. Then if you have any kind of cognitive deficits it’s going to be a million times worse.”