Brain Injury Testing

by Gary E. Dudley, Ph.D.

NEUROPSYCHOLOGY: Assessment of Brain Impairment as a Result of Injury

Neuropsychology has been organized into a distinct discipline in relatively recent years. However, research and practice in neuropsychology in the United States dates from the late 1940's and 1950's, with the pioneering work of Steryl Halstead and Ralph Reitan at the University of Indiana Medical School.

Neuropsychology is concerned with the measurement of brain/behavior relationships and treatment of the myriad of factors which lead to impaired brain/behavior relationships, such as trauma, toxicity and cerebral-vascular accidents (CVA, i.e. stroke). Through the work of Halstead and Reitan, the Halstead-Reitan Neuropsychological Test Battery was developed. This is a global and comprehensive battery of behavioral test procedures which seeks to quantify the relative efficiency with which individuals respond to test procedures which assess language, learning, cognitive flexibility, visual-spatial analysis, and a wide range of sensory and motor functions.

Our work in the area of neuropsychology is primarily involved with the assessment of specific cognitive functions as well as functional impairment. Referrals for neuropsychological testing are usually made by other health professionals, the State Workers' Compensation Bureau, attorneys and physicians. Our goal is to establish the degree of impairment of behavioral functions which are directly mediated by and dependent upon the integrity of the cerebrum. In so doing, we help to outline the initial steps in rehabilitation following acute CVA, head trauma, anoxia, or neurotoxicity.

One of the most complicated aspects of neuropsychological assessment has to do with the fact that rarely is there any information available about previous (premorbid) levels of neuropsychological functioning. This becomes an issue when the referral question is involved with an effort to establish loss of function following a specific trauma or neurological insult. The most frequent example of this is the effect of head trauma following a motor vehicle accident. Under ideal conditions, individuals would have previously had the assessment procedures administered in order to establish (premorbid) baseline levels of function, which could later be used in a comparison to post-trauma data.
However, because neuropsychological test procedures are time consuming, very rigorous and costly, premorbid data are rarely available. Over the past fifteen years, AAPA has offered to professionals (persons who are highly dependent on the integrity and high level of function of their capacities for complex mental processing, e.g., doctors, lawyers, accountants, and other professionals) the opportunity to undergo test procedures for the purposes of documenting their efficient and highly developed levels of neuropsychological functions. These data establish a baseline regarding their abilities and levels of function, which serves as a kind of "insurance" that intellectual and neuropsychological impairment following a trauma can be compared to data from identical test procedures administered prior to any evidence of trauma.

In the fifteen to twenty years that we have been providing neuropsychological assessment services, the most frustrating question we hear on the witness stand has been, "But Dr. Dudley, do you have an assessment using these identical procedures before this individual claims to have been injured?" When premorbid data are on file in our archives, it is most helpful to make direct comparisons with current data in the effort to establish a loss of function.