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NEUROPSYCHOLOGICAL TESTS PART- 1

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A SEMINAR ON NEUROPSYCHOLOGICAL TESTS.

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NEUROPSYCHOLOGICAL TESTS PART- 1

  1. 1. NEUROPSYCHOLOGICAL TESTS – PART - I BY DR. SUBRATA NASKAR MD Psychiatry Trainee DEPARTMENT OF PSYCHIATRY SILCHAR MEDICAL COLLEGE Email: nsubrata09@gmail.com
  2. 2. INTRODUCTION • PSYCHOLOGICAL TESTS ARE STANDARDIZED SCIENTIFIC TOOLS MEANT TO ASSESS VARIOUS PSYCHOLOGICAL CONSTRUCTS. • TO CONSIDER A MEASURE AS PSYCHOLOGICAL TEST, IT MUST HAVE THREE PROPERTIES. THESE ARE: 1. RELIABILITY: IT REFERS TO CONSISTENCY OF A MEASURE – HOW LIKELY IT IS TO PRODUCE THE SAME RESULTS IF USED AGAIN IN THE SAME CIRCUMSTANCES. 2. VALIDITY: IT REFERS TO THE ABILITY OF THE TEST TO MEASURE WHAT IT PURPORTS TO MEASURE. 3. NORM: THE TEST MUST HAVE A RANGE OF VALUES WITHIN WHICH MEMBERS OF A GIVEN POPULATION ARE EXPECTED TO PERFORM OR FUNCTION.
  3. 3. UTILITY OF PSYCHOLOGICAL TESTS IN CLINICAL PRACTICE • THEY ARE DEVISED AND USED PRIMARILY FOR DETERMINATION AND ANALYSIS OF INDIVIDUAL DIFFERENCES IN • - GENERAL INTELLIGENCE • - SPECIFIC APTITUDE • - EDUCATIONAL ACHIEVEMENT • - VOCATIONAL FITNESS • - NON INTELLECTUAL PERSONALITY TRAITS
  4. 4. TYPES OF PSYCHOLOGICAL TESTS • DEPENDING UPON THE TYPE OF STIMULUS, NUMBER OF SUBJECTS AND THE AREAS OF INVESTIGATION, PSYCHOLOGICAL TESTS ARE CLASSIFIED INTO VARIOUS TYPES: • OBJECTIVE • PROJECTIVE • INDIVIDUAL • GROUP
  5. 5. OBJECTIVE TEST • AN OBJECTIVE TEST IS A PSYCHOLOGICAL TEST THAT MEASURES AN INDIVIDUAL'S CHARACTERISTICS INDEPENDENT OF RATER BIAS OR THE EXAMINER'S OWN BELIEFS, USUALLY BY THE ADMINISTRATION OF A BANK OF QUESTIONS MARKED AND COMPARED AGAINST EXACTING SCORING MECHANISMS THAT ARE COMPLETELY STANDARDIZED.
  6. 6. REQUIREMENT FOR STANDARDIZATION • FREE FROM SUBJECTIVE JUDGEMENT • UNIFORM OR SPECIAL SET OF INSTRUCTION HAS TO BE THERE. • SAMPLE HAS TO BE SCIENTIFICALLY SELECTED FOR PARTICULAR TESTS • THE CONTENTS ARE TESTED AND RETESTED AND VARIOUS RESEARCHERS ARE INVOLVED
  7. 7. PROJECTIVE TEST • IT PROVIDES THE SUBJECT WITH A STIMULUS SITUATION WHICH GIVES THE PERSON AN OPPORTUNITY TO IMPOSE UPON IT HIS OWN PRIVATE NEEDS BASED ON PERCEPTION AND INTERPRETATION
  8. 8. INDIVIDUAL TEST • TESTS EMPLOYED TO MEASURE INDIVIDUAL CAPACITIES LIKE: • INTELLIGENCE • PERSONALITY • LEADERSHIP STYLE • COGNITIVE ABILITY • EMOTIONAL INTELLIGENCE
  9. 9. GROUP TESTS • USED TO TEST GROUP CHARACTERS AND ABILITY AS A WHOLE
  10. 10. APPROACHES TO NEUROPSYCHOLOGICAL TESTS • BATTERY APPROACH. • HYPOTHESIS TESTING APPROACH. • SCREENING APPROACHES.
  11. 11. BATTERY APPROACH • INCLUDES LARGE VARIETY OF TESTS. • ALL PARTS PRESENTED REGARDLESS OF PATIENTS PRESENTING COMPLAINTS. • ADVANTAGES: • IDENTIFIES PROBLEM THAT THE PATIENT MAY NOT COMPLAIN. • DISADVANTAGES: • TIME CONSUMING(6-8 HRS) • E.G - Halstead-Reitan Neuropsychological Test Battery (HRNTB)
  12. 12. HYPOTHESIS TESTING APPROACH • DETAILED EVALUATION OF AREAS RELATED TO PATIENTS COMPLAINTS. • RELATIVELY LESS EMPHASIS IS GIVEN ON ASPECTS OF FUNCTIONING THAT ARE LESS LIKELY TO BE IMPAIRED. • ILLUMINATES THE DIFFERENTIAL ROLE OF THE TWO HEMISPHERES. • ADVANTAGES: • DETAILED DESCRIPTION OF THE DEFICITS. • DISADVANTAGES: • OVERLOOKS UNEXPECTED AREAS OF DEFICITS. • E.G - Boston Process Approach
  13. 13. SCREENING APPROACHES • MORE FLEXIBLE AND EFFICIENT. • DRIVEN BY ECONOMIC FACTORS. • DETERMINES • WHETHER A DIAGNOSIS CAN BE MADE WITH LESS INFORMATION. • WHETHER ADDITIONAL TESTING IS NECESSARY IN ORDER TO IDENTIFY MORE SUBTLE PROBLEMS. • E.G - Repeatable Battery for the Assessment of Neuropsycholgoical Status (RBANS)
  14. 14. DOMAINS OF NEUROPSYCHOLOGICAL ASSESSMENTS • INTELLIGENCE TESTS. • TEST OF PERCEPTION. • LANGUAGE TESTS. • MEMORY TESTS. • VISUO SPACIAL TESTS • FRONTAL LOBE (EXECUTIVE FUNCTION TEST). • VIGILANCE TESTS. • PERSONALITY • POWER OF ABSTRACTION • MOTOR FUNCTIONS
  15. 15. TEST OF PERCEPTION
  16. 16. TESTS OF PERCEPTION • BENDER-GESTALT TEST (BENDER VISUAL MOTOR GESTALT TEST) • VISUAL OBJECT AND SPACE PERCEPTION BATTERY. • BEHAVIOURAL INATTENTION TEST.
  17. 17. BENDER VISUAL MOTOR GESTALT TEST
  18. 18. BENDER GESALT (VISUOMOTOR) TEST Lauretta Bender (1938) • AGE LIMIT • MEANINGFUL ABOVE 12 YRS OF AGE • <3YRS- UNABLE TO REPRODUCE ANY DESIGN • METHOD • THERE ARE 9 SEPARATE DESIGNS. • EACH DESIGN IN SEPARATE CARD WITH WHITE BACKGROUND. • PATIENT IS PRESENTED WITH UNLINED PAPER AND PENCIL • PATIENT IS ASKED TO COPY EACH DESIGN FROM THE CARD IN FRONT OF HIM • THERE IS NO TIME LIMIT. BENDER-II HAS GOT 16 FIGURES + RECALL PHASE
  19. 19. TEST MATERIALS: NINE SEPARATE DESIGNS, EACH PRINTED ON A WHITE BACKGROUND
  20. 20. • BASED ON THE GESTALT EFFECT DEVELOPED BY Kurt Koffka, Max Wertheimer, and Wolfgang Köhler • THE GESTALT EFFECT IS THE CAPABILITY OF OUR BRAIN TO GENERATE WHOLE FORMS, PARTICULARLY WITH RESPECT TO THE VISUAL RECOGNITION OF GLOBAL FIGURES INSTEAD OF JUST COLLECTIONS OF SIMPLER AND UNRELATED ELEMENTS (POINTS, LINES, CURVES...) • EVALUATION DEPENDS ON • FORM OF REPRODUCED FIGURES • RELATION TO ONE ANOTHER AND • TO THE WHOLE SPACIAL BACKGROUND.
  21. 21. INDICATION OF ABNORMALITY: 1. RELATIONSHIP OF DESIGN 2. DIFFICULTY IN ANGULATION 3. FAULTY AWARENESS OF PART WHOLE RELATIONSHIP 4. VARIABILITY IN LINE PRESSURE 5. FRAGMENTATION OR OVER SIMPLIFICATION OF FIGURE 6. CLOSURE PROBLEM 7. DISTORTION 8. OMISSION OF ESSENTIAL SEGMENTS OR ADDITION 9. PROGRESSIVE OR ISOLATED INCREASE OR DECREASE IN SIZE 10. PERSEVERATION
  22. 22. BENDER GESTALT PERFORMANCE BY A 10½- YEAR-OLD DYSLEXIC GIRL.
  23. 23. USES • TO DETECT • LEARNING DISABILITIES • MENTAL RETARDATION • SCREENING TEST FOR ORGANICITY • NEUROLOGICAL IMPAIRMENT • EMOTIONAL DISTURBANCES • MEMORY
  24. 24. VISUAL OBJECT AND SPACE PERCEPTION BATTERY
  25. 25. VISUAL OBJECT AND SPACE PERCEPTION BATTERY • PURPOSE: • THE VISUAL OBJECT AND SPACE PERCEPTION (VOSP) BATTERY IS DE-SIGNED TO EXPLORE OBJECT AND SPACE PERCEPTION. • AGE RANGE: • THE TEST CAN BE GIVEN TO INDIVIDUALS AGED 20 TO 84 YEARS. • THE VOSP (WARRINGTON & JAMES, 1991) IS A BATTERY OF EIGHT TASKS DEVELOPED TO TEST 2 THINGS: • OBJECT PERCEPTION • SPACE PERCEPTION
  26. 26. USE • USED TO ASSESS THOSE SKILLS FOR WHICH PATIENTS WITH RIGHT- HEMISPHERE DAMAGE DEMONSTRATE SELECTIVE DEFICITS. • TESTS 1 TO 4: • INCOMPLETE LETTERS, SILHOUETTES, OBJECT DECISION, AND PROGRESSIVE SILHOUETTES • TESTS 5 TO 8: • DOT COUNTING, POSITION DISCRIMINATION, NUMBER LOCATION, AND CUBE ANALYSIS. • IN ADDITION, ONE TEST OF VISUAL SHAPE DETECTION WAS INCLUDED TO ENSURE THAT PATIENTS HAVE ADEQUATE VISUAL-SENSORY CAPACITIES.
  27. 27. SHAPE DETECTION SCREENING TEST • THIS IS A TEST OF FIGURE GROUND PERCEPTION, USING 20 CARDS. • THE SUBJECT IS ASKED TO POINT OUT THE RANDOM PATTERN FIGURE THAT HAS A SPECKLED X SUPERIMPOSED IN THE MIDDLE OF THE PATTERN. • NUMBER OF CORRECT RESPONSES ARE SCORED. • PATIENTS SCORING <15 POINTS ON THIS SCREENING TASK SHOULD BE CONSIDERED INAPPROPRIATE FOR THE ADMINISTRATION OF THE VOSP.
  28. 28. TEST 1. INCOMPLETE LETTERS • THE INDIVIDUAL IS ASKED TO IDENTIFY BY NAMING OR TRACING 20 STIMULUS LETTERS DEGRADED BY 70% OR 30%. • THE TOTAL NUMBER OF CORRECT IDENTIFICATIONS IS COUNTED.
  29. 29. TEST 2. SILHOUETTES • THE SUBTEST CONSISTS OF 15 ANIMALS AND 15 COMMON OBJECTS PHOTOGRAPHED FROM AN UNUSUAL VIEW AND SHOWN ONLY AS DARK BLACK SILHOUETTES. • THE ITEMS ARE ARRANGED IN ORDER OF DIFFICULTY. • THE SCORE IS THE TOTAL NUMBER OF SILHOUETTES CORRECTLY IDENTIFIED.
  30. 30. TEST 3. OBJECT DECISION • EACH CARD SHOWS FOUR SILHOUETTES, CONTAINING THE SHAPE OF ONE REAL OBJECT AND THREE DISTRACTOR ITEMS (NONSENSE SHAPES). • THE EXAMINEE IS ASKED TO POINT OUT THE REAL ONE. • THE NUMBER OF CORRECT CHOICES (MAXIMUM = 20) IS RECORDED.
  31. 31. TEST 4. PROGRESSIVE SILHOUETTES • OBJECTS (HANDGUN AND TRUMPET) ARE SHOWN IN VARIOUS VIEWS AND PROGRESSIVELY MORE COMPLETE SHAPES. • EACH SERIES HAS 10 PROGRESSIVELY EASIER APPROXIMATIONS OF THE TARGET OBJECT. • SUBJECT IS ASKED TO IDENTIFY THE OBJECT. • THE NUMBER OF TRIALS ON EACH ITEM IS SCORED (MAXIMUM 10 + 10 = 20).
  32. 32. TEST 5. DOT COUNTING • THE 10 CARDS CONTAIN A NUMBER OF RANDOMLY ARRANGED BLACK DOTS. • THE INDIVIDUAL IS ASKED TO INDICATE HOW MANY DOTS THERE ARE. • THE NUMBER OF CORRECTLY IDENTIFIED CARDS IS SCORED (MAXIMUM = 10).
  33. 33. TEST 6. POSITION DISCRIMINATION • EACH OF 20 CARDS CONTAINS TWO SQUARE BOXES WITH A DOT IN THE CENTER. • ONE OF THE DOTS IS SLIGHTLY OFF-CENTER. • THE SUBJECT IS ASKED TO INDICATE THE DOT THAT IS EXACTLY IN THE CENTER OF THE BOX. • THE NUMBER OF CORRECT CHOICES IS SCORED (MAXIMUM = 20).
  34. 34. TEST 7. NUMBER LOCATION • EACH OF 10 CARDS CONTAINS TWO SQUARES. • THE UPPER SQUARE SHOWS RANDOMLY ARRANGED NUMBERS; THE LOWER SQUARE SHOWS ONE BLACK DOT. • THE INDIVIDUAL IS ASKED TO COMPARE THE TWO SQUARES AND INDICATE THE NUMBER ON THE UPPER BOX THAT CORRESPONDS TO THE POSITION OF THE DOT IN THE LOWER BOX. • THE NUMBER CORRECTLY LOCATED IS SCORED(MAXIMUM = 10).
  35. 35. TEST 8. CUBE ANALYSIS • EACH OF 10 CARDS CONTAINS THE OUTLINE DRAWING OF BRICKS. • THE SUBJECT IS ASKED HOW MANY “SOLID” BRICKS ARE SHOWN ON EACH CARD (I.E. NOT COUNTING “HIDDEN” BRICKS). • THE TOTAL NUMBER OF CORRECT COUNTS IS SCORED (MAXIMUM = 10).
  36. 36. BEHAVIOURAL INATTENTION TEST
  37. 37. • DEVELOPED BY WILSON ET AL. 1987 • EXAMINES UNILATERAL VISUAL NEGLECT. • TOTAL 15 SUBSETS. • 6 SUBSETS- TRADITIONAL PROCEDURES FOR EXAMINING FOR NEGLECT. • 9 SUBTESTS- IDENTIFIES EVERYDAY PROBLEMS THEREBY SERVING AS A GUIDE FOR REHABILITATION. • PICTURE SCANNING • MAP NAVIGATION, • TELEPHONE DIALLING • MENU READING • ARTICLE READING, • TELLING AND SETTING THE TIME ON A CLOCK FACE, • COIN SORTING • CARD SORTING, • ADDRESS AND SENTENCE COPYING .
  38. 38. ASSESSMENT OF EXECUTIVE FUNCTIONS
  39. 39. EXECUTIVE FUNCTION • EXECUTIVE FUNCTIONS ARE AN UMBRELLA TERM FOR A VARIOUS COGNITIVE PROCESSES AND SUBPROCESSES. • THE EXECUTIVE FUNCTIONS INCLUDE: • PROBLEM SOLVING • PLANNING • ORGANIZATIONAL SKILLS • SELECTIVE ATTENTION • INHIBITORY CONTROL • SOME ASPECTS OF SHORT TERM MEMORY.
  40. 40. COMMON TESTS USED • VERBAL FLUENCY TEST. • WISCONSIN CARD SORTING TEST. • STROOP TEST. • COGNITIVE ESTIMATION TEST. • STRATEGY APPLICATION TEST. • TOWER OF LONDON TEST. • TRAIL MAKING TEST. • GOLDSTEIN-SHEERER TEST.
  41. 41. WISCONSIN CARD SORTING TEST
  42. 42. WISCONSIN CARD SORTING TEST (WCST) • AGE RANGE • THE TEST CAN BE USED WITH INDIVIDUALS AGED 5 TO 89 YEARS. • DESCRIPTION • THIS TEST WAS DEVELOPED BY BERG AND GRANT (BERG, 1948; GRANT & BERG, 1948)
  43. 43. • PURPOSE • TO ASSESS ABSTRACTION ABILITY AND THE ABILITY TO SHIFT COGNITIVE STRATEGIES IN RESPONSE TO CHANGING ENVIRONMENTAL CONTINGENCIES. • THE TEST IS CONSIDERED A MEASURE OF • EXECUTIVE FUNCTION (HEATON ET AL., 1993) IN THAT IT REQUIRES • STRATEGIC PLANNING • ORGANIZED SEARCHING • THE ABILITY TO USE ENVIRONMENTAL FEEDBACK TO SHIFT COGNITIVE SET, • GOAL-ORIENTED BEHAVIOR • THE ABILITY TO MODULATE IMPULSIVE RESPONDING. • ABILITY TO FLEXIBLY SHIFT FOCUS AND SUSTAIN A COGNITIVE SET
  44. 44. • THE TEST CONSISTS OF FOUR STIMULUS CARDS, PLACED IN FRONT OF THE SUBJECT • THE FIRST WITH A RED TRIANGLE • THE SECOND WITH TWO GREEN STARS • THE THIRD WITH THREE YELLOW CROSSES • THE FOURTH WITH FOUR BLUE CIRCLES ON THEM.
  45. 45. • THE SUBJECT IS THEN GIVEN TWO PACKS EACH CONTAINING 64 RESPONSE CARDS, WHICH HAVE DESIGNS SIMILAR TO THOSE ON THE STIMULUS CARDS, VARYING IN COLOR, GEOMETRIC FORM, AND NUMBER. STIMULUS CARDS RESPONSE CARDS
  46. 46. • TIME LIMIT: • THERE IS NO TIME LIMIT TO THIS TEST. • BRAIN REGION INVOLVED • PREFRONTRAL CORTEX • IT REQUIRES PROPER FUNCTIONING OF EXTENSIVE CEREBRAL INTERCONNECTIONS BETWEEN SUBCORTICAL AND CORTICAL REGIONS OF THE BRAIN. • IT ALSO DETECTS: • PERSEVERATIVE TYPE OF ERROR.
  47. 47. SHORT FORM • THE ABBREVIATED FORM OF THE STANDARD WCST, THE WCST- 64,(AXELROD, WOODARD, ET AL., 1992; KONGS ET AL., 2000) INVOLVES GIVING ONLY THE FIRST DECK OF 64 CARDS.
  48. 48. • EXAMINEES SHOULD HAVE NORMAL OR CORRECTED VISION AND HEARING TO ADEQUATELY COMPREHEND THE TEST INSTRUCTIONS AND TO DISCRIMINATE VISUALLY THE STIMULUS PARAMETERS OF COLOR, FORM, AND NUMBER. • THE TWO PACKS OF CARDS ARE PLACED IN FRONT OF THE SUBJECT. • THE EXAMINER INSTRUCTS THE SUBJECT TO PLACE EACH RESPONSE CARD IN PILES BELOW ONE OF THE FOUR STIMULUS (KEY) CARDS, WHEREVER HE OR SHE THINKS IT SHOULD GO. • SUBJECT IS TOLD THAT THE EXPERIMENTER WILL THEN INFORM HIM OR HER WHETHER THE CHOICE IS “RIGHT” OR “WRONG.” • THE SUBJECT IS DIRECTED TO MAKE USE OF THIS INFORMATION AND TO TRY TO GET AS MANY CARDS “RIGHT” AS POSSIBLE. • WHILE IT IS PERMISSIBLE TO CLARIFY THE MEANING OF THE STIMULUS (KEY) CARDS AND THE MANNER IN WHICH THE CLIENT IS TO RESPOND, THE EXAMINER MUST NEVER VIOLATE THE INTEGRITY OF THE WCST BY GIVING ANY INDICATION OF THE SORTING PRINCIPLES OR THE NATURE OF THE SHIFT FROM ONE CATEGORY TO THE NEXT.
  49. 49. • THE SUBJECT IS REQUIRED TO SORT FIRST TO COLOR • ALL OTHER RESPONSES BEING CALLED “WRONG” • ONCE 10 CONSECUTIVE CORRECT RESPONSES TO COLOR HAVE BEEN ACHIEVED, THE REQUIRED SORTING PRINCIPLE SHIFTS, WITHOUT WARNING, TO FORM • COLOR RESPONSES ARE NOW “WRONG.” • AFTER 10 CONSECUTIVE CORRECT RESPONSES TO FORM, THE PRINCIPLE SHIFTS TO NUMBER, AND THEN BACK TO COLOR ONCE MORE. • THIS PROCEDURE CONTINUES UNTIL THE SUBJECT HAS SUCCESSFULLY COMPLETED SIX SORTING CATEGORIES (COLOR, FORM, NUMBER, COLOR, FORM, NUMBER), OR UNTIL ALL 128 CARDS HAVE BEEN PLACED. • RECORDING A PERFORMANCE, PARTICULARLY IF THE PATIENT WORKS RAPIDLY, CAN BE DIFFICULT. BRIEFLY, THE RECORDING FORM HAS 128 RESPONSE ITEMS, EACH ONE “CFNO” (C = COLOR, F = FORM, N = NUMBER, O = OTHER).
  50. 50. • THE TASK REQUIRES NUMEROUS OTHER SKILLS INCLUDING • BASIC VISUAL PROCESSING • NUMERICAL ABILITY • RULE INDUCTION ABILITY • THE ABILITY TO IDENTIFY THE MOST RELEVANT STIMULUS ATTRIBUTES • SPEEDED PROCESSING • THE ABILITY TO MAINTAIN THE CURRENT SORTING CATEGORY IN WORKING MEMORY • THE ABILITY TO SHIFT MENTAL SET, AND • THE APPROPRIATE MOTIVATIONAL SET.
  51. 51. STROOP TEST
  52. 52. STROOP TEST • DEVELOPED BY John Ridley Stroop IN 1935 • PURPOSE • THIS MEASURE OF COGNITIVE CONTROL ASSESSES THE EASE WITH WHICH A PERSON CAN MAINTAIN A GOAL IN MIND AND SUPPRESS A HABITUAL RESPONSE IN FAVOR OF A LESS FAMILIAR ONE. • AGE RANGE • VICTORIA VERSION FOR AGES 18 TO 94 • GOLDEN VERSION FOR AGES 5 TO 90.
  53. 53. • THIS MEASURE OF SELECTIVE ATTENTION AND COGNITIVE FLEXIBILITY WAS ORIGINALLY DEVELOPED BY STROOP (1935). • STROOP’S VERSION CONSISTED OF THREE WHITE CARDS, EACH CONTAINING 10 ROWS OF FIVE ITEMS. • THERE ARE FOUR PARTS TO THE TEST. • IN PART 1, THE SUBJECT READS RANDOMIZED COLOR NAMES (BLUE, GREEN, RED, BROWN, PURPLE) PRINTED IN BLACK TYPE. BLUE GREEN RED BROWN PURPLE X 10 ROWS
  54. 54. • IN PART 2, THE SUBJECT READS THE COLOR NAMES (BLUE, GREEN, RED, BROWN, PURPLE) PRINTED IN COLORED INK (BLUE, GREEN, RED, YELLOW), IGNORING THE COLOR OF THE PRINT (THE PRINT COLOR NEVER CORRESPONDS TO THE COLOR NAME). BLUE GREEN RED BROWN PURPLE X 10 ROWS
  55. 55. • IN PART 3, THE SUBJECT HAS TO NAME THE COLOR OF SQUARES (BLUE, GREEN, RED, BROWN, PURPLE). X 10 ROWS
  56. 56. IN PART 4, THE SUBJECT IS GIVEN THE CARD USED IN PART 2, BUT THIS TIME, THE SUBJECT MUST NAME THE COLOR IN WHICH THE COLOR NAMES ARE PRINTED AND DISREGARD THEIR VERBAL CONTENT. X 10 ROWS BLUE GREEN RED BROWN PURPLE
  57. 57. • OF MAJOR INTEREST IS THE SUBJECT’S BEHAVIOR WHEN PRESENTED WITH COLORED WORDS PRINTED IN NONMATCHING COLORED INKS. • STROOP REPORTED THAT NORMAL PEOPLE CAN READ COLOR WORDS PRINTED IN COLORED INK AS FAST AS WHEN THE WORDS ARE PRESENTED IN BLACK INK (PART 2 VERSUS PART 1). • HOWEVER, THE TIME TO COMPLETE THE TASK INCREASES SIGNIFICANTLY WHEN THE SUBJECT IS ASKED TO NAME THE COLOR OF THE INK RATHER THAN READ THE WORD (PART 4 VERSUS PART 3). • THIS DECREASE IN COLOR-NAMING SPEED IS CALLED THE “COLOR-WORD INTERFERENCE EFFECT.”
  58. 58. WHAT DOES IT TEST ? • PROCESSING SPEED • SELECTIVE ATTENTION • AUTOMATICITY • DEMONSTRATION OF INTERFERENCE IN THE REACTION TIME OF A TASK. • PARALLEL DISTRIBUTED PROCESSING
  59. 59. BRAIN AREA ACTIVATED • ANTERIOR CINGULATE CORTEX • DORSOLATERAL PREFRONTAL CORTEX. • MORE SPECIFICALLY, WHILE BOTH ARE ACTIVATED WHEN RESOLVING CONFLICTS AND CATCHING ERRORS, THE DORSOLATERAL PREFRONTAL CORTEX ASSISTS IN MEMORY AND OTHER EXECUTIVE FUNCTIONS, WHILE THE ANTERIOR CINGULATE CORTEX IS USED TO SELECT AN APPROPRIATE RESPONSE AND ALLOCATE ATTENTIONAL RESOURCES.
  60. 60. TOWER OF LONDON TEST • SHALLICE (1982) DEVELOPED THE TOWER OF LONDON (TOL) TASK TO MEASURE PLANNING AND PROBLEM SOLVING SKILLS IN PATIENTS WITH DAMAGE TO THE FRONTAL LOBES. • THERE ARE 3 PEGS. • THERE ARE A NUMBER OF BALLS. • NUMBER OF BALLS VARIES WITH AGE. • SUBJECT IS GIVEN A TARGET CONFIGURATION. • SUBJECT IS ASKED TO ACHIEVE THE TARGET CONFIGURATION IN MINIMUM NUMBER OF MOVES.
  61. 61. TO INCREASE DIFFICULTY THE NUMBER OF MOVES CAN BE SPECIFIED OR THE NUMBER OF BALLS CAN BE INCREASED
  62. 62. RULES • A) BALLS COULD ONLY BE MOVED ONE AT A TIME • B) THE BALLS MUST BE KEPT ON THE PEGS WHEN THEY ARE NOT BEING MOVED • C) THE MOVE IS FINISHED WHEN THEIR HAND IS TAKEN OFF THE BALL.
  63. 63. TOWER OF HANOI • ALTERNATIVE FORM OF TOL. • BASIC CONCEPT IS SAME, EXCEPT ONE EXTRA RULE IS THERE. • NO LARGE BALL CAN SIT ON A SMALL BALL.
  64. 64. TRAIL MAKING TEST
  65. 65. TRAIL MAKING TEST • AGE RANGE • THE AGE RANGE FOR THE INTERMEDIATE VERSION OF THE TMT IS 9 TO 14 YEARS, AND THAT OF THE ADULT VERSION IS 15 TO 89 YEARS. • ADMINISTRATION TIME • ABOUT 5 TO 10 MINUTES ARE NEEDED FOR TEST ADMINISTRATION.
  66. 66. • BOTH PARTS OF THE TRAIL MAKING TEST CONSIST OF 25 CIRCLES DISTRIBUTED OVER A SHEET OF PAPER. • THE PATIENT SHOULD BE INSTRUCTED TO CONNECT THE CIRCLES AS QUICKLY AS POSSIBLE, WITHOUT LIFTING THE PEN OR PENCIL FROM THE PAPER. • TIME THE PATIENT AS HE OR SHE CONNECTS THE "TRAIL." • IF THE PATIENT MAKES AN ERROR, POINT IT OUT IMMEDIATELY AND ALLOW THE PATIENT TO CORRECT IT. • ERRORS AFFECT THE PATIENT'S SCORE ONLY IN THAT THE CORRECTION OF ERRORS IS INCLUDED IN THE COMPLETION TIME FOR THE TASK. • IT IS UNNECESSARY TO CONTINUE THE TEST IF THE PATIENT HAS NOT COMPLETED BOTH PARTS AFTER FIVE MINUTES HAVE ELAPSED.
  67. 67. PART - A IN PART A, THE CIRCLES ARE NUMBERED 1 – 25, AND THE PATIENT SHOULD DRAW LINES TO CONNECT THE NUMBERS IN ASCENDING ORDER.
  68. 68. PART - B IN PART B, THE CIRCLES INCLUDE BOTH NUMBERS (1 – 13) AND LETTERS (A – L). HERE THERE IS ADDED TASK OF ALTERNATING BETWEEN THE NUMBERS AND LETTERS (I.E., 1-A- 2-B-3-C, ETC.)
  69. 69. SCORING • RESULTS FOR BOTH TMT A AND B ARE REPORTED AS THE NUMBER OF SECONDS REQUIRED TO COMPLETE THE TASK; THEREFORE, HIGHER SCORES REVEAL GREATER IMPAIRMENT. AVERAGE DEFICIENT RULE OF THUMB TRAIL A 29 SECONDS > 78 SECONDS MOST IN 90 SECONDS TRAIL B 75 SECONDS > 273 SECONDS MOST IN 3 MINUTES
  70. 70. WHAT DOES IT TESTS ? • TEST OF SPATIAL ANALYSIS • MOTOR CONTROL • ALERTNESS • CONCENTRATION • ABILITY TO SHIFT ATTENTION BETWEEN ALTERNATIVES.  THIS TEST IS INFLUENCED BY AGE AND EDUCATION.
  71. 71. ATTENTION, CONCENTRATION
  72. 72. TESTS EMPLOYED • DIGIT SPAN • PACED AUDITORY SERIAL ADDITION TEST (PASAT) • CONTINUOUS PERFORMANCE TEST. • DIGIT VIGILANCE TEST
  73. 73. DIGIT SPAN
  74. 74. DIGIT SPAN • PARTICIPANTS ARE PRESENTED WITH A SERIES OF DIGITS (E.G., ‘7, 2, 9') AND MUST IMMEDIATELY REPEAT THEM BACK. • DIGITS ARE NON SEQUENTIAL. • IF THEY DO THIS SUCCESSFULLY, THEY ARE GIVEN A LONGER LIST (E.G., '9, 2, 4, 1'). • THE LENGTH OF THE LONGEST LIST A PERSON CAN REMEMBER IS THAT PERSON'S DIGIT SPAN. • THE PARTICIPANT IS ASKED TO ENTER THE DIGITS IN THE GIVEN ORDER IN THE FORWARD DIGIT-SPAN TASK. • IN THE BACKWARD DIGIT-SPAN TASK THE PARTICIPANT NEEDS TO REVERSE THE ORDER OF THE NUMBERS. • ALSO TESTS WORKING MEMORY ALONG WITH ATTENTION & CONCENTRATION
  75. 75. PACED AUDITORY SERIAL ADDITION TEST (PASAT)
  76. 76. PACED AUDITORY SERIAL ADDITION TEST (PASAT) • ASSESS: • RATE OF INFORMATION PROCESSING • SUSTAINED • DIVIDED ATTENTION. • MEMORY • ARITHMETIC CAPABILITIES • IT WAS INITIALLY DEVELOPED BY GRONWALL IN 1977 TO MONITOR THE RECOVERY OF PATIENTS WHO HAD SUSTAINED MILD HEAD INJURIES.
  77. 77. METHOD • THE PASAT IS PRESENTED ON AUDIOCASSETTE TAPE OR COMPACT DISK TO CONTROL THE RATE OF STIMULUS PRESENTATION. • SINGLE DIGITS ARE PRESENTED EITHER EVERY 3 SEC (3. PASAT) OR EVERY 2 SEC (2. PASAT) • THE PATIENT MUST ADD EACH NEW DIGIT TO THE ONE IMMEDIATELY PRIOR TO IT. • THE TEST RESULT IS THE NUMBER OF CORRECT SUMS GIVEN (OUT OF 60 POSSIBLE).
  78. 78. DISCONTINUATION RULES • IF THE PATIENT CANNOT GET AT LEAST TWO ANSWERS CORRECT (CONSECUTIVE OR NOT) ON ANY ONE OF THE THREE 3 PRACTICE SEQUENCES. • IF THE PATIENT CANNOT GET AT LEAST ONE ANSWER CORRECT ON PASAT-3. TEST, DO NOT ADMINISTER THE 2. TEST.
  79. 79. CONTINUOUS PERFORMANCE TEST
  80. 80. CONTINUOUS PERFORMANCE TEST • ASSESS: • SUSTAINED ATTENTION • SELECTIVE ATTENTION • TYPES: • INTEGRATED VISUAL AND AUDITORY CPT (IVA-2) • TEST OF VARIABLES OF ATTENTION (T.O.V.A.) • CONNERS' CPT-II
  81. 81. PRINCIPLE • ALTHOUGH THE TESTS MAY VARY IN TERMS OF LENGTH AND TYPE OF STIMULUS USED, THE BASIC NATURE OF THE TESTS REMAINS THE SAME. • CLIENTS ARE PRESENTED WITH A REPETITIVE, BORING TASK AND MUST MAINTAIN THEIR FOCUS OVER A PERIOD OF TIME IN ORDER TO RESPOND TO TARGETS OR INHIBIT RESPONSE TO FOILS. • TESTS MAY USE NUMBERS, SYMBOLS, OR EVEN SOUNDS, BUT THE BASIC TASK HAS THE SAME CONCEPT.
  82. 82. TEST SCORING • CORRECT DETECTION • REACTION TIMES • OMISSION ERRORS • COMMISSION ERRORS • FAST REACTION TIME WITH LOTS OF COMMISSION ERRORS INDICATES IMPULSIVITY.
  83. 83. DIGIT VIGILANCE TEST • PURPOSE: ASSESS ATTENTION DURING RAPID VISUAL TRACKING • AGE RANGE: 20 TO 80 YEARS • ADMIN TIME: 10 MINUTES (TIMED) • RESPONDENTS ARE ASKED TO FIND AND CROSS OUT EITHER SIXES OR NINES, WHICH APPEAR RANDOMLY WITHIN 59 ROWS OF SINGLE DIGITS ON TWO SEPARATE PAGES.
  84. 84. MEMORY
  85. 85. MEMORY • WECHSLER MEMORY SCALE III • BENTON VISUAL RETENTION TEST • REY AUDITORY VERBAL LEARNING TEST • REY OSTERRIETH COMPLEX FIGURE TEST • RIVERMEAD BEHAVIOURAL MEMORY TEST • THE CALIFORNIA VERBAL LEARNING TEST
  86. 86. WECHSLER MEMORY SCALE III • PURPOSE: DESIGNED TO ASSESS • LEARNING • MEMORY • WORKING MEMORY. • POPULATION: INDIVIDUALS IN THE AGE RANGE OF 16-89 YEARS. • SCORE: EIGHT PRIMARY INDEXES AND FOUR SUPPLEMENTAL AUDITORY PROCESS COMPOSITES. • AUTHOR: DAVID WECHSLER.
  87. 87. • THE SCALE YIELDS A MEMORY QUOTIENT (MQ), WHICH IS CORRECTED FOR AGE AND GENERALLY APPROXIMATES THE WECHSLER ADULT INTELLIGENCE SCALE INTELLIGENCE QUOTIENT (WAIS IQ). • AMNESTIC CONDITIONS, SUCH AS KORSAKOFF'S SYNDROME, ARE CHARACTERIZED BY A DISPROPORTIONATELY LOW MQ BUT A RELATIVELY PRESERVED IQ.
  88. 88. SUBTEST DESCRIPTION • INFORMATION AND ORIENTATION • SUBJECT RESPONDS TO QUESTIONS REGARDING PERSONAL AND GENERAL (OPTIONAL) KNOWLEDGE (E.G., BIRTHDATE, NAME OF PRESIDENT, DAY OF THE WEEK) • LOGICAL MEMORY I AND II • SUBJECT RECALLS TWO PARAGRAPHS READ ALOUD BY THE EXAMINER, BOTH IMMEDIATELY AND AFTER A DELAY; A YES/NO RECOGNITION TEST FOLLOWS THE DELAY
  89. 89. • FACES I AND II • SUBJECT MUST RECOGNIZE FACES, BOTH IMMEDIATELY AFTER PRESENTATION AND AFTER A DELAY • VERBAL PAIRED ASSOCIATED I AND II • EXAMINER PRESENTS A LIST OF WORD PAIRS; THEN THE SUBJECT HEARS ONE WORD AND MUST PROVIDE THE WORD THAT WENT WITH IT. • THERE ARE FOUR TRIALS OF THE LIST. • THE PAIRS ARE ALSO TESTED AFTER A DELAY. • A RECOGNITION TRIAL IS ALSO INCLUDED; THE SUBJECT MUST IDENTIFY THE WORD PAIRS FROM A LIST OF DISTRACTORS.
  90. 90. • FAMILY PICTURES I AND II • THE SUBJECT IS SHOWN FOUR SCENES ONE AT A TIME AND THEN MUST RECALL THE CHARACTERS IN THE SCENE AND WHAT THEY WERE DOING. • RECALL IS ALSO TESTED AFTER A DELAY. • WORD LIST I AND II • A 12-ITEM LIST-LEARNING TASK IN WHICH THE SUBJECT MUST RECALL (OPTIONAL) THE LIST AFTER EACH OF FOUR LEARNING TRIALS. • RECALL OF THE WORD LIST IS ALSO TESTED AFTER PRESENTATION OF A NEW LIST AND AFTER A DELAY. • FINALLY, THE SUBJECT IS READ A LIST OF 24 WORDS AND MUST IDENTIFY THE LIST I WORDS. • VISUAL REPRODUCTION I AND II (VRI AND II) • THE SUBJECT MUST REPRODUCE FIGURES BOTH IMMEDIATELY AFTER PRESENTATION AND FOLLOWING A DELAY. • RECOGNITION, COPYING AND MATCHING CONDITIONS ARE ALSO PROVIDED.
  91. 91. • LETTER-NUMBER SEQUENCING • THE EXAMINER READS A LIST CONSISTING OF A COMBINATION OF NUMBERS AND LETTERS, AND THE SUBJECT MUST RECITE THEM BACK, THE NUMBERS FIRST IN ASCENDING ORDER, AND THEN THE LETTERS IN ALPHABETIC ORDER. • SPATIAL SPAN • THE EXAMINER TOUCHES A SEQUENCE OF BLOCKS THAT THE SUBJECT MUST REPEAT IN THE SAME ORDER. • IN THE SECOND TASK, THE SUBJECT MUST POINT TO THE SAME BLOCKS IN THE REVERSE ORDER. • MENTAL CONTROL • THE SUBJECT MUST RECITE SEQUENCES (E.G., DAYS OF THE WEEK) AS WELL AS MANIPULATE SEQUENCES (E.G., RECITE DAYS BACKWARD) • DIGIT SPAN • THE SUBJECT REPEATS STRINGS OF DIGITS OF INCREASING LENGTH SAID BY THE EXAMINER IN THE SAME (FORWARD) AND IN REVERSE (BACKWARD) ORDER. • DIGITS SHOULD NOT E IN SEQUENCE
  92. 92. BENTON VISUAL RETENTION TEST
  93. 93. BENTON VISUAL RETENTION TEST • PURPOSE • SPACIAL PERCEPTION • VISUAL AND VERBAL CONCEPTUALIZATION • SHORT TERM RETENTION AND RECALL • VISUOCONSTRUCTIVE ABILITIES. • DESCRIPTION • THERE ARE TWO MAIN ADMINISTRATION MODES FOR THE BVRT, REQUIRING EITHER • DRAWING OR • MULTIPLE-CHOICE RESPONSES FROM THE EXAMINEE
  94. 94. • BVRT HAVE THREE ALTERNATE FORMS (C, D, AND E) THAT ARE ROUGHLY OF EQUIVALENT DIFFICULTY. • EACH FORM IS COMPOSED OF 10 DESIGNS
  95. 95. • THERE ARE FOUR MAIN TYPES OF ADMINISTRATION. • ADMINISTRATION A: • THE STANDARD (AND MOST COMMONLY USED) PROCEDURE • EACH DESIGN IS DISPLAYED FOR 10 S AND THEN WITHDRAWN. • IMMEDIATELY AFTER THIS, THE SUBJECT IS REQUIRED TO REPRODUCE THE DESIGN FROM MEMORY AT HIS OR HER OWN PACE ON A BLANK PIECE OF PAPER. • ADMINISTRATION B : • EACH DESIGN IS EXPOSED FOR ONLY 5 S. • ADMINISTRATION C (COPYING) : • REQUIRES THE SUBJECT TO COPY EACH OF THE DESIGNS WITHOUT REMOVING THE STIMULUS CARD FROM SIGHT. • ADMINISTRATION D: • EACH DESIGN IS EXPOSED FOR 10 S AND THE SUBJECT MUST REPRODUCE THE DESIGN AFTER A 15-S DELAY.
  96. 96. • TWO ADDITIONAL MULTIPLE-CHOICE FORMS (F AND G) ARE AVAILABLE ONLY IN THE GERMAN EDITION OF THE TEST • THEY ARE USED TO MEASURE THE SUBJECT’S RECOGNITION, RATHER THAN REPRODUCTION, ABILITY (ADMINISTRATION M). • BECAUSE OF ITS MINIMAL RELIANCE ON LANGUAGE, ADMINISTRATION M IS ALSO APPROPRIATE FOR NON-ENGLISH-SPEAKING INDIVIDUALS. • THE MULTIPLE-CHOICE ADMINISTRATION CAN BE USED FOR PEOPLE WITH OR WITHOUT MOTOR HANDICAPS, TO DETERMINE WHETHER AN INDIVIDUAL’S DISABILITY LIES IN THE AREA OF MEMORY, PERCEPTION, OR DRAWING ABILITY.
  97. 97. SAMPLE OF MULTIPLE CHOICE
  98. 98. • SCORING • NUMBER CORRECTLY REPRODUCED AND NUMBER OF ERRORS MADE. • QUALITATIVE INFORMATION FROM TYPE OF ERRORS COMMITTED • DISTORTIONS • OMISSIONS • PERSEVERATIONS • ROTATIONS • MISPLACEMENT • ERRORS OF SIZE.
  99. 99. LANGUAGE
  100. 100. LANGUAGE • BOSTON NAMING TEST. • GRADED NAMING TEST. • TOKEN TEST. • SPEED AND CAPACITY OF LANGUAGE PROCESSING TEST.
  101. 101. TOKEN TEST
  102. 102. TOKEN TEST - De Renzi and Vignolo (1962) • THE TEST IS A PARTICULARLY USEFUL TOOL FOR ASSESSING SUBTLE RECEPTIVE LANGUAGE DYSFUNCTION. • THERE ARE TWENTY "TOKENS" USED (5 LARGE CIRCLES, 5 SMALL CIRCLES, 5 LARGE SQUARES, AND 5 SMALL SQUARES) OF FIVE COLORS (BLUE, GREEN, YELLOW, WHITE, AND RED). • THE 62 ITEMS ON THE TEST ARE DIVIDED INTO 5 PARTS THAT BECOME PROGRESSIVELY MORE DIFFICULT.
  103. 103. • TOKENS MUST BE IDENTIFIED BY THREE INDEPENDENT FEATURES. • SIZE • COLOUR • SHAPE • SUBJECT MUST GRASP THE SEMANTIC COMPLICATION. • MORE COMMON ABNORMALITIES SEEN IN APHASICS WITH LEFT- SIDED BRAIN DAMAGE.
  104. 104. BOSTON NAMING TEST
  105. 105. BOSTON NAMING TEST • PURPOSE • THE PURPOSE OF THE BOSTON NAMING TEST IS TO ASSESS VISUAL NAMING ABILITY USING BLACK AND WHITE DRAWINGS OF COMMON OBJECTS. • AGE RANGE • THE AGE RANGE IS 5 TO 13 YEARS AND 18 YEARS AND OLDER. • CURRENT VERSION: • 60 ITEMS • SHORTER VERSION: • 15 ITEMS
  106. 106. METHOD • FOR CHILDREN AND ALL APHASIC PATIENTS, TEST BEGINS WITH ITEM 1 AND DISCONTINUED AFTER EIGHT SUCCESSIVE FAILURES. • FOR ALL OTHER ADULT SUBJECTS, IT BEGINS WITH ITEM 30 (HARMONICA). • IF ANY OF THE NEXT EIGHT ITEMS IS FAILED, PROCEED BACKWARD FROM ITEM 29 UNTIL EIGHT CONSECUTIVE PRECEDING ITEMS ARE PASSED WITHOUT ASSISTANCE (I.E., WITHOUT PROVISION OF A STIMULUS OR PHONEMIC CUE) • THEN RESUME IN A FORWARD DIRECTION, AND DISCONTINUE THE TEST WHEN THE PATIENT MAKES EIGHT CONSECUTIVE ERRORS. • CREDIT IS GIVEN IF THE ITEM IS CORRECTLY NAMED WITHIN 20 S. • IF (AND ONLY IF ) THE PATIENT CLEARLY MISPERCEIVES THE PICTURE, HE OR SHE IS TOLD THAT THE PICTURE REPRESENTS SOMETHING ELSE AND IS SUPPLIED WITH THE BRACKETED STIMULUS CUES ON THE RECORD FORM.
  107. 107. ITEMS
  108. 108. • HELPS IN DIAGNOSIS OF: • LEARNING DISABILITIES • EVALUATION OF BRAIN-INJURY • ANOMIC APHASIA • ALZHEIMER’S DISEASE • VASCULAR DEMENTIA
  109. 109. ABSTRACT THINKING
  110. 110. TESTS EMPLOYED • GOLDSTEIN SHEERER TEST • PROVERB TEST • SIMILARITY TEST • DISSIMILARITY TEST
  111. 111. • THE TASK USED FOR EXAMINING THIS ABILITY IS INTERPRETING THE GENERALIZED MEANING OF PROVERBS. FOR THIS PURPOSE, PROVERBS ARE GENERALLY DEFINED AS WISE OR MEANINGFUL SAYINGS CAST IN A METAPHORICAL MODE. • IT IS THIS ABILITY TO UNDERSTAND THE METAPHOR AND THEN TO GENERALIZE THE INTENDED MEANING THAT CONSTITUTES THE CHALLENGE IN THIS TEST. PROVERB TEST
  112. 112. • THERE ARE TWO FORMS OF THE TEST, A AND B. • EACH FORM IS GIVEN UNDER TWO CONDITIONS: • REGULAR (SINGLE PROVERB STATEMENTS) • ENRICHED (SETS OF THREE PROVERB STATEMENTS THAT ALL HAVE THE SAME GENERALIZED MEANING). FORM – A Make hay while the sun shines FORM – B Ignorance is bliss. No news is good news. What the eye doesn’t see, the heart doesn’t grieve over.
  113. 113. • RESPONSES ARE RECORDED VERBATIM AND SCORED ACCORDING TO LEVEL OF ABSTRACT GENERALITY (SEE SCORING CRITERIA). • MAXIMUM CREDIT IS GIVEN FOR INTERPRETATIONS THAT ARE BOTH ACCURATE AND HIGHLY GENERALIZABLE • ZERO CREDIT FOR THOSE THAT ARE SIMPLY INACCURATE • REDUCED CREDIT FOR CORRECT BUT CONCRETE RESPONSES. • IT IS ESSENTIAL THAT EXAMINEES UNDERSTAND THE NATURE OF THE TASK AND ITS REQUIREMENTS. • IT IS OFTEN USEFUL TO GIVE AN EXAMPLE THAT CAN BE DISCUSSED. • EXAMINER MUST NOT TEACH GENERALIZATION OF MEANING DURING THE INTRODUCTION OF THE TEST
  114. 114. SCORING • 0 - FOR MANIFESTLY INCORRECT OR IRRELEVANT RESPONSES, I.E., THOSE THAT ARE NOT EVEN CORRECT IN CONCRETE FORM. • 1 - FOR QUITE CONCRETE (SAME CONTENT AS THE METAPHORICAL STATEMENT) • 2 - FOR CONCRETE INTERPRETATION BUT WITH A DIFFERENT—BUT STILL SPECIFIC—CONTENT. • 3 OR 4 - FOR ABSTRACT RESPONSES, WITH THE GREATER CREDIT BEING GIVEN FOR THE MOST ABSTRACT INTERPRETATIONS THAT HAVE THE GREATEST DEGREE OF GENERALIZATION.
  115. 115. AN EXAMPLE ROME WASN’T BUILT IN A DAY. • 0 POINTS: ROME WAS BUILT MOSTLY BY SLAVES. • 1 POINT: A CITY TAKES A LONG TIME TO BUILD. • 2 POINTS: BUILDING ANYTHING, WHETHER IT’S ONE HOUSE OR A WHOLE COUNTRY, TAKES A LONG TIME. • 3 POINTS: IF SOMETHING DOESN’T HAPPEN RIGHT AWAY, THAT DOESN’T MEAN IT NEVER WILL. • 4 POINTS: YOU HAVE TO BE PATIENT AND GIVE THINGS TIME TO HAPPEN.
  116. 116. • BEST WAY TO START: “Different people give different answers to these. You might say they mean different things to different people. I am very interested to know what they mean to you, what you think about them.” • IMPULSIVITY CAN BE DEALT BY • “Please take your time. I think you are answering too quickly, so you might not be giving me the best answers you could possibly come up with. Just slow down, take all the time you need, and be sure to give yourself plenty of thinking time.” • TEST WITH ATLEAST 3 PROVERBS !!
  117. 117. GOLDSTEIN SCHEERER TEST CUBE TEST COLOUR SORTING TEST HUE & BRIGHTNESS OBJECT SORTING TEST COLOUR FORM TEST 4 4 4 STICK TEST GENERATE PATTERN TESTS ABSTRACT AND CONCRETE THINKING
  118. 118. VISUOSPACIAL CONSTRUCT
  119. 119. VISUOSPACIAL CONSTRUCT • JUDGMENT OF LINE ORIENTATION • FACIAL RECOGNITION • CLOCK DRAWING TEST • REY-OSTERREITH COMPLEX FIGURE TEST
  120. 120. JUDGMENT OF LINE ORIENTATION
  121. 121. METHOD • THE TEST BOOKLET AND THE MULTIPLE CHOICE CARD ARE PLACED FLAT ON THE TABLE IN FRONT OF THE PATIENT AND AT A 45-DEGREE ANGLE TO THE MULTIPLE-CHOICE ARRAY, IN SUCH A WAY THAT BOTH ARE IN AN AREA OF PRESERVED VISION. • THE PATIENT IS INSTRUCTED TO LOOK AT THE TWO LINES OF THE STIMULUS CARD AND TO FIND “WHICH OF THE LINES BELOW ARE IN EXACTLY THE SAME POSITION AND POINT IN THE SAME DIRECTION.”
  122. 122. • PATIENT HAS TO TELL HOW MANY NUMBER OF THE LINES ARE THERE • IF THE PATIENT HAS DIFFICULTY COMPREHENDING THE INSTRUCTIONS, THE EXAMINER MAY PROCEED BY ASKING THE PATIENT TO SHOW THE CORRESPONDING DIRECTION FOR JUST ONE LINE. • INSTRUCTIONS AND PRACTICE ITEMS MAY BE REPEATED UNTIL THE PATIENT GIVES TWO CORRECT RESPONSES FOR THE PRACTICE ITEMS. • THERE IS NO TIME LIMIT FOR RESPONDING.
  123. 123. • TEST HAS 3 PARTS. • FAILURE: • PROSOPAGNOSIA • RIGHT HEMISPHERE DYSFUNCTION FACIAL RECOGNITION
  124. 124. PART 1 • MATCHING OF IDENTICAL FRONT-VIEW PHOTOGRAPHS. • THE PATIENT IS PRESENTED WITH A SINGLE FRONT-VIEW PHOTOGRAPH OF A SINGLE FACE (MALE OR FEMALE) AND IS INSTRUCTED TO IDENTIFY IT IN A DISPLAY OF SIX FRONT-VIEW PHOTOGRAPHS (THE TARGET AND FIVE DISTRACTORS) THAT APPEARS BELOW THE SINGLE PHOTOGRAPH. • THERE ARE SIX TARGET FACES, CALLING FOR A TOTAL OF SIX RESPONSES.
  125. 125. PART-2 • MATCHING OF FRONT-VIEW WITH THREE- QUARTER-VIEW PHOTOGRAPHS IS REQUIRED. • THE INDIVIDUAL IS PRESENTED WITH A SINGLE FRONT-VIEW PHOTOGRAPH OF A FACE AND IS INSTRUCTED TO LOCATE IT THREE TIMES IN A DISPLAY OF SIX THREE- QUARTER VIEWS, THREE OF WHICH ARE VIEWS OF THE PRESENTED FACE AND THREE VIEWS OF OTHER FACES.
  126. 126. PART-3 • MATCHING OF FRONT-VIEW PHOTOGRAPHS UNDER DIFFERENT LIGHTING CONDITIONS. • THE SUBJECT IS PRESENTED WITH A SINGLE FRONT-VIEW PHOTOGRAPH OF A FACE TAKEN UNDER FULL LIGHTING CONDITIONS AND IS INSTRUCTED TO LOCATE IT THREE TIMES IN A DISPLAY OF SIX FRONT VIEWS TAKEN UNDER DIFFERENT LIGHTING CONDITIONS. • THREE PHOTOGRAPHS IN THE DISPLAY ARE OF THE PRESENTED FACE, AND THREE ARE OF OTHER FACES.
  127. 127. • PATIENT IS PROVIDED WITH AN UNLINED LETTER-SIZE SHEET OF PAPER AND A PENCIL IN FRONT OF THE PATIENT. • “i want you to draw the face of a clock with all the numbers on it. make it large.” • AFTER COMPLETION OF THE CLOCK FACE • “now, please set the time to 10 after 11 (or 20 to 4).” • INSTRUCTIONS MAY BE REPEATED OR REPHRASED IF THE PATIENT DOES NOT UNDERSTAND, BUT NO OTHER HELP SHOULD BE GIVEN. CLOCK DRAWING TEST
  128. 128. SCORING CRITERIA FOR CLOCK TEST
  129. 129. ABNORMAL FINDINGS • OMMISSION • E.G. - HEMINEGLECT OF LEFT SIDE – PATIENTS FAILS TO DRAW ALL THE LETTERING OF HOURS ON LEFT SIDE. • PERSEVARATION • POOR ORGANIZATION
  130. 130. CLOCK DRAWING BY A PATIENT WITH VASCULAR DEMENTIA, SHOWING POOR PLANNING AND ORGANIZATION, PERSEVERATION, AND POSSIBLE NEGLECT.
  131. 131. MOTOR FUNCTIONS
  132. 132. MOTOR FUNCTIONS • FINGER TAPPING TEST • GROOVED PEGBOARD • GRIP STRENGTH
  133. 133. FINGER TAPPING TEST • PREFERRED HAND PALM DOWN, WITH FINGERS EXTENDED AND THE INDEX FINGER PLACED ON THE KEY. • DIRECT THE SUBJECT TO TAP AS QUICKLY AS HE OR SHE CAN, MOVING ONLY THE INDEX FINGER, NOT THE WHOLE HAND OR ARM. • THE SUBJECT IS GIVEN FIVE CONSECUTIVE 10-S TRIALS WITH THE PREFERRED HAND. • THE PROCEDURE IS THEN REPEATED WITH THE NONPREFERRED HAND.
  134. 134. • FIVE 10-S TRIALS ARE GIVEN FOR EACH HAND EXCEPT WHEN THE RESULTS ARE TOO VARIABLE FROM ONE TRIAL TO ANOTHER. • SPECIFICALLY, THE TEST PROCEDURE REQUIRES THAT THE FIVE CONSECUTIVE TRIALS FOR EACH HAND BE WITHIN A 5-POINT RANGE FROM FASTEST TO SLOWEST. • A MAXIMUM OF 10 TRIALS WITH EACH HAND IS ALLOWED. • DO NOT ALTERNATE HAND TRIALS.
  135. 135. USES • MEASURE OF SIMPLE MOTOR SPEED • PARTICULARLY USEFUL FOR DOCUMENTING LATERALIZED MOTOR IMPAIRMENT
  136. 136. GROOVED PEGBOARD TEST
  137. 137. INSTRUMENTS • INSTRUMENT CONTAINS – PEGS & PEGBOARD • ALL THE PEGS ARE THE SAME. • THEY HAVE A GROOVE, THAT IS, A ROUND SIDE AND A SQUARE SIDE AND SO DO THE HOLES IN THE BOARDS. • IDEA IS TO MATCH THE GROOVE OF THE PEG WITH THE GROOVE OF THE BOARD AND PUT THESE PEGS INTO THE HOLES. • HAD TO BE DONE AS FAST AS ONE CAN, USING ONLY THE DOMINANT HAND. • TOP ROW HAD TO BE FILLED COMPLETELY. • NO SKIPPING OF HOLES
  138. 138. ASSESS • EYE–HAND COORDINATION • MOTOR SPEED • REQUIRES SENSORY MOTOR INTEGRATION AND A HIGH LEVEL OF MOTOR PROCESSING • DEXTERITY
  139. 139. GRIP STRENGTH • GRIP STRENGTH - STANDARD MEASURE OF LATERALIZING DIFFERENCES IN STRENGTH
  140. 140. To be continued in next seminar…….. Neuropsychological Tests Part II Intelligence & personality
  141. 141. BIBLIOGRAPHY • COMPREHENSIVE TEXTBOOK OF PSYCHIATRY, VOL 2, KAPLAN AND SADOCK. • SYNOPSIS OF PSYCHIATRY, 10TH EDITION - BENJAMIN J SADOCK & VIRGINIA A SADOCK • COMPREHENSIVE HANDBOOK OF PSYCHOLOGICAL ASSESSMENT - VOLUME 1 -INTELLECTUAL AND NEUROPSYCHOLOGICAL ASSESSMENT BY Gerald Goldstein & Sue R. Beers • A Compendium of Neuropsychological Tests: Administration, Norms and Commentary, Third Edition BY ESTHER STRAUSS, ELISABETH M. S. SHERMAN & OTFRIED SPREEN. • Handbook of Psychology (12 Volume Set) by Irving B. Weiner • Essentials of School Neuropsychological - Miller, Daniel C • Lafayette Manual of grooved pegboard - www.lafayetteinstrument.com • Proverbs Test - Cambridge University Press www.cambridge.org/us/download_file/189012/ • INTERNET SOURCES
  142. 142. THANK YOU

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