Clinical NeuropsychologyClinical NeuropsychologyTopic 6

Definition Definition

The study of the relation between brain function & behavior.

Deals with the understanding, assessment, & treatment of behaviors directly related to the functioning of the brain

Neuropsychological Neuropsychological AssessmentAssessment

A non-invasive method of describing brain functioning based on a patient’s performance on standardized test s that have been shown to be accurate and sensitive indicators of brain behavior relationships.

Roles of Roles of NeuropsychologistsNeuropsychologists

Helps neurologists or other physicians to establish or rule out a particular diagnosis

Make predictions regarding the prognosis for recovery

Intervention & rehabilitation

Cont’dCont’d

Evaluate patients with mental disorders to help predict the course of illness as well as to help tailor treatment strategies to patient’s strengths & weaknesses.

History of History of NeuropsychologyNeuropsychology

Theories of Brain functioning

Edwin Smith Surgical Papyrus – a document thought to date between 3000 & 1700 BC, discusses localization of function in the brain

Cont’dCont’d

Pythagoras – human reasoning occurs in the brain

Galen ( 2nd cent BC) – mind was located in the brain

Cont’dCont’d19th Cent – damage to specific cortical areas was related to impaired function of certain adaptive behaviors

Franz Gall – phrenology; certain individual differences in intelligence & personality could be measured by noting the bumps & indentations of the skull.

Cont’dCont’dPaul Broca (1861) – found the location

of motor speech; localization of function – maps of the brain that located each major function

Pierre Flourens & Karl Lashley – concept of equipotetiality – although there is certainly localization of brain function, the cortex really functions as a whole rather than isolated units

Cont’dCont’d

Jackson & Luria – functional model; areas of the brain interact with each other to produce a behavior; behavior is a result of several functions or systems of the brain areas, rather than the result of unitary or discrete areas.

Cont’dCont’dNeuropsychological AssessmentPsychological tests were oriented to simple assessment of the presence & absence of brain damage

Ward Halstead – observed people with brain damage in natural settings, & identify specific characteristics of the behavior

Cont’dCont’dHalstead-Reitan Neuropsychological Battery

Luria-Nebraskan Neuropsychological Battery ( 1980)

Flexible battery approach to assessment

Review of the Brain Review of the Brain Structure & FunctionsStructure & Functions

Left Hemisphere – controls the right side of the body; language functions; logical inference; detail analysis

Right hemisphere – controls the left side of the body; visual-spatial skills, creativity, musical activities, perception of direction

Cont’dCont’d

Frontal lobes – executive functions; emotional modulation

Temporal lobes – linguistic expression; reception, & analysis, auditory processing of tones, sounds, rhythms & meanings that are nonlanguage in nature

Cont’dCont’dParietal lobes – tactile & kinesthetic perception, understanding, spatial perception, some language understanding & processing

Occipital lobes – visual processing, visually mediated memory

Cerebellum – motor coordination, control of equilibrium & muscle tone

Cause of Brain DamageCause of Brain DamageTrauma

Concussions – momentary disruptions of brain functioning

Contusions – severe outcome, may be followed by coma & deliriums

Lacerations – serious forms of damage

Cont’dCont’dCerebrovascular accidents ( stroke )

Occulusions – aphasia, apraxia, agnosia

Cerebral hemorrhage – death, paralysis, speech problems, memory & judgment difficulties

Cont’dCont’dTumors – headaches, vision problems, problems in judgment, poor memory, affect problems, or motor coordination

Degenerative disease – severe disturbance in many behavioral areas i.e motor, speech, language, memory, & judgment difficulties

Cont’dCont’dNutritional deficiences – neurological & psychological disorders i.e. Korsakoff’s psychosis

Toxic disorders – brain damage, delirium

Chronic alcohol abuse – deficits in memory formation, emotional regulation, & sensory integration

Consequences & Symptoms Consequences & Symptoms of Neurological Damageof Neurological Damage

Impaired orientationImpaired memoryImpaired intellectual functionsImpaired judgmentShallow & labile affect Loss of emotional & mental resilience

Frontal lobe syndrome

Methods of NAMethods of NA

Major approaches

Standard battery approach or Fixed battery approach

Flexible approach or hypothesis-testing approach

Testing Areas of Cognitive Testing Areas of Cognitive FunctioningFunctioning

Intellectual functioning – WAIS IIIAbstract Reasoning & Memory – WAIS III, WMS

Visual-perceptual Processing – Rey-Osterrieth Complex Figure Test, Block design of WAIS III

Language Functioning – Luria Nebraska

Test batteriesTest batteriesThe Halstead-Reitan Battery – category test, seashore rhythm test, finger oscillation test, speech-sounds, trail-making test, strength of grip test, sensory-perceptual examination, finger localization test, fingertip-writing perception test, tactile form recognition test, aphasia screening test

Cont’dCont’d

Luria-Nebraska Battery – motor functions, rhythm functions, tactile functions, visual functions, receptive speech, expressive speech, writing functions, reading skills, arithmetic skills, memory, intellectual processes

Intervention & Intervention & rehabilitationrehabilitation

Thorough assessment of the patient’s strengths & weaknesses is conducted

Development of the rehabilitation program given the patient’s condition

TrainingTrainingIn addition to training in general clinical psychology, it involves specialized training in theoretical, empirical, and practical aspects of the brain-behavior relationship.

Cont’dCont’d

Education, training, and supervision in Clinical Neuropsychology is available primarily at the postdoctoral level, although preparation begins at the doctoral level.

Be knowledgeableBe knowledgeableHouston Conference Guidelines

Provides an integrated model of professional education and training in Clinical Neuropsychology:

◦General Knowledge Base and Skills◦Doctoral, Internship and Postdoctoral Training Guidelines

◦Continuing Education◦Professional and Scientific Activity◦Subspecialties

DEFINITION OF A CLINICAL DEFINITION OF A CLINICAL NEUROPSYCHOLOGIST NEUROPSYCHOLOGIST (1989)(1989)

A professional psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The Clinical Neuropsychologist is a doctoral-level psychology provider of diagnostic and intervention services who has demonstrated competence in the application of such principles for human welfare following:

Cont’dCont’dA. Successful completion of systematic didactic and experiential training in neuropsychology and neuroscience at a regionally accredited university.

Cont’dCont’dB. Two or more years of appropriate supervised training applying neuropsychological services in a clinical setting. 

C. Licensing and certification to provide psychological services to the public by the laws of the state or province in which he or she practices.  

D. Review by one's peers as a test of these competencies.

*Attainment of the ABCN/ABPP Diplomate in Clinical Neuropsychology is the clearest evidence of competence as a Clinical Neuropsychologist, assuring that all of these criteria have been met.

UNDERGRADUATE FOCUS:

•Psychology coursework and/or major (esp. abnormal, developmental, statistics).

•Biology or behavioral medicine coursework (provides a strong foundation for graduate neuropsychology coursework)

•Research Assistanceship and/or involvement

PRELIMINARY STEP

UNDERGRADUATE TRAINING

SELECTING A GRADUATE SELECTING A GRADUATE PROGRAMPROGRAM

Graduate Schools: University or Professional?

University programs are highly competitive (low selection ratio). Your application will be helped by excellent grades, GRE scores and some previous research experience—preferably, a published paper, if only as a co-author.

Cont’dCont’dProfessional schools are easier

to get into, but they are very expensive. You will have to take out enormous student loans, or you might try to work while studying—perhaps even studying part-time. Also, many professional schools offer primarily the Psy.D. degree, reserving the Ph.D. (if they offer it at all) for a few, select students.

Neuropsychology Track?Neuropsychology Track?Specialization in NP can Specialization in NP can begin at the doctoral level.begin at the doctoral level.

Often, Clinical Often, Clinical Neuropsychology is offered as Neuropsychology is offered as a distinct track in clinical a distinct track in clinical psychology programs, psychology programs, designed to follow APA designed to follow APA Div40/Houston Conference Div40/Houston Conference guidelines.guidelines.

Cont’dCont’dRecognized tracks make it easier to Recognized tracks make it easier to

specialize (existing, easily accessible specialize (existing, easily accessible NP faculty, research labs, clinics, NP faculty, research labs, clinics, on/off campus practical sites, core on/off campus practical sites, core coursework curriculum…).coursework curriculum…).

No Track? That’s OK.No Track? That’s OK. Important to be proactiveImportant to be proactive

Seek out didactics, research and Seek out didactics, research and clinical training opportunities in the clinical training opportunities in the community to be competitive.community to be competitive.

Predoctoral NP Specialty Predoctoral NP Specialty PreparationPreparation

Core Coursework in NP

◦ In addition to the basic Clinical Psychology curriculum, competitive students have completed doctoral level coursework in:

Neuropsychology Assessment Clinical Neuropsychology Behavioral and Clinical neurosciences Behavioral (Clinical) Neurology

(coursework generally includes exposure to functional neuroanatomy, neuropathology, psychopharmacology, neuroimaging, relevant test construction/research, neuropsychology assessment, case conceptualization…)

Predoctoral Clinical Predoctoral Clinical ExperienceExperiencePractical Placement

Hospital (acute inpt, rehab, outpt services)Mental Health Clinics (LD, ADHD, TBI, CVA, MDC)Private Practice

Goal:◦ Exposure to a wide range of diagnoses, tests,

clinical settings, age range, conceptualization style…

◦ Experience conducting interviews, administering comprehensive test batteries, staffing cases, writing reports and working within a multidisciplinary treatment team.

ResearchResearchMany internship sites place a strong emphasis

on research and scholarly interest and “product” (even if you intend to practice as a clinician).

◦National conference attendance and association membership

◦ Journal club participation◦Poster presentations◦Book chapters◦Peer reviewed publications◦Grants

Tendency to prefer applicants who have successfully proposed or defended their dissertation prior to the start of internship.

Goal is to complete the education and training necessary for independent practice of clinical neuropsychology (CN)

Residency is a REQUIRED component in specialty education in CN

The equivalent of 2 years of full-time education and training Residency MUST occur on at least a half-time basis ENTRY criteria:

1. Entrance SHOULD be based upon completion an APA/CPA- accredited doctoral program.

2. Residents WILL have successfully completed an APA/CPA- accredited internship which includes SOME training in CN.

Houston Conference guidelines for postdoctoral training