Key role of neuropsychological assessment



image: A study coordinated by Dr Lucia W. Braga of the SARAH Network of Rehabilitation Hospitals shows neuroplasticity after intensive rehabilitation from a massive stroke in the left hemisphere that severely affected speech and speech function. language. The clinical improvement in communication was reflected in the neurostructural enhancement of white matter in the right hemisphere, as shown in MRI images of the brain before and after the procedure.
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Credit: Lucia W. Braga – SARAH Network of Rehabilitation Hospitals.

Amsterdam, Netherlands, October 6, 2021 – Neuropsychological assessment is an integral part of the rehabilitation of people with a history of neurological illness or injury. In this thematic issue of NeuroRehabilitation, international experts discuss its clinical and therapeutic applications, performance and symptom validity.

Neuropsychology integrates information from various health and behavioral sciences to produce a refined and comprehensive clinical picture that informs cognitive performance, diagnostic probabilities, and rehabilitation interventions. A neuropsychological assessment measures how well a person’s brain is functioning. Abilities tested include reading, language use, attention, learning, processing speed, reasoning, memorization, problem solving, mood and personality.

This thematic issue on clinical and therapeutic applications of neuropsychological assessment is edited by Daniel Klyce, PhD, ABPP, Central Virginia VA Health Care System; Virginia Commonwealth University Health System and Sheltering Arms Institute, Richmond, Virginia, USA; Ana Mills, PsyD, Virginia Commonwealth University Health System, Richmond, Virginia, USA; and Paul Dukarm, PhD, Virginia Commonwealth University Health System, Richmond, VA, USA.

“Neuropsychological assessments and interventions are designed to promote a person’s health and well-being, maximize function and promote independence,” the guest editors explained. “The field continues to demonstrate that neuropsychological practice is more than just a one-time assessment of a person’s abilities; it is a dynamic process that brings significant meaning to holistic treatment programs.

These articles demonstrate the great value that neuropsychological assessment brings to the science and practice of neurorehabilitation and to a better understanding of how individuals perform cognitive tests and how their brains respond to certain types of interventions designed to treat neurocognitive dysfunction. For example, modifying existing tests or adapting them to different contexts can provide new information about a person’s abilities or recovery potential.

The contributing researchers and clinicians are international experts in the validity of performance and stress testing, the growing role of neuroimaging in neurorehabilitation, and the clinical and therapeutic applications of neuropsychological assessment.

Two articles discuss performance validity testing (PVT), which the National Academy of Neuropsychology and the American Academy of Clinical Neuropsychology identify as a standard of practice in neuropsychological assessment. A study illustrates the use of PVTs in the context of telehealth, with particular applicability to the COVID-19 pandemic during which teleneuropsychology has rapidly evolved. This gives validity to screening for DVT over the phone, an important finding for the future use of teleneuropsychology in rehabilitative care. Another article presents a compelling argument for researchers and practitioners to view PVT performance on a continuum, rather than a dichotomous pass / fail outcome. “This perspective is an important step towards a more nuanced interpretation of an individual’s performance across tests,” commented co-editor Daniel Klyce.

Two contributions cover advanced efforts to improve understanding of neurocognitive performance and patterns of functioning through neuropsychological assessment, including an assessment of a symbol digit modality test (MTDS) adapted depending on the modality of answer is written or oral. Although the accuracy was not affected by the response modalities adapted for the MTDS, the efficiency of performance among those who provided written responses was significantly affected.

“These findings will inform ongoing efforts to address the limitations of the MTDS, a test that is an essential part of neuropsychological assessment in people with a history of neurological illness or injury,” noted co-editor Ana Mills.

The second article describes a unique association between the duration of post-traumatic amnesia (PTA) and memory impairment in people with a history of moderate to severe head trauma (TBI). Investigators found a persistent association between the duration of ATP and delayed verbal recall in the chronic phase of recovery from TBI.

Several articles explore the link between neuropsychology and neuroimaging, such as the application of quantitative radiographic technology to neurorehabilitation. A clinical commentary on the concept of plasticity from a neurorehabilitation perspective uses imaging to demonstrate that advances in neuroimaging are relevant to the future development of neuropsychological rehabilitation. “Advances in neuroimaging appear poised to lend considerable interpretive or predictive power to neuropsychological assessment,” said guest co-editor Paul Dukarm.

The issue ends with four articles that demonstrate the therapeutic value of integrating neuropsychological assessment into the rehabilitation treatment process. Studies illustrate the utility of neuropsychological measures in evaluating new rehabilitation interventions, particularly for computerized interventions that have seen a marked increase in their use during the COVID-19 pandemic; the role of neuropsychological assessment and intervention in a return-to-drive program for people with a history of brain injury, which is a significant rehabilitation goal for many people; a formal and evidence-based approach to integrate psychotherapeutic techniques into neuropsychological assessment throughout the rehabilitation process; and an integrative cognitive rehabilitation psychotherapy model that provides a framework for applying empirically supported therapeutic interventions across a range of theoretical orientations and in a biopsychosocial approach including cognitive, spiritual and cultural factors.

“Taken together, the articles in this issue demonstrate the breadth and depth of clinical neuropsychology’s contribution to the neurorehabilitation process,” explained the guest editors. “While some topics represent a nuanced examination of perennial discussions, such as the use of performance validity tests, other topics offer explorations of emerging science. “

The guest editors point out that more research is needed to bridge the gap between neuroimaging, neuropsychological test performance, and intervention methods among demographically diverse populations with neurological disease or injury. Understanding how these findings correspond to the day-to-day functioning of patients in their environment and communities will continue to be important work for the field of neurorehabilitation.

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