Recommendations for Driving After Neuropsychological Assessment: A Survey of Neuropsychologists

Objective: To determine which patient, provider and practice-related characteristics are associated with increased likelihood of driving-related recommendations following a neuropsychological evaluation.

Method: A total of 309 clinical neuropsychologists completed a survey evaluating the frequency with which they made various driving-related recommendations (e.g., take an on-road driving test) to a variety of clinical populations. Information regarding patient characteristics (e.g., perceived likelihood of adhering to recommendations), provider-related characteristics (e.g., years in practice) and practice-related characteristics (e.g., region of North America) were also collected. Correlation coefficients and multiple linear regressions controlling for patient diagnoses were used to examine which characteristics predicted greater likelihood of driving recommendations broadly. Significant characteristics were then entered into regressions to examine independent contributions of each characteristic to the likelihood of each individual driving recommendation.

Results: Neuropsychologists reported giving a range of driving recommendations to most clinical populations, with the exception of patients with psychiatric diagnoses. Several characteristics (e.g., patient impairment) were associated with greater likelihood of driving recommendations broadly. After controlling for diagnoses, three significant predictors emerged: higher frequency of individualized recommendations, greater caregiver presence, and greater number of recommendations given. All three characteristics generally predicted frequency of all individual driving recommendations.

Conclusions: While patients’ diagnoses may be indicative of whether they receive driving-related recommendations, certain patient and provider-related factors also uniquely contribute to the likelihood of driving-related recommendations after neuropsychological assessment.     

Neuropsychological Consultation with School Personnel: What Clinical Neuropsychologists Need to Know

Schools request consultation from neuropsychologists employed outside the school setting to enhance assessment and intervention for children with neurological, medical, and psychological conditions. The legislative and administrative parameters governing special education services for exceptional children most pertinent to the consulting neuropsychologist are examined. The role of the school-based multidisciplinary team in determining eligibility for special education is discussed. Potential roles for the clinical neuropsychologist on the school-based team and approaches to interprofessional collaboration between clinical neuropsychologists and school psychologists are presented. Reimbursement for services and ethical considerations are also discussed.     

Neuropsychological Assessment of Individuals with Expressive Disabilities in Addition to Traumatic Brain Injuries

Little empirical research has examined guidelines for neuropsychological assessment of people with severe physical and sensory disabilities. This study focused on people with expressive disabilities—people unable to speak, write, draw, or manipulate test materials. Measures were selected and adapted to be suitable for the assessment of cognitive functioning for such people. Responses were selected from multiple choice answers or were spelled out on an alphabet board. Individuals with expressive disabilities in addition to traumatic brain injuiry (TBI) were compared to individuals with TBI alone and a normative group. The measures were generally found to be reliable and valid assessment instruments. Individuals with expressive disabilities were able to manage the task requirements of the adapted tests. The results provided support for the adaptations trialed.     

Applications of Technology in Neuropsychological Assessment

Most neuropsychological assessments include at least one measure that is administered, scored, or interpreted by computers or other technologies. Despite supportive findings for these technology-based assessments, there is resistance in the field of neuropsychology to adopt additional measures that incorporate technology components. This literature review addresses the research findings of technology-based neuropsychological assessments, including computer- and virtual reality-based measures of cognitive and functional abilities. We evaluate the strengths and limitations of each approach, and examine the utility of technology-based assessments to obtain supplemental cognitive and behavioral information that may be otherwise undetected by traditional paper-and-pencil measures. We argue that the potential of technology use in neuropsychological assessment has not yet been realized, and continued adoption of new technologies could result in more comprehensive assessment of cognitive dysfunction and in turn, better informed diagnosis and treatments. Recommendations for future research are also provided.     

Minimal Neuropsychological Assessment of MS Patients: A Consensus Approach

Cognitive impairment is common in multiple sclerosis (MS), yet patients seen in MS clinics and neurologic practices are not routinely assessed neuropsychologically. In part, poor utilization of NP services may be attributed to a lack of consensus among neuropsychologists regarding the optimal approach for evaluating MS patients. An expert panel composed of neuropsychologists and psychologists from the United States, Canada, United Kingdom, and Australia was convened by the Consortium of MS Centers (CMSC) in April, 2001. Our objectives were to: (a) propose a minimal neuropsychological (NP) examination for clinical monitoring of MS patients and research, and (b) identify strategies for improving NP assessment of MS patients in the future. The panel reviewed pertinent literature on MS-related cognitive dysfunction, considered psychometric factors relevant to NP assessment, defined the purpose and optimal characteristics of a minimal NP examination in MS, and rated the psychometric and practical properties of 36 candidate NP measures based on available literature. A 90-minute NP battery, the Minimal Assessment of Cognitive Function in MS (MACFIMS), emerged from this discussion. The MACFIMS is composed of seven neuropsychological tests, covering five cognitive domains commonly impaired in MS (processing speed/working memory, learning and memory, executive function, visual-spatial processing, and word retrieval). It is supplemented by a measure of estimated premorbid cognitive ability. Recommendations for assessing other factors that may potentially confound interpretation of NP data (e.g., visual/sensory/motor impairment, fatigue, and depression) are offered, as well as strategies for improving NP assessment of MS patients in the future.     

The Prevalence of Seizure Types among Individuals Referred for Phase I Neuropsychological Assessment: Demographic and Neuropsychological Characteristics

The prevalence of seizure types among the subpopulation of patients referred for phase I neuropsychological assessment likely differs from the prevalence of specific seizure types within the general seizure population. Understanding the prevalence of clinical diagnoses is critical to maximizing the predictive value of any assessment or diagnostic technique, clinical neuropsychological assessment of patients with seizures being no exception. Data from a series of 835 patients referred for phase I neuropsychological evaluation are used to report the prevalence of specific seizure types, as well as neuropsychological and demographic characteristics. Considerations for clinical neuropsychological research and practice are briefly discussed.