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Macniven - Neuropsychological formulation: a clinical casebook

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Macniven Neuropsychological formulation: a clinical casebook
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Neuropsychological formulation: a clinical casebook: summary, description and annotation

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The interface of neuroimaging with neuropsychological findings in traumatic brain injury / Erin D. Bigler -- The role of cognitive neuropsychology in clinical settings : the example of a single case of deep dyslexia / Roberto Cubelli, Silva Pedrizzi and Sergio Della Sala -- A case of traumatic brain injury in adolescence, complicated by a history of premorbid learning difficulties and significant social concerns / Emily Talbot -- All in the family : Huntingtons disease, variability and challenges for clinical neuropsychology / Lynette J. Tippett and Virginia M. Hogg -- Neuropsychological aspects of temporal-lobe epilepsy : seeking evidence-based practice / Stephen C. Bowden, Leonie C. Simpson and Mark J. Cook -- Neuropsychological assessment of medico-legal capacity in the New Zealand context / Kay L. Cunningham -- Neuropsychological assessment of an American Indian with a ruptured right carotid aneurysm and associated subarachnoid hemorrhage / Vicky T. Lomay and George P. Prigatano -- Paediatric neuropsychological formulation of a traumatic brain injury with special reference to culture / Cathy Grant and Arleta Starza-Smith -- An integrative approach to differential diagnosis of subarachnoid haemorrhage and Korsakoffs dementia / Martha Sorensen -- Themes in the formulation of repeat assessments / Patrick Vesey and Robert D. Stephens -- Decisional capacity in the traumatically injured / Christina Weyer Jamora and Ron Ruff -- Educational disengagement following mild traumatic brain injury in childhood / Ingram Wright -- Cognitive neuropsychological formulation / Greg Savage.;This forward-looking reference defines and illustrates the process and themes of formulation in neuropsychology and places it in the vanguard of current practice. The book explains the types of information that go into formulations, how they are gathered, and how they are synthesized into a clinically useful presentation describing psychological conditions resulting from neurological illness or injury. Cases highlight the relevance and flexibility of narrative- and diagram-based formulation methods in approaching a diverse range of issues and conditions, from decisional capacity to cultural considerations, Huntingtons disease to deep dyslexia. Throughout this volume, formulation is shown as integral to treatment and rehabilitation planning alongside clinical assessment, cognitive testing, and diagnosis. Included among the topics: The interface of neuroimaging with neuropsychological findings in traumatic brain injury. Neuropsychological aspects of temporal-lobe epilepsy: seeking evidence-based practice. An integrative approach to differential diagnosis of subarachnoid hemorrhage and Korsakoffs dementia. Educational disengagement following mild TBI in childhood. Themes in the formulation of repeat assessments. Cognitive neuropsychological formulation. Formulation is essential in good neuropsychological assessment as it provides the foundation for appropriate intervention by bringing together the results of different evaluations into a coherent whole. ... Macnivens compelling and constructive book has assembled internationally known experts from diverse backgrounds to provide illumination of their own views and approaches to formulation, which makes the book a pleasure to read and should establish it as essential reading on clinical psychology and neuropsychology training courses. - Professor Barbara A. Wilson OBE, Ph. D., D. Sc. Neuropsychologists, clinical psychologists, and rehabilitation specialists will find Neuropsychological Formulation of critical importance not only to the literature of the field, but also to the developing role of clinical neuropsychology within healthcare systems.

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Editor and Authors 2016
Jamie A.B. Macniven (ed.) Neuropsychological Formulation 10.1007/978-3-319-18338-1_1
1. The Interface of Neuroimaging with Neuropsychological Findings in Traumatic Brain Injury
Erin D. Bigler 1, 2, 3, 4, 5
(1)
Department of Psychology, Brigham Young University, 1001 SWKT, 84602 Provo, UT, USA
(2)
Neuroscience Center, Brigham Young University, 1001 SWKT, 84602 Provo, UT, USA
(3)
Magnetic Resonance Imaging Research Facility, Brigham Young University, 1001 SWKT, 84602 Provo, UT, USA
(4)
Department of Psychiatry, University of Utah, 1001 SWKT, 84602 Salt Lake City, UT, USA
(5)
The Brain Institute of Utah, University of Utah, 1001 SWKT, 84602 Salt Lake City, UT, USA
Erin D. Bigler
Email:
Keywords
Neuroimaging Forensic neuropsychology Traumatic brain injury Biomarkers
Neuropsychological assessment provides the psychometric framework to identify the neurobehavioral and neurocognitive consequences of a traumatic brain injury (TBI) . Neuropsychological assessment has a long tradition as a stand-alone method to characterize the level and degree of impaired functioning from TBI. However, twenty-first century advanced neuroimaging procedures are now available, which provide anatomical and functional details about the brain, the nature of potential pathologies, and their influence over time (Bigler ) points out for neuropsychology to embrace twenty-first century technologies it needs to integrate the available neuroinformatics, the most important of which may be the information contained in neuroimaging studies.
The TBI case presented herein outlines some of the neuroimaging methods and findings that could routinely be incorporated into the neuropsychological assessment.
Case
The patient was a 63-year-old truck driver involved in a head-on collision caused by another semi travelling at highway speeds that had lost control, coming from the opposite direction. As a consequence of the severity of the collision and vehicular damage an extended extrication was required. The patient was found unconscious by highway patrol and eyewitness accounts with obvious trauma to the head including extensive facial lacerations, bleeding, and multiple other injuries including an initially compromised airway. At the scene, the Glasgow Coma Scale (GCS) of the patient was rated as 7/15 by emergency medical service as the patient was being extricated, which was also the emergency department (ED) GCS score before sedation and intubation. Day-of-injury (DOI) CT imaging documented multiple intraparenchymal petechial hemorrhages, consistent with diffuse axonal injury (DAI); some of which are shown in Fig. ). The patient received limited inpatient rehabilitation, which included cognitive rehabilitation by a speech therapist.
Fig 11 Axial day-of-injury CT scan showing the location of two of several - photo 1
Fig. 1.1
Axial day-of-injury CT scan showing the location of two of several petechial hemorrhages right at the graywhite matter junction ( white arrow , right ) in the left frontal lobe and right internal capsule ( red arrow , left ) adjacent to the globus pallidus, common findings associated with traumatic shear lesions (Gean and Fischbein )
Five Months Post-Injury
The patient was seen on two occasions for neuropsychological consultation, 5 months and 2 years post-injury. Litigation was present as the accident was caused by the other truck driver, but was settled out of court. Due to persisting memory complaints, he was evaluated approximately 5 months post-injury to assist in treatment planning. When initially seen, the patient complained of short-term memory problems and moodiness, corroborated by the spouse. From a self-report perspective, he described his problems with mood by stating My wife thinks I have a short fuse. He characterized his memory problems as forgetfulness. He was still receiving physical therapy for residual deficits in motor and balance function as well as cognitive rehabilitation when initially assessed. He continued to experience posttraumatic headaches on a regular basis and described a moderate headache on the day of neuropsychological assessment.
By mental status standards the patient was doing well. He was fully oriented, appropriately engaged in conversational speech without any notable impairment in fluency or prosody, and had no difficulty remembering four words on immediate recall. Although he perceived maladroitness with motor skills, they were not outwardly evident. Mental status exam was considered to be rather unremarkable.
Consistent with the rather unremarkable mental status examination the neuropsychological findings, summarized in Table ). The combination of slowed processing and attentional problems can be disruptive to working memory, especially when competing stimuli are present in the natural environment.
Table 1.1
Wechsler Abbreviated Scale of Intelligence (WASI)
5 months post-injury
Standard score
Percentile
Verbal IQ
Performance IQ
Full scale
2 years post-injury
Verbal IQ
Performance IQ
Full scale
5 months post-injury
Seconds
z-score
Trails A
2.8
Trails B
1.0
2 years post-injury
Trails A
0.02
Trails B
0.05
California verbal learning test
Trials
T-B
S-Free
S-Cue
L-F
L-Cue
5 Months post-injury
Raw score
2.0
0.0
1.0
1.0
0.00
43 (T)
1.5
0.5
1.0
1.0
1.5
2 Years post-injury
Raw score
z-score
0.05
0.05
0.00
0.5
0.5
48 (T)
1.0
0.5
0.5
3.0
0.5
On self-report questionnaires, including the Beck Depression Inventory, Symptom Checklist-90, and Personality Assessment Inventory, the patient reported mild to moderate levels of depression. At this point he had not been receiving any mental health intervention, including no pharmacotherapy. In light of these emotional findings, treatment recommendations including psychiatric and psychotherapy referrals were made.
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