Brain Therapy Center Brain Injury Therapy

 

 

        Benefits of
        Neuropsychological Assessment
        (Neuropsychological Testing)


        By Harold L. Burke, Ph.D.

         

        Benefits of neuropsychological assessment (neuropsychological testing) and understanding brain-behavior relationships

        Neuropsychological assessment is an evaluation of cognition, mood, personality, and behavior that is conducted by licensed clinical neuropsychologists (clinical psychologists who are specialists in brain-behavior relationships). Such an evaluation usually includes a formal interview, a review of medical and/or educational/vocational records, interviews of significant others (as necessary), and neuropsychological testing using standardized neuropsychological instruments. Particularly unique to this process is that it quantifies a patient’s higher cortical functioning that may include various aspects of attention, memory, speed of information processing, language, visuospatial ability, sensory processing, motor ability, higher-order executive functioning, and intelligence.

        Such an assessment offers several benefits:

        • Often neuropsychological assessment will aid in the proper and accurate diagnosis of the patient’s illness and/or the etiology of symptoms. This has obvious implications for proper medical care. Moreover, Dr. Burke has found in his clinical practice that patients are usually relieved to learn what is actually wrong with them. This is the case even when the news is rather dire and the implications are serious. On the other hand, in some cases the assessment shows that the patient’s brain is not as impaired as the patient had feared and that symptoms may be relieved by following recommendations provided in the report.    
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        • Even if the etiology is known, such assessment quantifies the severity of impairments and provides objective measures of aspects of cognition, emotions, personality, and behavior. The assessment is often invaluable, particularly in cases of suspected progressive deteriorating illness (e.g., Alzheimer’s Disease) in which repeated assessments may be conducted to document either further decline or remission. In addition, the detail and the quantification provided by a neuropsychological assessment (made possible by sophisticated psychometric measurements) often allow more accurate prognoses and better decision-making by the patient, the family, and other medical professionals who treat the patient.
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        • Such an assessment provides many details about the strengths and weaknesses of the patient that in turn can help the patient and/or family to learn how to cope with problems or even decrease symptoms. Such information can help the patient, physicians, and family to decide if rehabilitation is a good option and, if so, what the exact details of the program should be.
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        • Neuropsychological assessment is very often one of the most critical pieces of evidence in forensic settings when the existence or extent of brain injury is relevant to the facts or disposition of a case. This can be especially critical in cases of traumatic brain injury in which neuroimaging fails to show brain damage but the neuropsychological assessment reveals significant impairments. Conversely, such assessment may reveal that an individual in litigation is malingering (faking brain impairment) for external gain. This type of diagnosis is made possible by the use of validated assessment instruments and specific patterns of test results that have been found to suggest malingering.

        How long does neuropsychological assessment take?

        Actual testing of the patient can take from 6 to 12 hours if a comprehensive evaluation is required and logistically feasible. However, less intensive screenings may take less time. In addition, extra time is required for the neuropsychologist to review records, score tests, interpret test results, make diagnostic formulations, and write a formal report. Due to these additional tasks, it is common and acceptable practice to charge one additional hour for every hour of actual time spent with the patient.

        Do insurance companies cover neuropsychological assessment?

        Very often such assessment is covered under health insurance plans although the determination of coverage depends on the actual policy. Importantly, it is always a good idea to check first with the patient's insurance carrier to make sure such assessment is covered and to what degree. When checking, a person should make sure to ask if there are any limits on how many hours per day the policy covers. If the policy only covers one hour per day and if the insured hopes to be reimbursed to the allowable maximum for services, that information needs to be communicated to the neuropsychologist at the beginning of the assessment so that proper scheduling of testing can be planned. Some policies also require pre-authorization that sometimes also means getting a referral from a physician. These procedures are sometimes required because neuropsychological assessment can be very complex and time intensive, and the insurance company wants to make sure that it is medically justified.

        Do the patient and/or family members get the results of the assessment?

        At the Brain Therapy Center, the patient and/or family members almost always get the results of the assessment directly from Dr. Harold Burke, the neuropsychologist and the Director of the Brain Therapy Center. The assessment results entail a session that typically lasts from one to two hours in which the doctor goes over the major findings of his formal report in language that the patient and family can understand. He makes recommendations and answers questions about the results and the implications of his findings. He usually gives a copy to the patient and the family. Of course, the family is only invited to this session if the patient desires since the information is protected under confidentiality and new HIPPA laws. Exceptions occur with incompetent patients or patients who Dr. Burke deems are not capable of understanding the results or who would be so adversely affected by hearing the results that harm would come to them. These exceptions are quite rare as some information usually can and should be given directly to the patient whenever possible. On some occasions when patient incompetence is involved, two sessions will be conducted, one with the patient and the other with the conservator(s). Dr. Burke takes great care and time in these feedback sessions as he wants the results to be given with compassion and sensitivity. Patients and/or family members usually ask many questions and experience a myriad of emotions.

           

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