What is a Neuropsychologist?
Most people know what a psychologist is. However, most people do not know that, other than an MRI that scans brain structures, one of the most vital instruments to measure the presence, or the extent, of a brain injury, is neuropsychological testing. In many serious accident claims, lawyers will often call a neuropsychologist to give expert evidence about their client’s injuries, ability to work and future treatment costs.
Neuropsychology is the study of the relationship between brain function, and behaviour, emotion and cognition. For this reason, many individuals with head injuries or other serious injuries that have resulted in changes in thinking and behaviour, will often be assessed by a neuropsychologist.
Cognitive (brain) changes are not always the result of a blow to the head or other type of acquired brain injury. Diminished oxygen to the brain (“hypoxia”), strokes, and blood loss (as blood transmits oxygen) are also events that may result in changes to brain function, such as behavioural and emotional changes, memory changes, difficulties with understanding and interpreting information, etc. Mood and substance disorders, such as anxiety and depression, can also have an impact on cognitive function. Chronic pain conditions and medications – alone or together – can also alter a person’s ability to think, behave and process emotions in the same way they did before their accident.
An MRI or CT scan may show evidence of a brain injury such as swelling, bleeding or shearing. When this type of evidence is absent, but an injured person nonetheless complains of difficulties with thinking (memory, problem-solving, word-finding, organization), their lawyer may arrange for a neuropsychologist to see the person. A neuropsychologist is a special type of psychologist who has the training and expertise to conduct an assessment that will measure impairments to brain functioning and, at times, identify a cause or multiple causes – a mild concussion, for example, or a combined effect of mild concussion, chronic pain and depression.
A neuropsychological assessment includes an interview component, where the individual is asked questions by a psychometrist and/or the individual is asked to complete a self-reporting questionnaire. The other component involves the completion of standardized tests, administered by the neuropsychologist. The entire assessment can take up to a full day; some individuals, such as those with severe brain injuries, need to take a break or frequent breaks, in which instance the assessment may be completed over a number of days.
The interview portion of the assessment may be difficult for the individual who has severely impaired cognitive functioning. Family members may be required to assist, particularly with details about the person’s past academic and medical history.
The type and description of these standardized tests is beyond the scope of this article. Some of the tests can include:
- The Beck Depression Inventory
- California Verbal Learning Test
- Controlled Oral Word Fluency Test
- National Adult Reading Test
- Pain Catastrophizing Scale
- Wechsler Adult Intelligence Scale-IV
- Wechsler Memory Scale-III
Generally, the standardized tests measure the person’s general intellectual functioning and place it within a percentile rank. This will be measured and compared against the person’s pre-accident academic and occupational achievements. The balance of the tests will measure attention/concentration and processing speeds, speech-language abilities, memory and new learning abilities, sensory-motor function (manual dexterity, speed and performance with both hands), and executive functioning. Where the person has been in an accident there is usually a pain assessment and an assessment of his/her emotional functioning.
Your lawyer will have provided the neuropsychologist with a brief of all medical, educational, employment and psychological documentation in advance.
The results of the neuropsychological assessment are helpful and informative for a number of purposes, namely:
- It may provide a diagnosis, such as brain disease, depression or post-concussion syndrome.
- Where the injured person is involved in litigation, it will provide insight about the cause of the person’s difficulties with thinking, i.e. the cause of his/her cognitive impairment, particularly where brain scans have been normal.
- It will provide further information about the extent of the person’s cognitive impairments, and identify specific areas of cognitive functioning that may be more impaired than others, i.e. the person may have specific difficulties with verbal memory, or suffer from an overall executive function disorder.
- The neuropsychologist will suggest rehabilitative and treatment options for the individual, i.e. occupational therapy or psychotherapy.
- Where the injured person has stopped going to school or stopped working, the neuropsychologist may provided an opinion as to whether the person’s impairments will impede useful functioning at school or at work, and may suggest alternatives to the person’s pre-accident career path. This in turn will have an impact on the person’s loss of income claim.
- Where the person was injured in a motor vehicle accident, the findings may lend themselves to a conclusion – along with other available medical evidence – that the person has sustained a Catastrophic Impairment
Following the neuropsychological assessment, the neuropsychologist may provide a feedback session for the person and his/her family. The neuropsychologist will also write a comprehensive report, summarizing the test findings and answering questions the lawyer may have about treatment options, future prognosis and ability to work. Typically, the lawyer will share the neuropsychological assessment with the client’s other treating health care practitioners while also filing the assessment as an “expert report” at trial.