The fields of clinical and experimental neuropsychology have been useful in solving a number of practical problems as well as more theoretical ones. For example, clinical neuropsychological procedures have been applied in the assessment and treatment of individuals suspected of having Alzheimer's disease. This disease is difficult to confirm unless a sample of brain is removed and inspected microscopically, a procedure that is quite invasive and is rarely attempted until after the patient's death. Neuropsychological test procedures have contributed dramatically to the accurate diagnosis of Alzheimer's disease without the use of invasive measures such as surgery.
Typically, a series of memory, language, perceptual, and problem-solving tasks are given to the individual when the disease is first suspected. The patient is then tested serially at six-month intervals, and the overall pattern of test scores across time is evaluated. If the patient tends to display a decre-mental pattern of performance across two or more cognitive domains (for example, memory and language), a diagnosis of dementia is supported.
Along with the measurement of various cognitive functions, neuropsy-chology also seems particularly equipped to investigate other aspects of the disease. While a patient's performance on a test battery is helpful, other features must be examined in diagnosing the disorder. For example, depression, hallucinations, delusions, and verbal or physical outbursts are often common with the disease. Conversely, the appearance of certain other signs or symptoms make a diagnosis of Alzheimer's disease unlikely. Because of this diverse collection of psychological and behavioral symptoms, clinical neuropsychology may be the best manager of services for these patients.
A second application of neuropsychological techniques concerns the recent surge in rehabilitation efforts with the brain-injured. Many individuals who have sustained an injury to or have a disease of the brain have great difficulty returning to their premorbid jobs or avocations. Neuropsychological rehabilitation attempts to assist these patients with ongoing cognitive difficulties as they reenter the work and home settings. Very often, people who have brain injuries do not have problems with all cognitive domains but rather with a select few (for example, attention or language). Because of this selective impairment, clinical neuropsychologists can focus their efforts on improving an individual's attentional abilities or use of language.
A specific example of neuropsychological rehabilitation can be seen in the case of an individual who has been involved in a motor vehicle accident. These patients tend to sustain primary damage to the frontal aspects of the brain because they withstand the initial impact. Damage to the frontal re gions normally produces individuals who are very unaware of their surroundings. Furthermore, they typically lack appropriate social skills as well as planning and organizational abilities. These abilities can be improved, however, if the patient works with a neuropsychologist who knows what to expect, based on the exact area of damage.
Generally, rehabilitation involves intensive exposure to the problematic cognitive task. In the case of a patient with damage to the frontal area of the brain, this might entail placement in a group situation in which the patient practices social skills. Specific activities might include working on conversation skills, role-playing a job interview or asking for a date, or working on a group project. Individual sessions with the patient might be better suited for the treatment of the organizational and planning deficits experienced by frontal patients. Here, the neuropsychologist might teach the patient to use a diary to plan the week's activities and learn to solve problems to get things done.
While neuropsychologists often assist patients in acquiring compensation strategies to work around their particular difficulties, there are other rationales for rehabilitative efforts. Many researchers and psychologists believe that practicing the impaired function assists the repairing brain in doing that task. There appears to be a six- to twelve-month period immediately after a brain injury when the brain is developing pathways around the damaged tissue. Many believe that during this critical period, it is important to engage the patient in activities that were most compromised by the injury. Thus, if the injury took a major toll on memory abilities, the patient should be exposed to exercises and activities that demand he or she remember things.
In general, neuropsychology has tremendous applied value for persons who have sustained a neurological insult such as a stroke or brain injury. Furthermore, it is useful in the initial assessment and accurate diagnosis of a given neurological disorder, as well as in the continued care and treatment of individuals with known brain pathology.
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