The purpose of this study was to determine if the Glasgow Coma Scale (GCS) provides a valid indication of severity after closed head injury. A second purpose was to determine the nature of the deficits seen with head injured persons shortly after injury.The subjects were 69 patients ages 13 through 26 selected from consecutive closed head injury admissions to a large acute care hospital. The subjects received comprehensive neuropsychological testing after having passed the Galveston Orientation and Amnesia Test.Two a priori hypotheses were specified for each of eight neuropsychological test groupings (i.e., motor, memory, visuographic, achievement, abstraction and concept formation, language, problem solving, and psychometric intelligence). For each of the eight test groupings two, one-way multivariate analyses of covariance (MANCOVA) were used to determine statistical significance. Premorbid IQ was used as a covariate in all of the analyses. Specifically, these a priori contrasts were GCS group (8 compared with GCS group 9-15 and GCS group 9-12 compared with GCS group 13-15. Each of the significant MANCOVA tests was followed with discriminant analysis.The results revealed that 15 out of the 16 null hypotheses were rejected (p<.05 or less) thus providing clear evidence for the usefulness of the GCS as an indicator of the severity of injury. Most notable of the results is that the GCS group comparison of 9-12 and 13-15 reached significance in seven of the eight comparisons. Given this finding, there seems justification for the GCS division of 9-12 denoting a moderately injured group and 13-15 denoting a mildly injured group as was proposed in previous research. Redundancy indexes of 6% to 25% were obtained which indicated small to relatively large effect sizes for the various criterion variates.With discriminant analysis it was determined that accurate classification into GCS groups could be achieved in 64% to 94% of the cases based upon a combination of premorbid IQ and the criterion variates. This represented an increase in classification accuracy of from 13% to 51%to be over what could be accomplished with knowledge of the premorbid IQ alone. The motor test composite, problem solving test composite and abstraction and concept formation composite revealed the highest rates of reclassification.

Among the goals of the neuropsychological assessment are to detect the presence of brain damage, localize which areas of the brain may be dysfunctional and describe subsequent functional impairments. The sensitivity of neuropsychological instruments in carrying out these functions is a question of some debate. The purpose of this study is to determine the utility of lateralizing indicators from the WAIS-III, McCarron Assessment of Neuromuscular Development (MAND) and Haptic Visual Discrimination Test (HVDT), from the McCarron-Dial System Neuropsychological Assessment Battery (MDS), in ascertaining the presence or absence of brain damage as well as location of lesion. The classification accuracies of using performance level indicators from these tests and lateralizing indicators, alone and together, were compared.

To date, no research exists examining criterion-related validity of alternate, computerized forms of the Category Test. The intent of this study was to address criterion-related validity of three full forms of the Category Test. In that, the goal was to examine equivalency of each version in their ability to differentiate brain-injured from non-brain-injured individuals. Forty-nine (N = 49) healthy adults and 45 (N = 45) brain-injured adults were tested using three versions of the Category Test, the BDI, and the WAIS-R NI. ANOVA indicated no significant differences between versions of the Category Test or an interaction between Category Test version and group membership on the total error score. MANOVA performed between versions of the Category Test and Subtest error scores indicated significant differences between versions on Subtest 3 and Subtest 6. Group membership (brain-injured v. non-brain-injured) produced a significant main effect on all subtests of the Category Test except Subtest 2. Several exploratory analyses were performed examining the relationship between neuropsychological impairment, group membership based on Category Test error scores, and the WAIS-R NI. Clinical applications, such as the use of serial testing to index neurorehabilitation gains, were discussed.

This study examined the effectiveness of cautioning and education on simulating a mild traumatic brain injury on several neuropsychological measures. The measures used included the Word Memory Test (WMT), Wechsler Adult Intelligence Scales® - Third Edition (WAIS®-III), Wechsler Memory Scales®-3rd Edition instrument (WMS®-III), 16-item version of the Rey Memory Test, and a self-report symptom checklist. Five experimental groups were used including clinical and non-clinical controls, as well as three simulation groups. The design and implementation of this study also attempted to correct several methodological short comings of prior research by increasing the incentives for participants, expanding the generalizability of findings and examining research compliance and participant self-perception through debriefing. Discriminant analysis was utilized to determine if specific functions existed that would correctly classify and distinguish each experimental group. Several discriminant functions had at least moderate canonical correlations and good classification accuracy. Results also include utility estimates given projected varying base rates of malingering.

Reitan and Wolfson's General Neuropsychological Deficit Scale and Left and Right Neuropsychological Deficit Scales were applied to Halstead-Reitan test data of individuals with psychotic or substance abuse disorders with and without a head injury.

The Embree/Butler scoring system served as criterion for ascertaining brain dysfunction on the protocols of 100 subjects--50 had been diagnosed by health professionals as having brain dysfunction, and 50 had been diagnosed as having no brain dysfunction. In comparing the hospital's diagnoses with those of the Embree/Butler method, the data strongly supported the hypothesis that the Embree/Butler scoring system did effectively discriminate (chi square of 77.99 < .01) between those with organic brain syndrome (or cerebral dysfunction) and those with psychiatric classification. A point-biserial correlation was used to distinguish the relationship between diagnosis and the score. A cutoff score of above 14 produced the least false-negative or false-positive evaluations.

Alexandria Luria's approach to neuropsychological assessment and his theory of brain functioning have been exploited in order to develop a neuropsychological evaluation procedure for children which incorporates a conceptualization of brain-behaviour development. Luria's Neuropsychological Investigation for adults was administered to intact children aged eight to 14 years in order to ascertain which tasks were beyond their capabilities. These were then adapted or deleted. The adapted version of the protocol was then administered to a second group of intact children to determine that the proposed adaptations were appropriate. This process was guided by the results of a statistical analysis which revealed significant findings with respect to age, socioeconomic status, and task performance. A model of brain-behaviour development and interpretive protocol were devised. Together these provide a conceptual and interpretive framework for the battery. Developmental trends which emerged whilst developing Luria's Neuropsychological Investigation for Children (LNI-C) were consistent with the progressive development of successively more complex forms of information processing as depicted in this model. They were also in keeping with prominent developmental theories such as those of Piaget and Vygotsky. These trends revealed that children made most mistakes on adult LNI tasks involving abstract reasoning, the simultaneous synthesis of data, and complex goal-directed behaviour - all of which apparently reflect tertiary cortical zone functioning. Fewer mistakes were related to a lack of training and inability to process the same quantity of information as adults - difficulties which seemed related to secondary zone functioning. None of the mistakes made appeared to reflect subcortical or primary zone functioning. The LNI-C was applied to brain-damaged children who had had a CT scan in order to demonstrate its application and the hypothetico-deductive process of interpreting findings using the concepts of syndrome analysis and double dissociation. The LNI-C findings were consistent with the general pattern of symptoms Luria described for different brain disorders and lesion localities in children, although additional insight into the nature of the sequelae present was gained in each case. In early brain damage, the most frequent disturbances were a disruption in the role played by executive functions and the ability to process data simultaneously - both of which are associated with the tertiary zones of the brain. Furthermore, these disturbances appeared to be important factors underlying disturbances to language and educationally acquired skills. The qualitative, process-orientated nature of the LNI-C proved effective for identifying the factors underlying disturbances described in paramedical reports. These seemed to be the linchpins on which retraining should focus. It was argued that the CT scan was limited in its ability to identify the type of diffuse and/or multifocal brain pathology frequently found in children. The usefulness of the model of brain-behaviour ontogeny and interpretive protocol for diagnosis, understanding and predicting the developmental consequences of childhood brain pathology was demonstrated on the basis of nine brain disorders. Finally, areas of future research were highlighted by the study. / Thesis (Ph.D.)-University of Natal, Durban, 1989.

Computers are used for diagnostic and training in the neuropsychological rehabilitation. PLANTEST is a program for the IBM-PC that was developed for diagnostic support. It implements a test that gives information about the reduced ability of brain-injured patients to make plans regarding a certain task.The presented thesis describes a knowledge-based system that can be used to develop new test versions for PLANTEST. The program is called SolvePT and it can prove the solubility of test material used in PLANTEST. It can also automatically generate new test material. The program uses an exhaustive forward-chaining, depth-first search and is implemented in Prolog. The datastructures and algorithm of the program as well as space and time requirements are discussed. / Department of Computer Science

Neuropsychological tests have been used in differentially diagnosing schizophrenic and brain damaged populations. Research indicated some subgroups of schizophrenia exhibit certain symptoms of brain damage; and that schizophrenia involves difficulty in sensory integration. The Haptic Visual Discrimination Test (HVDT) designed to test tactilevisual integration, Bender Gestalt, and Information and Digit Symbol subtests of the WAIS were used to test performance abilities of forty schizophrenic subjects, forty subjects medically diagnosed as brain damaged (10 right hemisphere, 10 left hemisphere, and 20 diffuse), and normals as defined by the standardized age norm scores.

Among the goals of neuropsychological assessment are to detect the presence of brain damage, localize which areas of the brain may be dysfunctional, and describe subsequent functional impairments. The sensitivity of neuropsychological instruments in carrying out these functions has long been a question of debate. The purpose of the present study was to determine the utility of various performance level indictors and lateralizing indicators from the McCarron-Dial System Neuropsychological Assessment Battery (MDS) in ascertaining the presence or absence of brain damage as well as location of lesion. Models used in the present study appear to provide increased classification accuracy compared to other studies utilizing the MDS. The MDS was also shown to be comparable to other well-known neuropsychological batteries, including the Halstead-Reitan Neuropsychological Test Battery (HRB) and the Luria-Nebraska Neuropsychological Battery (LNNB) with regard to distinguishing between those with brain damage and normal controls, and also localizing brain lesion. The results of this study offer clinicians parsimonious models to evaluate for presence of lesion and its location so this information may be used to make accurate, thorough diagnoses and appropriate treatment and rehabilitation recommendations.