Point of Neuropsych Assessment
 

Yesterday at my brain injury clinic appointment, my physiatrist suggested it may finally be time for a neuropysch assessment. He doesn't like to do them too soon after injury, likes to give everything a chance to resolve, but now I've passed my 1 year anniversary and its time to consider it.

This is not something that's covered under canadian health care. Part of it may be covered under our extended benefits through my husband's employment, but that will be minor.

It costs between $2000 - $4000 to have done, so most of this will be out of pocket. My injury is not due to a car accident, so there's no insurance and I chose not to sue anyone because of my accident, so no money is coming there either.

Explain to me so I can understand what the point of it is. I understand it should help pinpoint ongoing cognitive deficiencies, but then what? What happens with that info? Is it just for personal knowledge? Is it to gain access to some next level of therapy?

I'm already well aware of some areas that are difficult for me, things I used to be very good at that are now nearly impossible.

Its not like I need this testing to justify my injury for a lawsuit or for an employer or anything. We can spend the money, I just wonder if its WORTH spending the money.

Thanks!
Starr

Neuropsychological Testing
 

Starr,
If you google this and watch some u tube videos on this it will explain the importance to you.

I am having one done to help prove disability for the purposes of applying for disability. Also so i can get the right kind of treatment and help and understand what is happening with me and ways to cope. They can also detect very early disease such as Parkinson's, M.S, early dementia, early Alzheimer's.

Good luck to you,

A good NP will asses your deficits and then give solid advice as to how to minimize any issues because of those deficits. For many the assessment is required for causality in determining liability. Also if one must work the assessment will have occupational accommodations for the employer.

For me it protected my health and safety as well as others. You can also get more definitive answers as to when you will need to start considering quality of life issues. I. E. When you need to seriously consider coping strategies for life long deficits.

For me, the NPA's best value was affirming the struggles I have and properly defining some that I did not understand. It helps me let go of the things I can not change.

With the knowledge of my condition, I can focus more on work-arounds, accommodations, and learning to avoid certain situations. The behavioral diagnostics helped my wife better understand me. It took a few years before she actually tried to understand the behavioral issues but when she did, it helped immensely.

If your husband has insurance that will partially cover an NPA, it may also have a network based fee structure. Most NPA's are based on fees tied to pages in the report. The NP may have a way to give you a simpler report since this NPA will not be used in litigation.

A preliminary abbreviated assessment or interview may help you understand the value of a full NPA.

Tough question to answer but the NPA info can be useful even if it is expensive information.

My best to you.

Sorry for suggesting you look at u tube videos
 

Apparently, I have given confusing and wrong information to you. Please disregard my suggestion that you can get information on the Internet. I was sent a very nasty message informing me not to give confusing information to people. This was how I learned the answer to the questions you are asking but we apparently have a genius on this board who knows all.
Sorry. I was only trying to help. No harm or confusion was meant on my behalf.
Good luck to you.

I replied privately to Brain Patch and have obviously offended her.

I tried to correct some misinformation she posted about NeuroPsychological Assessments. She said "They can also detect very early disease such as Parkinson's, M.S, early dementia, early Alzheimer's." This comment is not based on fact. Many make unsupported claims about their NPA skills but Ph.D.'s and Psych.D.'s are not authorized to make a medical diagnosis. Only an MD is authorized to make a medical diagnosis.

NPA's may diagnose symptoms or dysfunctions that are indicators of a medical illness or injury but that is not the same as detecting early disease. MS is a medical diagnosis based on MRI and other diagnostic tests. I have been evaluated for MS and the MRI was negative. The other symptoms are just overlaps of other conditions.

I understand that Brain Patch is in chronic pain and wish her well and relief from her pain and discomfort. I have recently had my first few days free of head aches in many months and know the stress pain can cause.

My best to you all.

Just a reminder that members are free to share whatever information they wish to here, even if other members do not agree with it.

We advise everyone to always check with their own physicians about anything they read here. This forum is for open sharing of information, and no-one except the mods and admins can tell another member not to post something (and even mods and admin do not "censor" anything unless it specifically violates the forum guidelines, which do NOT exclude open sharing of information)

Also requesting that if any members are concerned about any posts or PMs, please report it to us rather than bring a disagreement onto the forums

Starr, I am in Ontario and I'm queued up and waiting for the test myself. How it worked for me: my family doctor suggested a psychological screening where it was determined that I should under-go the testing to determine next steps. All of that has been covered by OHIP so far and no-one said anything to me about paying so much money, or any money for that matter. If your medical doctor does not know about PCS then ask him/her to investigate further.
A psychiatrist can determine if your symptoms are enough to diagnose PCS.
I'm interested to see how it goes for you, please keep us posted.
Jamie

thedude58,

you should ask about price before you agree to those tests! I'm also in Ontario and was not in a motor vehicle accident or anything where insurance or WC would cover my expenses and my neuropsycologist wants me to have the testing also and its over $2000 and up depending on the tests. Doesn't matter if a doctor orders it or not. Perhaps if a psychiatrist does it then it's covered but I've not heard of that before. Let me know if you find a way to get one for free!

CC

Thank you, I'll ask, but I don't think that is the case. I've been referred to Ontario Shores in Whitby, by a psychiatrist who agreed that my symptoms are PCS. Your doctor cannot refer you without the assessment first. Or, most likely, only the psychiatrist can make the referral to the specialists. Anyway, I'll see what i can find out.
Have you spoken to an MD or is your care coming from elsewhere, like an Osteopath, for instance. If that's the case, I'm reasonably certain that they cannot make that determination.
Jamie

I'll add too, that I don't remember what testing I'll be undergoing, however the hospital has assured me that it is covered by OHIP. My injury occurred in 1972, a long time ago, in a different province, far, far away. Kidding aside, I'll post here, what exactly, I find out.

Hi Jamie,

Everyone agrees I have PCS. I'm seeing my primary care doctor, neurologist, optometrist and neuro psychologist. I'm waiting to see an optometrist and I'm about to see a new neurologist... so lots of MD's involved! The psychiatrist you're seeing is probably the big difference here. My neuro psych testing is being recommended to show where my deficits are and what we can work on and what issues I will have if I attempt to return to work and any accommodations needed.

I think the other reason she wants to do them is because I seem to be in denial/disagreement with the fact that there are things wrong and in order to improve I need to know what's wrong. does that make sense?

Anyhow, good luck with your testing and please let us know what you find out! I've done some reading on Ontario Shores and it looks like an awesome place to go.

Take care,
CC

I was also referred by an MD but, even so, in Manitoba, neuropsych assessment is not an insured service. I decided against it because I was starting to get a very good handle on my own cogitive deficits....most relating to vision and visiual memory, luckily enough! My long term disability insurer with my work finally asked me to go for one and they paid. It was reassuring in that my 'IQ' was still relatively intact, and I had major deficits in visually related tests. It was horribly difficult to do the test...i did it one hour at a time over a three week period. It wiped me out!

The test does not usually get to the heart of some major deficits, such as those related to executive functions, planning, motivation, apathy, detachment, multi-tasking abilities.

Good luck!

Mokey said, "The test does not usually get to the heart of some major deficits, such as those related to executive functions, planning, motivation, apathy, detachment, multi-tasking abilities."

This depends on the battery of tests used in the NPA. The MMPI-II should point to some of the psychological issues, motivation, apathy, etc. Multi-tasking is part of the trail making test and some tests that create a conflict to thought processes but they are often visually oriented. Your NP may have chosen to not have you do some tests because they were not relevant to his directive from the insurance co or he already was aware of you difficulty in that area. He may have also pre-determined that multi-tasking was not going to be a strong skill for you.

My two NPA used mostly different tests to measure the same functions. The Halsted Reitan Battery used to be the gold standard but more recently, NP's have used other batteries of tests or designed their own battery of tests.

So, it is hard to predict what the NPA will be like. Attorney Gordon Johnson discusses the differences in NPA batteries at www.tbilaw.com and wwwsubtlebraininjury.com

Best to just relax and take the tests and let your symptoms/limitations show themselves.

My best to you as you decide this issue.

There are tests that measure executive function. I am surprised your NPA report did not comment on executive functioning.

Mine was recent and IMO the largest part of the testing was measuring my psychological health. Drove me crazy. 1300 written questions (fill in the dot, true or false) measuring if I think street drugs are ok, measuring if I'm a liar, measuring if I think it's ok to steal to get ahead... I was stumped as to why any of this mattered. It sure was exhausting.

It's just my opinion but I'm glad I didn't pay for the entire day, because I felt the tests given were somewhat stupid and a waste of time.

The parts I did like were the oral tests measuring my spatial skills, my memory, my vocabulary... Actual real life skills as opposed to whether I'm a depressed drug seeking liar and thief.

The oral test was less than half the day. The report isn't ready yet so I'm not sure yet if it was worth it. Will keep you posted on my thoughts there.

I'm sure they all use different measures and tests depending on who is paying them and what the desired finding is about. (in my case WCB is paying them so it's no surprise the majority of the testing was to see if I'm a liar, but it was still stupid and exhausting)

Also of note, the NP day (including travel and a winter storm) took so much out of me, my setback is still ongoing 10 days later. It was the worst setback I've had to date, setting me back at least a couple months all the way to the full head, swollen feeling, ears tight and ringing, completely dazed, fresh injury feeling.

Thank you all for your input on the neuropsych assessments... I'm still undecided at this point, but am leaning towards not spending the money on doing them. $2-$4k out of pocket is a huge amount of money that I just can't see the value in my own personal situation.

Tomorrow I have an appointment with my rehab psych (different than neuro psych) and will discuss it with her. She knows the ins and outs and will have an opinion on this and I'll see if that changes my mind.

While we *could* afford it if needed, I can think of many things I'd rather spend that money on. I just can't see how doing a series of tests to point out my difficulties has value to me. I already know what things are harder (impossible) than they used to be, I don't need them documented.

Thanks!
Starr

I certainly don't want to pay $2000+ out of pocket to be set back 2-3 months either! Sounds very counter productive. Thanks for the warning on that MsRrio and I hope you're feeling better soon. 1300 written questions at this point is ridiculous! I had the same types of questions when an insurance company sent me to see their doctor....tried to trick me into saying I would use street drugs if it would make me feel better. Wouldn't drop the subject....annoying...

I hope everyone is having a good day.


CC

Hello everyone. I've been referred/scheduled for a Neuropsychological assessment at Ontario Shores. I have confirmed that the testing is covered by OHIP.
Cheers,
Jamie

I hope you get some answers Jamie! I guess the trick is having a psychiatrist on board not just a psychologist. I can't get in to see a psychiatrist unless I'm suicidal or need medications and neither apply so I'm stuck paying for everything myself. Let us know how it goes and what kind of recommendations and help you get from it.

Take care,
CC

Correct. I told my family doctor what I suspected about PCS. She didn't really know much, but after she did some investigating she referred me to a community psychiatrist for a screening. I told him why I was there and he showed me the description of PCS and the symptoms in his big book a psychiatry. YES, its there, and he recommended the testing. You may want to take a similar approach with your doc.

I'll be sure to keep everyone posted on how it goes, I still haven't received a date, but it may be in September. I've been waiting since June.

Jamie :eek:

Actually, I found out more about OHIP coverage for neuropsych assessment. It IS covered under OHIP no matter whether a psychologist or psychiatrist or any other MD refers you... HOWEVER, due to some VERY recent changes, different hospitals (like the Ottawa Hospital) are restricting access to the assessments through OHIP in an effort to reduce provincial wait times.

While they are not actually legally allowed to do this, most people are not aware of this and they are taking advantage of people willing to pay out of pocket. We are currently researching more into this to see whether the government is willing to step in and tell the hospitals they are not able to dictate this two tiered system or not.

People will still be allowed to get private neuropsych assessments at private psychology offices if they want out of pocket, but the hospital should not be dictating this.

Just a heads up. I'm not sure what other hospitals other than The Ottawa Hospital is doing this... but neuropsych assessments should be covered under OHIP by any MD referral, including your own GP and also a regular psychologist.

Starr

Thanks for that Starr, you did your homework!

My husband is chasing it down, not me.. I don't have the energy to do it... but I thought I'd share it here. When he learns more, I'll add to it.
Starr