nuerophsyc assement?
 

So im going for a nuerophysc assement soon. Not exactly sure the date yet but I know im going.

What exactly is this? How long does it take? Whats it used for?

Im just slightly worried about it because it sounds difficult. Ill admit, my brain power is not what it used to be, but the cognitive therapy ive been doing has helped a lot.

What kind of questions do they ask? Are they actually difficult in nature? Is it timed?

Any personal experiences or stories that you guys have would be greatly appreciated!

I will be anxious to see how it goes... This is part of the brain study I am doing down at University of Texas... I will find out soon enough

Think I should have my wife present as well?

A Neuro Psych Assessment is not a pass/fail exam. It is used to diagnose how your brain is working. If you are struggling with any kinds of mental tasks, it will usually define those struggles. There is no way to prepare for an NPA. In fact, you do not want to prepare. You want to perform just like you do on a normal day. If you struggle with memory, that is fine.

An NPA can take from 2 hours to 8 hours. It depends on the battery of tests administered. There are multiple parts to an NPA. Some are paper and pencil. Others are question and answer with the tester. These are not questions about your knowledge. You will be read some information and be asked to recall that information. You will likely do a Trail Making test. Maybe a finger tapping test. Some do a test drawing an image that was shown for a set period of time. This is visual recall.

There may be a test to determine if you are depressed and what kind of a personality you have.

Don't worry about the difficulty. It is designed to test you to see where your brain fails. It says very little about who you are as a person.

I've done 3 1/2 NPA's. 3 full tests and one abbreviated NPA.

The personal value you will likely get is quite simple. It will show what is happening in your brain and confirm to others what you already know and are trying to say.

It can be used to direct a rehab clinic in ways to help you recover lost functions.

Your wife will not be allowed to accompany you. The tester may have a few questions for her but I doubt it. The insurance company is not interested in paying for the extra time.

So, just relax and be patient. It is a good thing.

btw, Have you talked to a Work Comp attorney ? It would be a very good idea.

My best to you.

Mark from Idaho is absolutely right they you should not try to prepare for a neuro-psych. There is also not one standard test, so the experience does vary from person to person.

That said, one thing that is universal are "forced memory" tests to weed out malingers. I know you aren't faking, so this won't be an issue for you. Just don't be surprised if the opening questions are so easy, you're thinking, "Why am I here?"

As you shouldn't prepare for the neuro-psych, and the testing is different from patient to patient, I debated about whether or not to provide you with a snapshot of my experience. In the end, I figured, you asked, and it might help allay your anxieties. Besides, you can always look it up on Wikipedia. So here goes...

My neuropsychologist was wonderful and really determined to get an accurate picture of how I was doing, especially compared to old me. She said that was important because, as I was very high functioning before my mva, she suspected I might test "average" in some places, leaving my insurer to claim I wasn't injured seriously.

To make sure that didn't happen, in addition to providing copies of ALL of my medical records, she asked me to have friends and relatives send in written statements about me, before and after my TBI. I wasn't to see any of their submissions, so they could be candid, without hurting my feelings. She interviewed my husband and young daughter. She also asked for all of my school transcripts, work evaluations, IQ tests, etc... By the time this was done, she had a good picture of premorbid me, which helped her put my test results into perspective.

Tests do vary from patient to patient. Firstly, what you're asked depends on your age and education level, so you can be measured against your peers. No one expects an 85 year old to process information as quickly as someone four decades younger. The testers also have many, many tests to choose from. They often select which to administer, based on the subjects education, job, mechanism of injury, etc...

In my case, my test was oriented to a younger adult with degrees, and post graduate degrees, in both arts and math.

I was tested on my general knowledge: "Who was Abraham Lincoln?" "What is a sentence?" "How many continents are there?" "Provided the definition of the following words, etc... " (I was a published writer.)

As my day job involved mathematics, I was also asked to answer high level questions in algebra and calculus. For those, I was given pencil and paper. I was also asked simple math questions, orally. (Yeah, that went great. I'd forgotten the first number before the doctor got to the end of the question. :p )

The tester read out long, random lists of numbers and asked me to repeat the ones I could remember. I felt flustered and thought I was just blurting out numbers I was picking out of the air. Turns out I was giving them ALL back, but in exactly reverse order. Weird.

I also remember doing a peg board test, being asked to spot patterns, tested on facial recognition, being asked to recall lists of objects, being asked to draw pictures, taking the word/colour quiz to access impulsiveness, being asked, throughout the other tests, to recall details from a story that had been read to me at the beginning. There was a lot of other stuff, too - I was there all day.

The testing was grueling. Mark from Idaho mentioned that sometimes tired patients are allowed to take rests. Aside from a short lunch, my neuro-psychologist wouldn't permit me any breaks.

She said that, as my job required me to make decisions based on complicated calculations, under pressure, in real time, for prolonged periods, it was important to access my ability to maintain focus and accuracy. If I couldn't do that (turned out I wasn't even in the ballpark's parking lot :() there was noway the insurance company could argue that I could return to a career, where even small errors, or moments of hesitation, could have catastrophic consequences.

A few weeks after the testing, I had a three hour interview to discuss her conclusions (yes, they were devastating) and was given a written report.

On other thing I should have mentioned is that the entire session should be recorded on tape.

This is standard procedure because honest neuro-psychologists record sessions so that they can refer back to it while writing their report. Be suspicious of any tester who does not want to document your test this way. That tape is your best defense against an unfair interpretation of your results.

If they refuse to tape your session, tell them you're bringing your own recording equipment. If they object, insist on another tester. PROTECT YOUR INTERESTS.

Hockey,

Your NPA sounds far more targeted that a normal NPA battery. This is likely because there was a focus on whether you could return to your job where you needed to perform at high levels.

I have had 3 NPA's. The WAIS-II intelligence scales showed me in the high 90's percentiles in most areas. That was the only math or knowledge oriented testing. The same WAIS-II showed I have a severely slowed processing speed. I think it was at the 25% level, maybe the 10% level.

The common knowledge testing appears to be more of a baseline test.

None of my testers recorded the sessions. The issue of recording the sessions should be mentioned to a good WC attorney.

kevs NPA may be a thorough battery or just a basic functioning battery. Often, WC is only willing to pay for a basic battery.

So kev, relax and discuss this with a WC attorney before moving forward.

My best to you.

Im assuming since I have no college background and work in a physical environment job that ill be given some basic tests?

The thing i really want them to pinpoint is why I have trouble multitasking, or remembering stuff if you distract me.

Hello Hocky, As Mark mentioned, your NPA did a very good job. My NPA evaluated my tests against same age group but not the education. I have Master in Science and I have very high demanding job as a software engineer in on line payment processing. Single mistake can cost a lot to the user as well as the company and can ruin my career.

He told me that my memory is in the average range in my age group. Me and my family do notice change in my memory since my accident so I was hoping to have detail report on the area where I have to concentrate on so that I can improve.

I asked him if he can compare my result on the base of education and edge but he mentioned there is no studies based on education. One more thing I got to know about Kaiser. :(

Often, those of us with high performing brains will notice a big difference when our performance drops to average. My memory was very good before my injury. I rarely needed memory aids and was in the habit of relying on my memory rather than aids. When my memory failed, this difference was very noticeable and I had a difficult time developing memory work-arounds.

pinka, you may need to have your report assessed by an occupational psychologist. An OP may have a better understanding of how your struggles impact your work abilities. Keep in mind that Kaiser's NP's are oriented in diagnosing conditions so they can rehab a patient to hopefully regain ability to live independently and successfully. They do not get concerned with returning patients to "high" functioning levels.

Yup thats one of my issues. For example I love reading. But now its severely limited because I have trouble after a while focusing and I forget some of the story. Like im fine with the main story and main character, but minor chacters and minor substories or easy to spot plot twists I now have trouble with. Ill often find myself wither taking notes, or going back pages to reread stuff. My comprehension of it seems fine though

I have the same problem. I gave up trying to read fiction. I lose track of the characters. These are issues you need to note in a journal.

Kev,

Have you called any WC attorneys yet.

Not yet Mark. Im severely strapped on cash, but I do have one in mind that I have limitedly spoke with for now.

Also I am keeping a journal of this per order of the therapist.

Im having some definite anxiety over this testing though. I just want to do well so I can go back to work.

You don't need cash to hire a WC attorney. They get paid by the WC system. Plus, they all offer an initial review of your case with no strings attached.

Ok thank you.

Is it normal to feel anxious for this particular test?

Can you share some of your memory work-arounds... I am beginning to think more and more that my memory is not going to come back and that I am going to have to come up with work-arounds... This has been a VERY depressing thought since I have ALWAYS had a great memory!

sarah,

Tell me about the situations where you have memory struggles. I will tell you how I handle those situations. For example, if I am using the stove, I turn the timer on for 5 minutes if I need to walk away so it will buzz and call me back to the stove if I forget.

Like Mark, before my injury I didn't need any memory aids. I shopped without a list, never missed an appointment and memorized contact information effortlessly. Yeah, I was a bit of a freak. :D

As a result I had never developed basic skills, like keeping a scheduler, making lists, etc... After my TBI, I was a babe in the woods - and a complete disaster. Fortunately, I had a therapist who really helped me find workarounds for my memory issues.

As Mark said, let us know your specific deficits. If it's one we've had to address, maybe our little tricks will help you.

Agreed. Willing to help teach you workarounds that my therapist has taught me so far.

Evidently im really good at chunking.

I seriously struggle with word recall, especially when I get flustered. Honestly there were not many debates, on subjects that I was well versed, that I would turn down... Now I find myself walking away and being upset with people because I know that they are wrong but I can not debate because I can not come up with a stream of words that will last long enough to get my point across.

When I do stop to search for a word i can not look at the person while I am doing it... I have to shut my eyes and I am sure I seem extremely rude.

Like Hockey said... I could shop with out a list, I had phone numbers in my head and could recall on a dime... I knew where everything was and could articulate where it was even if it was, I wan the black shirt that is third form the top in the drawer that is to the left of the sock drawer (example)...

I have signed my maiden name to checks, and doctors records... I have been married for 10 years...

I have learned to be slow to comment in debate like situations. I think through my comments and rehearse them. It has greatly improve how I am received because my comments are much more though out. I think my comments are better received that they were when I was quick to speak up.

I went from sounding arrogant and egotistical to sounding intelligent and thoughtful.

The closed eyes trick is important. I often tell people why I close my eyes. Most understand.

What you're describing is aphasia. It is caused by damage to the central nervous system and is fairly common in TBI patients. (I've got it, too.) You might benefit from working with a speech language pathologist.
www.nidcd.nih.gov › Health Info › Voice, Speech and Language

I am noticing more and more just how many more memory issues I am having. Hockey, you mentioned that there is a therapist for this? what kind of therapist would that be? I don't think I am fully aware of all the PCS symptoms I have. I notice a new symptom even after 9 months post-concussion. My brain feels heavy and unclear and I feel like my brain is getting more rusty!!! I have trouble planning my actions. Before the injury, I would automatically/effortlessly micro-manage my actions "leave the hallway light on, go to my room, email someone, get ready for bed, turn off the hall way light" now, this planning is very difficult and I forget as I am doing my second task why I did the first one or what the third one is!!!! Does this ever get better?

if it makes you feel better I lost my typing skills then regained them. also my memory has gotten better than the worst period.

I did Attention Processing Therapy (APT). http://www.lapublishing.com/attentio...s-training-apt I found it helpful.

The person who worked with me on APT happened to be a Speech Language Pathologist. She noticed my speech problems (stutter, aphasia, disfluency, etc...) and helped with those, too. A really caring person, she also helped me develop better coping skills, like how to follow a detailed list of instructions.

My psychologist also helped me with memory and daily living issues. She taught me to keep a memory book, to avoid unnecessary decisions (I could get bogged down having the choose from a drawer full of socks), etc...

So not sure if anyone has ever done both an NPA and belong to lumosity.com.

But, I just signed up for lumosity.com just to help my therapy since next week is my last session.

So far Im doing decent I guess. For my age I rank in the lower perctinles for some of the stuff, but they have their own nueropsych assement on their site. I ranked 101 for a score with the average of 100 for most people my age. So that was nice. I was 80% for memory for 40% for reaction time.

Not sure if some of the tests are the same, but I did some trail making, some tests where I had a bunch of circles, and they would flash and I would have to memorize the order, and then they would add more. started with 3 and ended with 7. Then another one, I think it was spacial memory, and it was the same as the last test, just in reverse order. Then they had a decoding test, where they gave u a legend with symbols and their numbers, then would flash the symbol on the scree and you had to respond with the correct number for the symbol, but luckily the legend stayed on the screen. There was also another one, that was real difficult but I did decent on it, where they would give you 3 sets of blocks and you would try to figure out the pattern. Was tough. The hardest ones were the remember which dots lit up. I did great on them up until 6 or so started lighting up. Same for the reverse order. I got very frustrated by the end of it.

They would also show you a card with a shape on it, then ask you a question as was this the last card, yes or no, then show another card, sometime with the same shape sometime with a different one. Also had one where they would show you two shapes and ask true or false questions, like is the triangle to the right of square, true of false ect.

Anyways I thought it was a really good site with some good tests. Really similiar to the stuff ive been doing in cognitive therapy

Although it did seem that my response time was much longer than I wouldve of liked, and they certainly note that during the tests it seems.

But even though that was lumosity's test, it sounds sort of similiar to the the descriptions ive heard from others. I actually did pretty good at it, and it got rid of my anxiety I had about it.

Have terrible short term memory and word recall, am talking to someone and either go completely blank...as in cannot even think of a word..or struggle to fine the word that makes sense, trying not to let the worried stares people have when this happens bother me.

At home, lists everywhere and timers help.

At what point in your recovery should you have the NPA? Should you recover to the point where you can get through the assessment without feeling like you are going to throw up? I know the assessment will be gruelling for any TBI/PCS patients, but when should one pursue this test to get the most accurate results?

I think the question is, Why would one need an NPA ? For most, it is to quantify one's condition for an insurance company/liability claim. Most health plans will not pay for an NPA without a strong reason.

An NPA will have accurate results for the time when it is administrated.