So I went and met with the neuropsychologist last week and she gave me the results and a report. Overall, I guess I wasn't surprised by the results, but maybe disappointed. Part of me was hoping that the results would come back saying nothing was wrong with me and all the problems I thought I was having were just being imagined and if I just tried harder... and all that. You know the rest.

I don't know what the next steps are yet, if there will be any or not, I've not met with my physiatrist yet and he's the one that will be directing that. So right now, I'm just sort of left with this 4 page report. I won't type out the whole thing, just the parts that I think might be interesting or relevant?

The really good part of the whole NPA is that in talking to the neuropsych, nothing that was discovered during testing will trigger any issues with my drivers license, so I can keep on driving, which is a big deal to me. So I'm happy about that.

Not sure what the rest of the NPA means for me and my future.

(Just a bit of reminder history, this is my first NPA and my accident was February 2012, so just over a year ago. The only meds I take is topamax. I'm 41, college grad, used to work in high tech, left high tech a few years back to hobby farm)

The tests that were administered, WAIS-IV, Trail Making Test, Hooper Visual Organization Test, Boston Naming Test, Verbal Fluency Tests, Wisconsin Card Sorting Test, California Verbal Learning Test-II, Rey-Osterreith Complex Figure Test, Brief Visualspatial Memory Test-Revised, partial MWS-III (selected sub tests), Auditory Consonant Trigrams Test.

Full scale IQ ended up in the low average range. This was because all the tests were averaged and while many were average, some were far below average and brought the overall score way down.

Semantic and phonemic fluency task were in the impaired range and may reflect executive difficulties in strategic search and self initiation.

Impaired performance was seen on a task of visual search (searching among several similar stimuli for as specific target) whereas low average performance was noted on a measure involving clerical coding skills.

"Starr" also demonstrated impoverished working memory. Specifically, WAIS-IV Working Memory Index fell in the impaired range (2nd percentile) with poor performance on tasks requiring mental arithmetic problem solving or measuring auditory attention span.

On the latter, particular difficulty was noted on working memory (longest backwards span was 2 digits, below 1st percentile) whereas forward span of 6 digits placed her registration space at the borderline range.

When asked to hold letter triplets in mind while simultaneously counting backwards for varying intervals of time, her abilities fell at the borderline to impaired range. This indicated further vulnerability to distraction and interference when working memory in required.

Visual planning as measured by solution of paper and pencil mazes was impaired. "Starr" indicated that she had difficulty coping with the multiple dark lines contained in each maze. This again suggests difficulty dealing with visual interference.

Her ability to learn a list of 16 unrelated words was low average across 5 trials. Performance on the initial learning trial indicated reduced single trial learning and although she did benefit from repetition of the information, her learning curve was somewhat shallow. In addition, there was evidence of mild retroactive interference from an interposed list when short term recall of this original material was assessed.

Generally speaking, "Starr" demonstrated impoverished performance on a more complex verbal learning task, with poor encoding of information if not repeated, shallow acquisition despite repeated exposure and susceptibility to retroactive interference effects when required to acquire additional information prior to an extended consolidation period for the original information.

Conclusion:
The results indicate a number of relatively well preserved skills. Fundamental verbal abilities were generally intact, as were visual spatial skills, strategic thinking and memory for contextualized verbal and visual information. Visual learning was intact as well.

She demonstrated some subtle executive difficulties. Impaired semantic and phonemic fluency possibly reflect executive difficulties such as strategic search and self initiation. Higher order attention, speed of information processing and working memory skills were variable.

In terms of learning ability, her difficulties in this assessment were noted particularly with more complex verbal information. Results indicate that encoding may be poor when she does not have opportunity for rehearsal of information and it is mildly limited despite repetition. Furthermore, learning was affected by retroactive interference by new material during consolidation stages.

These results are certainly consistent with typical sequalae of post concussive syndrome. Given that the difficulties appear under the relatively well controlled conditions of a testing environment, it is likely that they are more pronounced in a more complex day to day environment where multi tasking, rapid information processing and greater reliance on single trial learning is required.

In order to improve function, "Starr" could consider implementing a variety of compensatory strategies that could include:

1. Taking extra time to process information when conditions require multi tasking or selective attention (conditions of distraction or interference).

2. Removing distraction from the environment when performing mentally challenging tasks.

3. Performing mental activities in shorter sessions, with ample time in between tasks to rest and consolidate information.

4. Writing information required for problem solving down.

5. Working at a self regulated pace and avoiding excessive time limited conditions.

6. Performing tasks one at a time.

7. Using a multi modal approach (visual, oral repetition, written, etc) when learning new information

8. Creating ample opportunity for repetition of new material

9. Using energy conservation techniques effectively to maximize her cognitive performance.

Starr