Course Outline. Course Directions. Cognition and Its Primary Domains: A Course for Clinicians. For cognition and each of its domains

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1 Cognition and Its Primary Domains: A Course for Clinicians Nancy Helm-Estabrooks, Sc.D. Boston University School of Medicine & Colleen Karow, Ph.D. University of Rhode Island N. Helm-Estabrooks and C. Karow, 2003 Course Outline Cognition as a broad concept Primary Domains of cognition Attention Memory Language Executive Functions Visuospatial Skills For cognition and each of its domains What they are Why important Practical implications Informal tasks and standardized tests Test your skills Note: References, publication information and CEU posttest appear at course s end Course Directions Audiovisual presentation will play automatically Click on the pause button while taking notes and tests Other options to navigate through the course Use VCR-like buttons to pause, play, reverse, or move forward. Use the Course Outline appearing on left side of screen. Click on any title to advance to slide Click the play button to listen to the audio file 1

2 What is Cognition? Cognition is all the processes by which sensory input is transformed, reduced, elaborated, stored, recovered and used. (Neisser;; 1967). Cognition refers to what we know and the processes that enable us to acquire and manipulate information. (Bayles, 2001, p.252). What is the difference (if any) between cognition and intelligence? According to Lesak (1995), early investigators attributed cognitive activity to a single function called intelligence. With refinement of testing procedures and careful case studies of individuals with brain damage, it became evident that intelligence is not a unitary variable, but rather is comprised of specific cognition functions. What are the components/domains of cognition? Cognition can be viewed as having five primary domains: Attention Memory Language Executive Functions Visuospatial Skills 2

3 Why is it important for clinicians to understand all domains of cognition? Since it is difficult to think of any human learning situation in which the human is not in some way actively responding, organizing, and reorganizing the material, human learning will almost always involve some type of cognitive activity. (Ellis, 1972, p.4). Practical Implications of Cognition In everyday terms, all our purposive responses, thoughts and actions call upon some domains of cognition. Consider what is required to: hold a phone number in mind while dialing it, drive a car from home to work, shop for groceries, prepare and serve a Thanksgiving dinner. Clock Drawing/Setting: An Informal Test of Multiple Cognitive Functions Typical administration Ask examinees to: Draw a clock, put in all the numbers and set the clock to ten minutes after eleven. 3

4 Skills Needed for Clock Drawing/Setting To successfully complete this task (see Freedman, et al, 1994; Helm-Estabrooks & Albert, 2003), the following skills are required: Language skills understanding the instructions and retrieving and writing numbers Executive skills - planning the task and making any necessary adjustments or corrections Visuospatial skills possessing an internal representation of visuospatial features of a clock, ability to retrieve this representation, and guide production Skills Needed for Clock Drawing/Setting (Cont.d) Memory skills - storing and later retrieving the time setting Attention and motor processes guiding and executing the mental image, attending to both sides of space Concept of time- understanding, calculating and representing the concept of time using a short hand to represent the hour and a long hand to represent minutes Resistance to stimulus pull resisting the stimulus pull to 10 which is not only named in the instructions ( ten( minutes after eleven ), but lies adjacent to the number 11 Clocks Drawn by Adults with Acquired Brain Damage Example 1 4

5 Example 2 To Command Example 3 To Command Example 4 To Command To Copy 5

6 Some Standardized Tests of Cognition Raven s s Progressive Matrices (Raven, 1995) Cognitive Linguistic Quick Test (Helm- Estabrooks,, 2001) Woodcock-Johnson III Tests of Cognitive Abilities (Woodcock, McGrew, & Mather,, 2001) Raven s s Progressive Matrices (Raven, 1995) The RPM is a test of intellectual ability/analogical thinking that employs design patterns and requires only a pointing response. Thus, it is often used with individuals with language and speech impairments. Three forms of the test are: Standard Progressive Matrices Coloured Progressive Matrices (a shorter and simpler form) Advanced Progressive Matrices (for people with above average intellectual ability) Cognitive Linguistic Quick Test (Helm-Estabrooks Estabrooks,, 2001) The CLQT is for use with adults ages with known or suspected neurological dysfunction. It can be administered in minutes. Cut-off scores for 10 tasks (including clock drawing) are based on performance of nonclinical populations. Together the tasks probe the five primary cognitive domains (attention, memory, executive functions, language, visuospatial). The CLQT has a clock task with an easily applied system for scoring responses. Note that this test is available in both English and Spanish versions 6

7 Woodcock Johnson III Tests of Cognitive Abilities (Woodcock, McGrew, & Mather 2001) The Standard Battery consists of 10 tests; the Extended Battery ten additional tests. W-J III has 5 new cognitive clusters, and 8 new tests measuring information-processing abilities such as working memory, planning, naming speed and attention. Appropriate for ages 2-90+, the WJ-III provides normative data from over 8,800 subjects located in more than 100 geographically diverse communities in the United States. Attention - What is it? Attention is a multifaceted, multisensory mechanism that provides the foundation for all other cognitive processes (Helm-Estabrooks Estabrooks, 2001). Attention refers to the ability to select, shift, divide and/or maintain thought or action Attention is closely related to but different from arousal, which is defined as the degree of wakefulness exhibited by an individual (Filey( Filey, 2002). Allows us to monitor what is going on internally as well as externally. Why is it important for clinicians to understand attention? Attention is essential to performance on all clinical and daily tasks, and the ability to attend is critical to learning. 7

8 Is attention a unitary phenomenon? Attention is made up of specific attentional subsystems mediated by local cortical centers and global attentional processes mediated by the brain as a whole. Attentional Components Include: Passive Attention Vigilance (Sustained Attention) Selective Attention Divided Attention Alternating Attention Passive Attention The mechanism that allows an incoming stimulus to be automatically responded to by the somatic or autonomic nervous system. Made up of two components: Startle A protective mechanism that responds to intense stimuli. Orienting response This occurs from unexpected environmental changes that results in a tuning in to the stimulus. Note: Passive attention may not be clinically remediable. 8

9 Selective Attention A filtering system that allows us to focus on relevant stimuli and ignore irrelevant stimuli. Allows selected stimuli for attention to receive extended or enhanced cognitive processing, while the environmental or internal distractions are filtered from conscious awareness. Disorders in selective attention can occur from specific frontal or posterior parietal lobes (most notably in right hemisphere) or from more diffuse brain disorders (e.g., TBI). Vigilance (Sustained Attention) The ability to maintain attention over time for a repetitive task. Controlled attention sustaining attention to a task that requires higher amounts of cognitive processing over time, such as performing mental calculations on a list of numbers. Rote attention maintaining attention to one specific stimulus or to an activity that does not require additional mental processes, such as separating a deck of cards by color. Divided Attention The ability to attend or respond to multiple tasks simultaneously. Divided attention is a high level function that is necessary to daily life; however, there is an impact on performance (referred to as concurrent cost ) for each of the tasks receiving attentional processing. After brain damage the ability to divide attention can become a significant barrier to returning to important multifunction tasks, such as driving. 9

10 Alternating Attention The ability to shift attentional focus from one task to another. Many activities of daily life require both divided and alternating attention. What parts of the brain mediate forms of attention? The brain dedicates vast amounts of processing to the attentional system. The diffuse attentional system is a widespread collection of connections described as the attentional matrix. The most important structures involved in monitoring both the external and internal sensory information networks are the thalamus and cerebral hemispheres [particularly the frontal lobe] (Filley( Filley,, 2002). Right Hemisphere and Attention The RH is specialized in narrowing attention toward specific spatial stimuli (Filley( Filley,, 2002) Cortical regions in the right hemisphere are said to be dominant for a spatial attentional system. Specific brain areas include (Mesulam M-M. 2000): Parietal lobe Responsible for spatial attention Frontal lobe Dorsolateral prefrontal cortex Directs attentional resources Cingulate gyrus Maintains motivation and effort during attentional tasks 10

11 What are some common causes of attention deficits? ADHD Schizophrenia Toxic and metabolic disturbances Hypoxia Traumatic Brain Injury Stroke Dementia Right Hemisphere Brain Damage What are some informal tasks of attention? Cancellation tasks Letter/number Symbol Line bisection tasks Letters with curves task Stroop tasks Symbol Cancellation Task 11

12 Line Cancellation/Bisection Task Cross out each line at its midpoint Letters with Curves Tell the patient to name the letters of the alphabet that have curves in them. Have the patient say the list aloud. Letters with curves B C D Letters without curves A E F H Stroop Task Blue Red Green Yellow Brown Red Blue Green Green Blue Red Yellow Blue Red Brown Green Blue Yellow Red Yellow Green Brown Yellow Green Red Blue Green Red Blue Blue Red Green Yellow Brown Yellow Blue Red Brown Green Blue Red Yellow 12

13 What are some commonly used formal tests of attention? Trail Making Test A test that requires connecting lines between 25 numbers (trails A) and 25 letters and number in alternating order (trails B). Requires 5-10 minutes to administer. Norms are available for children and adults years of age (Spreen( and Strauss, 1991). Selective Reminding Test (Busche( Busche,, 1973; directions available in Spreen and Strauss, 1991) Paced Auditory Serial Addition Test (Gronwall( Gronwall,, 1977) Trails for Numbers Trails with Numbers and Letters 1 D 3 4 A G 2 B C E

14 Paced Auditory Serial Addition Task The Paced Auditory Serial Addition Test (PASAT) is a test used to assess the rate of information processing and sustained attention. Examinees are asked to add together pairs of single digit numbers read from a list. Pairs of number can be presented at different paces ranging from 1.2 to 2.4 seconds per number. Take a Test of Attention! (Serial Addition Task) You will hear a list of numbers that you will have to add together in a special way. I will start by saying two numbers (for example - 1, 3 ) 3 You add these numbers together and tell me the answer, which is 4. I will then tell you a new number (e.g., 2 ) You must add this new number to the last number you heard me say (which was 3 ), therefore your answer would be 5 because [3+2=5] Note that you have ignored the sum of your previous addition. Let s s try it! Ready?... If you get stuck just keep trying, you can catch up at any time. 14

15 Answers Answers Memory: What is it? Memory is a group of complex processes that depends on several intact functions including the ability to: attend to and register new information. retain, process and store this information (learning). retrieve stored information from the recent and more distant past. Why is it important for clinicians to understand memory? Retained memory functions are essential to our daily existence; to living independently. Memory is also essential to regaining skills affected by brain damage (rehabilitation). Without conscious memory, only non- cognitive forms of learning may occur. 15

16 Is memory a unitary phenomenon; one thing? Schacter and Tulving (1994) describe four types of memory. Procedural memory Working Memory Semantic Memory Episodic Memory Procedural memory operates at an automatic level and can be regarded as noncognitive. Working memory, semantic memory and episodic memory require contemplation and conscious awareness and, thus, are regarded as cognitive. Procedural Memory Allows us to perform automatic tasks that were learned gradually. Some procedural memories are learned without ever having entered our conscious awareness. Used to perform tasks without thinking about them, thus allowing us to turn our attention and thoughts to stimuli and tasks requiring purposeful use of cognitive resources. Working Memory Working memory is used in performing tasks requiring short-term storage and manipulation of new, or previously learned, information. Working memory is necessary for daily tasks such as retaining and following directions. Working memory also is considered critical to high-order, goal-directed language tasks such as delivering a lecture. 16

17 Semantic Memory Semantic memory encompasses our factual and conceptual knowledge of the world such as subclasses of fruits and animals. Semantic/conceptual knowledge is critical to language learning and use, and influences performance of daily chores. In everyday life, semantic memory may help guide our search for items at a grocery store (e.g. should we look in the bakery section or dairy section). Episodic Memory Episodic memory is the memory of one s own experiences and personal past. It allows us to record and consciously recall events of our lives against the background of all happenings to which we are exposed. An example of practical use of episodic memory is the ability to fill out a personal information form. What part(s) of the brain mediate forms of memory? Many cortical structures involved Frontal Lobes Prefrontal cortex for working memory and organization of information Hippocampus (located deep in the temporal lobe) Long term memory (information storage) Diencephalon Thalamus, hypothalamus (which has many connections to the limbic system and the frontal lobes) Basal Ganglia Procedural memory 17

18 What are some common causes of memory disorders? Anoxia Alcoholism/Korsakoff Korsakoff s syndrome Alzheimer s s disease Closed head injury Seizure Disorders Multi-infarct dementia Focal Strokes What are some commonly used tasks/tests of memory? Rivermead Behavioral Memory Test (Wilson et al., 1991) California Verbal Learning Test (Delis et al., 1987) Rey-Osterrieth Complex Figure (Meyers & Meyers, 1995) Rivermead Behavioral Memory Test (Wilson, et al, 1991) The RBMT was designed to assess memory skills of practical relevance to adults (e.g., remembering appointments, recognizing faces) and document changes in memory as the result of natural recovery and treatment. The test yields a Total Memory score and has four parallel forms. A screening version is also available. 18

19 California Verbal Learning Test (Delis, et al, 1987) This test of verbal memory is for adults ages It consists of a shopping list of 16 items that belong to one of four categories. The CVLT is also a test of semantic knowledge in so far as learning is facilitated by the ability to recognize and group together tools, articles of clothing, fruits, herbs and spices. Examinees are allowed 5 trials (if necessary) to learn the list. Recall also is tested immediately after introduction of an interference list and again after a 20-minute delay. At the end, a recognition trial can be administered. The CVLT-C (Delis et al., 1994) is used with children ages Rey-Osterrieth Complex Figure (Meyers & Meyers, 1995) The R-OCF is used to assess visual memory but accurate execution also depends on good visual perception and construction, and motor dexterity for drawing. Typically, the figure is shown to examinees who then are asked to: Copy the figure Recall and reproduce the figure without warning after 3 minutes. Recall/reproduce the figure after a 30 minute delay See Spreen and Strauss (1991; p. 159) for scoring procedure The Rey-Osterrieth Figure 19

20 Reproduce the Figure Take a Test of Memory! Look at the following designs and remember them. Which two designs did you see? 20

21 Remember these designs! Which two did you see? Language: What is it? Language is a socially shared code that uses a conventional system of arbitrary symbols to represent ideas about the world that are meaningful to others who know the same code. (Nelson,1993; p.27) Language is uniquely human. It allows us to communicate our needs, feelings, and ideas, to increase our knowledge, and to advance our species, as well as ourselves. 21

22 What is the clinical importance of language? Must comprehend instructions to carry out clinical tasks Critical to self expression; reporting needs/thoughts/feelings Often required for successful performance on tests of other aspects of cognition Is language a unitary phenomenon; one thing? Language is a complex system of human behavior comprised of interrelated components including semantics, syntax, morphology, phonology,, and pragmatics. Semantics The semantic aspect of language refers to our conceptual knowledge; the knowledge of meaning. Semantic knowledge allows us to abstract single features of entities, to use these features for organizing the world, and to apply symbols to these concepts. It is our semantic knowledge that allows us, for example, to categorize a lemon as a citrus fruit, and the fact that a living being might be killed by a stone but the reverse is not possible. 22

23 Semantic Knowledge In each set, which one does not belong and why? Syntax Syntax is the set of rules that govern: word order in particular languages; acceptable combinations and sequences for subtypes of words. Syntax has a strong cognitive/semantic component, so that we know, for example, the class of verbs that can follow particular nouns, (e.g. The lion [animate verb] ), and that transitive verbs are followed by a noun (e.g. The girl drank [name of liquid] ). Syntactic rules allow us to rearrange words to indicate the same concepts (e.g. Time is money vs. Money is time) or to indicate different thoughts (e.g. She is gone. vs. Is she gone? ). Morphology Morphology refers to the rules that govern words at the most basic level of meaning: the morpheme. Morphology allows us to modify word meaning by adding or subtracting morphemes from root words. For example, By adding an s to dog we indicate the concept of more than one. By adding ed to walk we indicate that this activity took place sometime in the past. 23

24 Phonology Phonology refers to the speech sounds or phonemes of particular languages and the rules for combining them. For example, speakers of English know that: The letter z will be followed by a vowel, The combination mn in the initial position is so rare it appears in only one root word. The plural s is pronounced sss following t (e.g. mats), but ez following d (e.g. fads). Phonological Knowledge Examples- Which of the following English names can you pronounce? Mr. Flet Mrs. Gejk Miss Lirk Mr. Zup Ms. Tfaz Dr. Ralt Pragmatics Pragmatics refers to the permissible ways language can be used; the rules that allow us to use the other aspects of language to communicate appropriately. Examples of language-use guided by our pragmatic knowledge: how to enter, carry on, and exit a conversation how to use the correct level of formality in our language when speaking or writing to a particular person when and how to use humor how to understand the unstated meanings of indirect requests (e.g. Isn t t it hot in here? ) 24

25 What part(s) of the brain mediate language? Specific areas in the left hemisphere are dominant for language functions. The main language areas surround the sylvian fissure on the lateral surface of the hemisphere and include: Broca s area located in the premotor region of the frontal lobe Wernicke s area located in the posterior portion of the superior temporal gyrus Angular gyrus located in the posterior/inferior parietal lobe The arcuate fasciculus and superior longitudinal fasciculus are white matter pathways that interconnect the widespread language network across the left hemisphere. What are common causes of language disorders? Developmental Specific language disability Mental retardation Autism Attention-deficit hyperactivity disorder Hearing impairment Acquired language disorders caused by: Strokes Tumors Traumatic brain injury Neurodegenerative disorders Infections Seizures What are some commonly used tasks/tests of language? Vocabulary Boston Naming Test Revised (Kaplan et al., 2001) Peabody Picture Vocabulary Test III (Dunn and Dunn, 1997) Tests of Aphasia Boston Diagnostic Aphasia Examination III (Goodglass( et al, 2001) Western Aphasia Battery (Kertesz( Kertesz,, 1982) Aphasia Diagnostic Profiles (Helm-Estabrooks Estabrooks,, 1991) 25

26 Boston Naming Test (Kaplan et al., 1983) The BNT consists of 60 line-drawn objects items ranging from high to low word frequency. It is a test of vocabulary, word-retrieval and spoken confrontation naming. Examinees with visuoperceptual problems are allowed category/semantic cues. Examinees with word-retrieval problems are given phonemic cues. Normative data are available for children and adults. Peabody Picture Vocabulary Test III (Dunn and Dunn, 1997) Measures receptive vocabulary and screens verbal ability Appropriate for ages 2-6 through 90+ Provides standard scores, percentile ranks and age equivalents Two different forms available with 204 items per form that are grouped into 17 test sets; takes minutes to administer Boston Diagnostic Aphasia Examination III (Goodglass et al, 2001) The BDAE-3 yields 43 scores that relate to recognized aphasic syndromes The short form provides access to diagnostic classification and quantitative assessment. The BDAE-3 includes the Boston Naming Test-Revised and the updated edition of the text, The Assessment of Aphasia and Related Disorders. These subtests can be grouped along several dimensions as follows: Fluency Naming Oral reading Reading Comprehension Auditory Comprehension Repetition Writing Paraphasia Music Automatic speech Spatial and Computational skills 26

27 Western Aphasia Battery (Kertesz,, 1982) The WAB is used to evaluate clinical aspects of language function and reading, writing, calculation ability, and nonverbal skills. Oral language subscores allow classification of aphasia syndromes. The WAB Aphasia Quotient is a measure of severity of language impairment. Aphasia Diagnostic Profiles (Helm-Estabrooks Estabrooks,, 1991) The ADP contains nine brief subtests yielding standard scores and percentile ranks. The subtests are used to create composite scores and five profiles of patient performance: Aphasia Classification Profile Aphasia Severity Profile Alternative Communication Profile Error Profile Behavioral Profile The ADP can be administered and scored in 40 to 45 minutes. Take a test of language 27

28 Executive Function: What is it? The term, Executive Function refers to the skills that comprise the highest level of human cognition. Executive functions include the ability to: plan, sequence, accomplish goal-directed activities in a flexible manner as demanded by situational and environmental changes. Attention and working memory skills are fundamental to these higher order, problem-solving processes. Why is it important for clinicians to understand Executive Function? Good executive functions are critical to: productive, independent living planning and performing all non-routine activities. Poor cognitive flexibility has great impact on everyday existence and may be a major deterrent to gainful employment and good social relations. Cognitive inflexibility results in problems with set-shifting that may manifest themselves clinically as forms of perseveration which can contaminate performance on tests and therapy tasks. Are Executive Functions One Thing? Hallmarks of executive functions are: Initiation of purposeful behavior Creativity Effective planning Effective problem-solving Self monitoring and self regulation Cognitive flexibility (the ability to respond to or manipulate information and situations in different ways). _ Note: Working memory (cognitive manipulation of new or previously learned information) is sometimes regarded as an aspect of executive functions. 28

29 What part(s) of the brain mediate executive functions? Primarily mediated by the dorsolateral frontal lobes Other functions of this brain region include, Motor programming Working Memory (A temporary storage center often referred to as the mental scratch pad Baddeley,, 1992) The dorsolateral frontal lobes are heavily interconnected to the structures of the basal ganglia and the thalamus (Cummings, 1993) What are common causes of executive dysfunction? Traumatic brain injury (penetrating and closed head) Degenerative diseases of dementia Frontal temporal dementia ( Pick s s disease) Alzheimer s s disease Parkinson s s disease Huntington s s disease Multiple sclerosis Vascular diseases Stroke Lacunar state Tumors Infections What are some commonly used tasks/tests of Executive Function? Generative Tasks Generative Naming Design Generation Trails Tasks Mazes Wisconsin Card Sorting Test (Grant and Berg, 1993) Tower of Hanoi (Simon, 1975) Delis-Kaplan Executive Function System (Delis, Kaplan, and Kramer, 2001) 29

30 Generative Naming Generative naming (also called verbal fluency ) ) is an executive language task requiring purposeful mental search for exemplars of a given semantic category (e.g., names of animals) or phonemic category (e.g., words that begin with F ). Working memory is also required to keep track of items already listed and to monitor output according to rules such as No proper names. Generative naming typically is a timed-task (one minute for each category) and is sensitive to any form of brain damage. Design Generation Design generation tests productivity and creativity skills, and ability to self-monitor, remember and follow rules, develop and use effective strategies, and (under timed conditions) to rapidly vary responses. Wisconsin Card Sorting Test (Grant and Berg, 1993) The WCST consists of a deck of 128 cards. Each card depicts one, two, three or four circles, triangles, stars, or crosses colored either red, green, yellow, or blue. Examinees are asked to place each cards under one of four key cards according to an unstated (by form, color, or number) principal The examinee must deduce from the clinician s s pattern of responding ( correct( correct or incorrect ) the current sorting rule After 10 correct sorts the clinician says incorrect and the examinee must by trial and error deduce the new sorting rule. The Modified Wisconsin Card Sorting Test (Nelson, 1976) employs only 48 cards, reduces discontinuation of the correct sorting strategy to 6 correct sorts, and eliminates cards that share more than one attribute with the key cards. 30

31 Tower of Hanoi (Simon, 1975) The TOH consists of a wooden platform with three posts and four disks of graded size. At task beginning, all four disks are stacked from biggest to smallest on the left-most post. The task is to move all the disks to the right-most post (stacked from largest to smallest) following a set of rules (the most important is that examinees must never put place a larger disk on a smaller disk). The score is the total number of moves required to complete the task. Delis-Kaplan Executive Function System (Delis, Kaplan, and Kramer, 2001) The D-KEFS is a comprehensive battery of nine stand-alone tests that evaluate higher- level cognitive functions (e.g., flexibility of thinking, inhibition, problem solving, planning, impulse control) in children and adults. The nine tests include sorting, trail making, verbal and design fluency, color-word interference, a tower and a 20 questions test, word context and proverb tests. Take a test of executive function! Directions: This is an alternating color- coded counting task. There are two sets of numbers 1 through 12; one colored red, one colored black. Point first to the red number 1. Then, point to the black number 12. Alternate between red and black numbers, going up to 12 in red and down to 1 in black

32 Visuospatial Skills: What are they? Visuospatial skills allow for appreciation of the spatial aspects of visual experience (Benton and Tranel,, 1993) Visuoperception is the ability a to discriminate, identify, synthesize, and analyze simple and complex forms Visuoconstruction is the t ability to manipulate parts of objects; combining them to depict the whole. Visual Spatial Skills Include: Judgment of Direction and Distance Identifying the directional orientation of lines Primarily mediated by the right hemisphere Localization of Points in Space Can be assessed by presenting two dots on a card and asking examinees to discriminate if they are on the same vertical/horizontal plane Most often impaired in right parietal-occipital areas, less notably in left parietal-occipital areas, and not usually impaired in frontal lobe lesions. Visuospatial Skills (Cont d.) Topological Orientation Ability to describe the spatial arrangement of a familiar place Describe how to get to a known place Finding the way through a building Reading and using a map A higher level visual spatial skill that can be dependent on memory, representation, and attention 32

33 What are some commonly used tests/tasks of visual spatial ability? Hooper Visual Organization Test (Hooper, 1958) The HVOT consists of cut up line drawings of 30 common objects. The examinee must analyze and mentally integrate the pieces and name the target objects. Visual Spatial Task Figure 1 displays two lines. Identify (by letter) the matching lines in Figure 2 Figure 1 Figure 2 A B C 1. J D 2. I E H G F Facial Discrimination Task A. B. Which two are the same person? C. D. 33

34 Visual Construction Ability to organize visual information drawing a house or a man putting together a puzzle Deficits most commonly associated with posterior lesions of the left or right hemisphere. Often assessed through block design and stick construction of objects, copying line drawings or drawing to verbal commands An important note regarding visual spatial skills: Visual perception can be intact and yet constructional skills can be compromised (e.g., secondary to graphomotor apraxia). But, if visual perception is impaired it will affect constructional skills because of faulty feedback. Visuocontruction Task Copy task of Rey Osterrith Figure Design Copy (63 year old male, right CVA) 34

35 REFERENCES 1. Baddeley, A.D. (1992) Working memory. Science, 255, Bayles, K.A. (2001). Understanding the neuropsycholgical syndrome of dementia. Seminars in Speech and Language, 22 (2). 3. Cummings, J.L. (1993). Frontal-subcortical circuits and human behavior. Archives of Neurology, 50, Delis, D., Kaplan, E., & Kramer, J. (2001). Delis-Kaplan Executive Functions System. San Antonio, TX: The Psychological Corporation. 5. Delis, D., Kramer, J., Kaplan, E., & Ober, B. (1987). California Verbal Learning Test Adult. San Antonio, TX: The Psychological Corporation. 6. Dunn, L. M. & Dunn, E. S. (1997). Peabody Picture Vocabulary Test (3 rd edition). Pine, MN: Academic Guidance Press. 7. Ellis, H Fundamentals of human learning and cognition. Dubuque, IA: W.C. Brown, Publisher. 8. Filley, C. (2002). The neuroanatomy of attention. Seminars in Speech and Language, 23,(2). 9. Freedman, M., Leach, L., Kaplan, E., Winocur, G., Shulman, K.I., & Delis, D.C. (1994). Clock Drawing. A Neuropsychological Analysis. New York: Oxford University Press. 10. Goodglass, H. Kaplan, E., & Barresi, B. (2001). Boston Diagnostic Aphasia Examination (3 rd ed.). Baltimore, MD: Lippincott, Williams and Wilkins. 11. Grant, D.A., & Berg, E.G. Wisconsin Card Sorting Test. Tampa, FL: Psychological Assessment Resources. 12. Helm-Estabrooks, N. & Albert, M. L. (2003). Manual of Aphasia Therapy. Austin, TX: Pro- Ed, Inc. 13. Helm-Estabrooks, N. (1992). Aphasia Diagnostic Profiles. Austin, TX: Pro-Ed, Inc. 14. Helm-Estabrooks, N. (2001). Cognitive Linguistic Quick Test. San Antonio, TX: The Psychological Corporation. 15. Kaplan, E., Goodglass, H, & Weintraub, S. (2001). Boston Naming Test (revisied). Baltimore, MD: Lippincott, Williams and Wilkins.

36 16. Kertesz, A. (1982). Western Aphasia Battery. San Antonio, TX: The Psychological Corporation. 17. Lezak, M.D. (1995). Neuropsychological Assessment. New York: Oxford University Press. 18. Mesulum, M-M. (2000). Attentional networks, confusional states, and neglect syndromes. In: Mesulam M-Principles of Behavioral and Cognitive Neurology, 2 nd edition. Oxford: Oxford University Press, Meyers, J.E., and Meyers, K.R. (1995). Rey Complex Figure Test and Recognition Trial. San Antonio, TX: The Psychological Corporation. 20. Nelson, N.W. (1993). Language, speech and communication (Chapter 2 pp ) In: N.W. Nelson. Childhood Language Disorders in Context. New York: Macmillan Publishing Company. 21. Raven, J.C. (1995). Raven s Coloured Progressive Matrices. San Antonio, TX: The Psychological Corporation. 22. Schacter, D.L. & Tulving, E. (1994). What are the memory systems of 1994? In D.Schacter and E. Tulving (Eds). Memory Systems. Cambridge, MA: MIT Press. 23. Spreen, O., & Strauss, E. (1991). A Compendium of Neuropsychological Tests. New York: Oxford. 24. Wilson, B., Cockburn, J., & Baddeley, A. (1991). Rivermead Behavioral Memory Test. Revised Edition. Suffolk, Eng: Thames Valley Test Co. 25. Woodcock, R.W., McGrew, K.S., & Mather, N. (2001). Woodcock-Johnson III Tests of Cognitive Ability. Itasca, IL: Riverside Publisher