Neuropsychological Assessment: Applications to the Work Setting

Transcription

1 : Applications to the Work Setting! Arlin Pachet, Ph.D, R.Psych., ABPP Board Certified Clinical Neuropsychologist! September 30,

2 Presentation Objectives! (NPA) overview What is an NPA? What is a neuropsychologist? Components of an NPA!Required components of an NPA? What renders an NPA invalid and unreliable?!common questions asked!what is the meaning of a cognitive deficit?!can an NPA assist in predicting functional potential (e.g., RTW potential)?!!! 2

3 A Neuropsychologist is what?! A doctoral level psychologist with specialized training in the relationship between brain function and behaviour! Neuropsychologists have extensive training in the anatomy, physiology, and pathology of the nervous system and specialize in evaluating people who are thought to have something wrong with the way in which their nervous system is functioning. 3

4 ! A comprehensive analysis of brain functioning and the extent of cognitive impairment resulting from brain insult, brain trauma, etc..! Also incorporates a thorough assessment of the potential emotional sequelae of an injury 4

5 ! Comprised of: Clinical interview Review of medical records Collateral interviews Administration of a battery of psychological and neuropsychological tests 4-8 hours of direct client interaction 5

6 ! Assesses domains of: learning and memory attention, concentration, processing speed reasoning, judgment, and problem solving spatial abilities language functions effort and motivation intellectual and academic abilities emotional status 6

7 ! Intrinsically performance based! Behavioural observations extremely important (anxiety capitulation)! Self-reports of functioning can be affected by neuropsychiatric conditions (e.g., misattribution bias)! Self-reports of function do not necessarily correlate with performance under standardized conditions 7

8 ! Concept of normative comparison.! Comparing performance to reference groups of the same age, sex, and educational attainment.! Considering demographic factors. 8

9 ! Normative comparisons allow for determination whether an individual is performing at or below expectations.! Performance that is poorer than expectations can be quantified and interpreted accordingly. 9

10 A cognitive deficit means?! An NPA provides general and specific information about current levels of cognitive performance.! An average or composite score across multiple abilities provides an overall index of how well a person functions cognitively at the current time.! Normal variability in normal populations! Vocation, education, age, gender can affect test performance 10

11 A cognitive deficit means?! The larger the score differs from expectations the more likely this impairment will have implications for actual function! Definition of impairment will be relative to the patient s premorbid status 11

12 Common Questions Addressed! Common questions often asked: Prognosis or MMI Pre-injury complicating factors Treatment recommendations? Effectiveness / utility of prior treatment? 12

13 Common Questions Addressed! Common questions often asked: Diagnosis? Did a brain injury occur? Mental health problems? Severity of problems? Validity concerns (feigning, inconsistency). RTW? Restrictions or limitations? 13

14 and Return to Work! The ecological validity challenge:! functional and predictive relationship between performance on neuropsychological tests and the patient's performance at work! Requires consideration of a multitude of factors, not simply the test scores 14

15 and Return to Work! Consideration of work demands:! Is speed required?! Communication abilities?! Is the job safety-sensitive?! Is the job repetitive and structured?! How accommodating is the employer?! Consideration of cognitive profile (strengths and weaknesses) 15

16 and Return to Work! The results suggest impairment of at least mild severity. Will this have functional implications on RTW?! Anosognosia! Willingness to compensate! Mental health overlay 16

17 and Return to Work! What is missing from an NPA?! Can t simply focus on numbers and psychometrics! Behaviour and behavioural assessment is also integral and is often missed! Dysexecutive issues! Personality issues and exacerbation of underlying issues 17

18 and Return to Work! Dysexecutive issues! initiative! motivation! distractibility! perseveration! impulsivity! Collateral interviews 18

19 and Return to Work! Personality and RTW! Mood issues! Motivational issues / feigning 19

20 Contact Information Dr. Arlin Pachet Pachet Assessment & Rehabilitation Services Inc. Suite 326, Valley Ridge Dr. NW Calgary, AB T3B 5V4 Ph: Fax: ! 20