| Litigation — Assessments |
Expert Neuropsychological AssessmentsAssessing the long-term consequences of Traumatic Brain Injury requires expertise and experience. In addition to assessing clients for litigation purposes, Dr. Donald E. Read (Reg. Psych) also consults to our interdisciplinary team that provides assessment and treatment for survivors of traumatic brain injury. This gives him access to the real life experiences of survivors over the longer term and provides him with a perspective on the needs of brain injury survivors that is not available to most Neuropsychologists. Dr. Read was trained specifically in the field of Neuropsychology at McGill University and the Montreal Neurological Hospital, and has many years of experience in this field.Prior to joining the team at Raincoast Community Rehabilitation Services in 1990 Dr. Read taught Neuropsychology at the University of Victoria for six years and was subsequently on faculty at the Chedoke McMaster Hospitals in Ontario.
Situational / Functional Assessments of Brain Injury ImpairmentAssessing the long-term consequences of traumatic brain injury can be a long and complicated process. The basic questions to be addressed involve what the injured persons can and cannot do in everyday life: at work, at home and at play. It is particularly important to assess the individual's relationships with other people. Most often assessments of cognitive and emotional function are carried out in a clinician's office. The more functional aspects of daily life are often evaluated in simulated setting such as a model kitchen at a rehabilitation centre, where the mechanics of food preparation and cooking can be observed. While these types of formal assessment can provide valuable information, they tend to lack ecological validity: that is, they do not provide an adequate assessment of the types of situations that the brain-injured individual has to face in everyday life. It is for this reason that Raincoast Community Rehabilitation Services uses a situational/functional assessment to augment Neuropsychological and Occupational Therapy assessments.Functional assessments provide a unique and powerful way to evaluate and quantify impairments of higher cognitive functioning and social behaviour in individuals who have suffered a traumatic brain injury. This approach to assessment is particularly useful in situations where standardized neuropsychological assessment tests are not yet available, are not sensitive enough, or do not provide sufficient information for assessment or treatment purposes. At Raincoast Community Rehabilitation Services a functional assessment is guided by known brain-behaviour relationships and neuropsychological principles. The assessment is done by a rehabilitation specialist under the direction of a Neuropsychologist, and takes place in the client's own community. Problems resulting from damage to the frontal-lobe systems of the brain such as:
Some of the subjective complaints of survivors of traumatic brain injury may not reveal themselves on formal neuropsychological testing. When such complaints are consistent with the known consequences of a brain injury, and are accompanied by corroborative information from friends and family members, then a functional assessment can be invaluable for documenting the specific difficulties being experienced by the survivor. Clear predictions can be made prior to assessment, based on known brain-behaviour relationships. Then specific situational tests can be created to assess the survivor's functional abilities in his/her own community. It is not unusual for a Neuropsychologist to assess a traumatically brain-injured client and have that client perform normally or almost normally on formal neuropsychological assessment tests. Yet collateral interviews of significant others in the client?s life reveal consistent reports of functional problems in everyday life. This problem most often occurs when the impairments reported for the client are those associated with the known effects of damage to the frontal lobes of the brain. When you consider the nature of these impairments and the circumstances under which neuropsychological assessment testing is normally carried out, it becomes obvious why this type of problem can arise. Neuropsychological testing is normally carried out on a one-to-one basis in a quiet, distraction-free, office environment. A great deal of natural structure and direction is provided by the test situation. This tends to offset or mask any problems that the client may have with distractibility, short attention span, poor planning and organizational abilities, or impulsivity. In addition, problems with social inappropriateness cannot be directly measured through neuropsychological testing. Once a neuropsychological assessment has been completed, if there is a mismatch between the results of formal testing and the problems that the client is reported as having in the community, then the possibility arises of carrying out a functional assessment of that client in his/her own community. The advantage of carrying out a functional assessment in the client?s own community, having the client carry out tasks that have previously formed part of his/her normal daily life, effectively takes care of any arguments that might be raised about the tasks being novel or too difficult for the client. The Neuropsychologist evaluates the specific problems reported by or for the client from a neuropsychological (brain-behaviour) prospective. One client, for example, reported that he would repeatedly make a special trip to a store to purchase a particular item for a project that he was involved in. When he got to the store he would becomes distracted by other items on the shelves in the store (distractibility), forget to purchase the item he set out to get (prospective memory impairment), and would instead often buy something else that drew his attention (impulsivity). He would then drive home, set to work on his project again, only to realize that he had forgotten to purchase the very item he needed. These types of problems, in a client who prior to the injury would have had no difficulties remembering to make a specific purchase, suggested the presence of impairment of frontal-lobe function. For the Neuropsychologist to confirm the presence of frontal-lobe dysfunction a pattern of impairment must emerge that is consistent with the known effects of frontal-lobe injury. This type of functional assessment typically takes place over a two to three-day period and is comparable in cost to the cost of a full neuropsychological assessment. Suggested criteria for determining when to request that a functional assessment be carried out are as follows:
Expert Vocational AssessmentsA Vocational Assessment is often needed to identify what an individual has lost occupationally or vocationally as a result of brain injury and to identify the individual's occupational future. In addition to assessing the direct results of traumatic brain injury, this includes identifying any related losses due to physical injuries, for example, and how these interact with brain injury impairments and affect an individual's occupational future. Psychologist, John Pullyblank, (Ph.D., R.Psych.), has considerable experience in Vocational Assessment and works with the team at Raincoast Community Rehabilitation Services regarding brain injury cases.
Situational Employability AssessmentsSituational assessments can be used to overcome the problem of ecological validity when assessing survivors of traumatic brain injury. Both neuropsychological assessments and traditional vocational assessments are weakened by a lack of ecological validity.Vocational assessments attempt to correlate a client's characteristics with characteristics of occupations. The difficulty when doing this with brain-injured clients is not being able to know the client's characteristics well enough. By assessing a client based on data collected through observations on one or more job sites over a four to six week period it is possible to get an accurate view of the client's characteristics, i.e., to determine whether and how neuropsychological deficits are manifested as impairments that interfere with a return to employment. The neuropsychological assessment will tell us a client's cognitive and emotional strengths and weakness. The situational assessment will tell us what the client actually can and cannot do based on direct observation used in combination with other relevant information including neuropsychological assessments. Situational assessment is particularly important and useful in identifying impairments in the area that most often prevents return to work, and which is not adequately revealed through neuropsychological assessment or vocational assessment, i.e., social interaction and communication and in cases where there is frontal lobe impairment. Neuropsychological testing does not adequately reveal the extent of frontal lobe impairment and its implication on the work site. Situational assessment will tell us whether a client is competitively employable and the general nature of the employment the client is capable of if they are employable. If it is necessary to do so for clients who are found to be employable through situational assessment then vocational assessment can be used to identify specific occupations with the benefit of more accurate information about the client's characteristics. The situational assessment can be used to inform the vocational assessment where a full vocational assessment is still required with the result being a more accurate vocational assessment. Typical areas assessed through observations on work sites include:
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