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. |
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