The role of nonstandard neuropsychological assessment in rehabilitation: History, rationale, and examples.

Abstract

CAPlANANDSHKtlERsional creativity, observational expertise, flexibility, and ingenuity in the service of developing a multidimensional understanding of patientstheir abilities and deficits, their emotional state, self-regulatory functions, the impact of environmental variables on test performance, and so forth.Thus, Although the merits of unvarying standardized procedures are unarguable for some purposes, we contend that clinical assessment of cognitively compromised or emotionally distressed patients frequently demands a more flexible approach. In this, we concur with the statement of two experienced neuropsychologists who wrote:In evaluating clinical patients, however, the neuropsychological examiner encounters a wide range of emotional and physical problems that can interfere with testing and sometimes cause the results to be invalid. Through sensitive handling of the patient and appropriate minor adjustments in testing procedures (emphasis added), such problems can usually be overcome, while still adhering to the essential standardized aspects of the test. (Heaton & Heaton, 1981, p. 526) Other authors have made similar points. In setting forth guidelines for the evaluation of stroke patients, Hibbard and Gordon (1992) explicitly stated, "Testing procedures should be modified to test maximal functioning and learning abilities" (p. 14). Barbara Wilson, a pediatric neuropsychologist, wrote There are situations in which the test administration procedures must be modified in order to obtain meaningful information . . . the whole issue of goals of an assessment enters here. For some, adherence to standardized procedures is important and a "cannot do" score is felt to be sufficient information. For others-and we generally find ourselves in this group-the goal of the assessment is to obtain all information possible about the functioning capacities of the child and to facilitate the production of maximum performance (pp. 157-158).A focal concept of this chapter is that cognitive, emotional, or physical limitations, though certainly worthy of assessment in their own right, may undercut the validity of certain tests, thereby forcing examiners to choose between (a) by-the-book administration that yields data of questionable meaning and (b) procedural modification in an attempt to derive some useful information from the measures. A major objective of this chapter is to suggest ways that clinicians may avoid this kind of psychometric showdown by viewing the evaluation process in a less constrained manner.By way of illustration, consider the hazards of attempting to assess verbal memory in a patient with expressive aphasia. The typical format for testing this function requires the individual to repeat material (e.g., story content, word lists, digit strings) that is read by the examiner. That

Development of a Tactile Wisconsin Card Sorting Test.

“…Without proper standardization and validation of the necessary procedural adaptations, however, the reliability and validity of the test results remain uncertain. Accordingly, in response to directives from Lezak (1995) and others (Caplan & Shechter, 1995) to validate more suitable alternatives for neuropsychological assessment in rehabilitation settings, several prior investigators have attempted to develop intellectual measures for use with persons with visual impairment (e.g., Nelson, Dial, & Joyce, 2002). However, we are unaware of any tests specifically adapted and/or validated to measure executive functions in this population.…”

“…Many neuropsychological tests that assess higher cognitive functions are dependent on vision, such that standard administration procedures may not yield valid results for individuals with visual impairment. To this end, rehabilitation neuropsychology has a long history of modifying standard assessment procedures so as to derive meaningful data from standard clinical tasks (see Caplan & Shechter, 1995, for a review). Without proper standardization and validation of the necessary procedural adaptations, however, the reliability and validity of the test results remain uncertain.…”

Responsive assessment and the freedom to think for ourselves.

“…Freedom to explore. The second issue in test selection has to do with the desirability of satisfying statistically defined standards versus the freedom to explore the richness and variability of human behavior under conditions of compromised brain function (Caplan & Shechter, 1995).…”

“You can’t touch this”: Delivery of inpatient neuropsychological assessment in the era of COVID-19 and beyond

“…This work has described and assessed how common standardized neuropsychological and psychological assessments (e.g. Wechsler Adult Intelligence Scale -Revised; Wide Range Achievement Test-Revised; Raven Matrices; Benton Visual Retention Test; Minnesota Multiphasic Personality Inventory) can be adapted for patients with sensory, motor, cognitive, or perceptual impairments, whom otherwise would be unable to benefit from an assessment (Caplan & Shechter, 1995). Similarly, we propose that conducting contactless in-person assessments may be especially relevant in inpatient medical and psychiatric settings, where an inability to conduct a neuropsychological evaluation may present a barrier to discharge (e.g.…”