Neuro Testing

As advances in medical care have improved the ability of injured or ill individuals to survive a medical crisis, not just life, but the quality to life of those survivors becomes the main concern for both the individual as well as the family. The Dallas Neuropsychological Institute, is primarily dedicated to helping all of our survive reach the very best quality of life which is possible. Problems addressed by Clinical Neuropsychology, to include those resulting from: When to Refer to Us

Patients come to us at any stage of their recovery process. Sometimes several years after the initial injury patients are referred for cognitive remediation and treatment of secondary depression.

However, the optimal time for psychological intervention is as soon after injury as is possible. At this time the first signs of cognitive dysfunction, depression, anxiety, and frustration begin, but hopefully have not yet caused secondary personality changes, job or school failure, or severe acute psychological symptoms.

When treated early, cognitive failures, emotional distress, and psychological symptoms resulting from chronic disability can often be effectively treated with supportive psychotherapy, cognitive remediation, biofeedback, and family consuItation .

Our Evaluation Service

All patients receive a neuropsychological evaluation by our bilingual staff. Thorough evaluation helps us to determine the severity of symptoms and screen for other factors, such as personality or family system variables, which may be affecting your ability to get well fast. The procedure involves neuropsychological testing and clinical interview.

The clinical interview, performed by a Board Certified Clinical Neuropsychologist, consists of review of the present problem, medical records, medical history, present treatment, social history, behavioral observations, and psychological results. From this information, impressions and recommendations are generated.

When needed, we provide neuro-psychologically-based supportive psychotherapy. This consists of counseling with a focus on helping the patient understand present lifestyle changes needed during rehabilitation and interventions designed to address and enhance present emotional levels of functioning.

Luria's Neuropsychological Investigation and the Center for Rehabilitation Hirnskade

The Dallas Neuropsychological Institute, P.C. has been fortunate to maintain a formal relationship with Anne-Lise Christensen, Ph.D. and the Center for Rehabilitation Hirnskade, University of Copenhagen, Amager since 1985 and is the only Metroplex neuropsychological practice to receive formal collaborative training in the methods of Luria's Neuropsychological Investigation. Due to methodological and philosophical differences between Luria's Neuropsychological Investigation and other methods of patient assessment, the following descriptions taken from Dr. Luria's and Dr. Christensen's work help to explain the type of neuropsychological examinations typically perfomed by the Dallas Neuropsycholgocial Institute and how these differ from those offered by "weekend workshop" approaches:

"During the last decades neuropsychological examination of patients with focal brain lesions has become one of the most important methods of local diagnosis of brain injuries. It is obvious that the classical neurological methods, evolved for investigation of the most elementary functions of the brain such as sensitivity, movements, tonus and reflexes, are insufficient for an analysis of the function of the most complex cortical zones. These zones . . . have to do with the organization of complex behavioural processes, e.g. gnostic and practical forms of activity, speech and the cognitive processes. Thus disturbances in these complex functions can be diagnosed by methods which have little resemblance to the methods used in classical neurology.

". . . It therefore became necessary to develop a new methodology for a neuro-psychological approach to the problem of focal diagnostics of lesions of these complex cortical zones. This goal has entailed extensive and complicated studies not only of the symptoms of disturbances of higher cortical functions, but also qualification of defects and an analysis of the factors underlying these behavioural defects. . . It must be emphasized that a most important role is played not only by the selection of proper methods, but also by an adequate analysis of the symptoms, i.e. a qualification of the symptoms achieved by these techniques."
"It is true of this investigation, that the use of the method demands skill and knowledge. Human brain functions being so complex as they are, simpler methods cannot be expected to provide the same amount of information, and it does seem more reasonable to advocate for the training of and study by those who use the tool rather than simplification of the tool itself. . . The neuropsychological investigation is a component of the clinical investigation of the patient. This includes a thorough anamnesis, detailed observation of the patient's behaviour while in the consulting-room or hospital, analysis of the neurological symptoms and a series of additional objective examinations . . . By these means the foundations are laid for the topical diagnosis. Like the clinical investigations the neuropsychological investigation must be based on sound ideas of the possible types of disturbance that may be encountered in brain lesions. It is absolutely necessary that the neuropsychologist have solid knowledge of the syndromes arising from brain lesions in various locations; otherwise it will be impossible for him to direct his investigation to the discovery of one of those syndromes.
"The neuropsychological investigation is usually preceded by a conversation with the patient, during which information is obtained of the history of the present condition, of the general state and particular aspects of the patient's mental activity.

"The investigation begins with a series of preliminary tests. In this first stage a relatively large number of tests revealing the various aspects of the patient's mental activity have to be included. . . The primary aim at this first stage is to discover the state of the individual analyzers - optic, auditory, kinesthetic and motor - and to ascertain the various structural levels of the mental processes; the level of direct sensorimotor reactions, the level of mnestic organization of activity, and the level of complex, mediated operations, in which a leading role is played by the connections of the speech system.

"The second, selective, stage of the investigation must be devoted to more detailed investigation of the group of mental processes in which the preliminary tests have detected the presence of definite defects. It must be built up, firstly, on the basis of the results obtained in the first stage and secondly, by taking into account the facts that are obtained in the course of the second phase of the investigation itself. This part of the examination is thus strictly individualized, it is more complex, yields richer results and calls for greater flexibility in the conduct of the examiner. . . The tests included in this part of the investigation must be integrated tests for the examination of complex forms of activity, the performance of which may be disturbed in different ways with different lesions."

[In the first and second stages of my examination, Mr. Schlumpfe was therefore administered a variety of Luria's Investigative procedures, first to detect neuropsychological disturbances and secondly to qualify such disturbances. This qualification differs from the "Golden Nebraska" or standard Halstead-Reitan procedures which arbitrarily administer all tests to all patients regardless of the need or problem encountered, and which frequently assign arbitrary scores to a patient's performance which is really qualitative rather than quantitative in nature. Therefore, scores are not assessed on the Investigation data sheet, but, rather, qualitative ratings are made at this point in the assessment. Further quantification and qualification of neuropsychological processes are obtained by the administration of formal standardized psychological tests such as the California Verbal Learning Test, and the resulting data integrated into an overall clinical neuropsychological impression of Mr. Schlumpfe.]

"The third, and final, stage of the investigation is the formulation of a clinical psychological conclusion, based on the results obtained and their comparative analysis. The fundamental defect must be identified; we must describe how this defect is manifested in the various forms of mental activity and as far as possible the pathopsychological factor underlying the defect must be indicated. A thorough and complete analysis may then serve as a basis for an assumption of a possible local lesion as responsible for the observed phenomena, and only then can we begin to distinguish the relative importance of the general cerebral factors which are more or less associated with local lesions of the brain."


For the neuropsycholgical examination, a number of flexible procedures may be used, to include a number of those developed by Harvey Levin, Ph.D., with Dr. Hopewell as a resident at the University of Tecas Medical Branch in Galveston, Texas as well as other innovative approached developed by Dr. Hopewell such as the Driver's NeuropsycholgoicalRating Scale, the KAS-R Personality Test, and the Children's Emotional Intelligence Test.

Rehabilitation, Consultation, and Life Care Planning

The Dallas Neuropsychological Institute draws upon the expertise of a large number of rehabilitation experts to provide both national and international coordination within the United States as well as abroad of rehabilitation services to severely disabled individuals. Services offered by the Dallas Neuropsychological Institute include: