Dr Kathryn Peace and Ron Bracey look at the effects of a traumatic brain injury, and discuss the importance of a neuropsychological assessment.

Neuropsychological l assessment identifies and quantifies cognitive impairment, and emotional and behavioural change following brain injury. Cognitive impairments are deficiencies in mental abilities, such as memory, attention, and the capacity to learn, think and plan. It is oi particular relevance to an individual suffering from post-traumatic stress symptoms, or due to structural or functional changes resulting from direct injury to the brain itself. Assessment of this type is warranted when a person has suffered a moderate 10 severe brain injury and occasionally following a mild injury. Factors that suggest a full neoropsycholgical assessment may be justified are:

• Loss of consciousness at the time of injury
• Loss of memory at the time of injury, and the time immediately afterwards (post-traumatic amnesia) Poor memory, poor attention and/or poor concentration
• A change in personality, i.e. unusually aggressive or uncooperative behaviour
• An inability to cope with everyday activities or a job that the person was able to do without difficulty prior to injury

Sometimes, especially when orthopaedic injuries have been present, a significant head injury may be overlooked in hospital. This is because tho usual behavioural, cognitive and emotional changes seen in the early post-head injury recovery period may not be noticed if the person is bed-bound and has no demands placed on them.

Similarly, it is possible for a person who appears to have had a relatively minor brain injury to suffer quite significant cognitive impairment. So, if complaints about changes to mental ability or personality change are maintained over some months following even a minor head injury, a neuropsychological assessment may be justified.

Loss of insight and self-awareness are frequently present following brain injury, so many people with significant cognitive impairment are unaware of their own difficulties. However, their family members or close friends usually notice the changes. Therefore, it is useful to discuss the client with friends and family when deciding whether a neuropsychological assessment is necessary.

What is a neuropsychological assessment?

It typically involves three [o lour hours of contact time with the client, and several more hours to score and interpret tests and write tho report. Contact lime includes:

• Time to build a rapport and prepare the client, as a neuropsychological assessment is usually an anxiety-provoking situation
• Pre-injury personality, mental status and capabilities are assessed, and are details of any loss of consciousness, post-traumatic amnesia and changes resulting from tho accident
• A relative or close friend may also be interviewed if there are concerns about the self-awareness of the client
• Administration o! a battery of tests to explore the following areas of cognition: attention; visual-spatial abilities; language; memory and learning; executive functions (self-regulation, planning, mental flexibility); changes in emotional functioning (e.g. depressive symptoms or anxiety); and changes in behaviour (e.g. aggression, impulsivity or lack of motivation) since the accident.

The report should be able to address:

• Changes in cognition, emotion and behaviour following an injury
• Summaries of any relevant reports that are pertinent to the injury or status of the client
• The likelihood that the changes are due to brain injury per se or secondary to emotional distress
• The likely prognosis for recovery
• The impact of the changes on capacity for independent living
• Recommendations for rehabilitation or treatment

Who can carry out a neuropsychological assessment?

Clinical neuropsychologists undertake training additional to their general clinical qualification to understand, assess and treat those who have suffered brain injury (either traumatic or as a result of a neurological illness). The body that monitors the qualifications of clinical neuropsychologists is the Neuropsychology Division of the British Psychological Society.

A competent neuropsychological assessment can provide unique and quantifiable medical-legal evidence of the client’s previous and current psychological status, and make accurate and predictive commentary about the future. As medical-legal evidence, it is invaluable in helping to map out the cognitive and psychosocial effects oi traurnatic impact on a client’s lite and the future recovery they are likely to make.