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The Luria-Nebraska Neuropsychological Battery is a relatively new neurodiagnostic test, and there is a growing demand for material on the more advanced aspects of its interpretation. This book, organized around the theoretical meaning of items, the empirical correlations between items, and the factor structure of the individual scales, is a first response to that demand. It will serve to give greater understanding of the psychological skills that underlie each item on the Luria-Nebraska battery—an understanding prerequisite to the techniques of “syndrome analysis” described in the writings of A. R. Luria—and it will be particularly useful to those who have limited experience with actual case material. The major part of the book is an analysis of each Luria-Nebraska scale, either item by item or as a unit. For each scale the authors examine the theoretical intent of the items and the underlying skills according to Luria’s theory. They then present the results of item interrelations analysis to determine whether the items tap common skills. Finally they describe the factor structure of the various scales, exploring the interrelations of items within each scale. In addition to analyzing the behavioral scales of the Luria-Nebraska battery, the book reviews a number of other empirical scales that further aid interpretation—particularly the experimental localization scales that tap focal deficits in specific areas of the brain. Also included are case histories that illustrate the process of diagnosis in patients who receive a series of Luria-Nebraska batteries over the course of their treatment. Finally, the authors briefly discuss subcortical disorders—an issue often ignored in clinical neuropsychological testing.
Clinical neuropsychology has become a field of major prominence dur ing the past several years, as well as a field of great complexity. As a result of the extensive amount of activity that neuropsychology has experienced recently, two major developments have emerged. First, several approaches have evolved regarding comprehensive neuro psychological assessment. There are presently several standard test bat teries in common use, as well as an approach to assessment that does not make use of standard batteries, but rather fits the evaluation accom plished to the particular diagnostic problems presented by the indi vidual patient. Second, a great deal of specialization has emerged, with assessment procedures developed for evaluation of specific types of neuropsychological deficit. The purpose of this volume is to review these developments, particularly with reference to their implications for application in clinical settings. The history of this book's development is of particular interest. Some years ago, the Veterans Administration became concerned with developing an optimal method of neuropsychological assessment for its many health-care related facilities. Initially, the problem was con ceptualized in terms of whether the VA should encourage wider use of the long-established Halstead-Reitan Neuropsychological Test Battery (HRB) or promote more extensive use of the recently developed Luria Nebraska Neuropsychological Test Battery (LNNB). A conference was funded to bring together authorities in clinical neuropsychology to dis cuss this matter and present a series of papers to invited psychologists from various VA facilities.
This book developed out of the editors' longstanding interest in the retraining of traumatically brain-damaged adults and the management of their behavior by family members. A search for relevant experimental evidence to support the clinical use of behavioral principles for retrain ing, which began in 1977, turned up little empirical support. Moreover, the literature on retraining was dispersed among a variety of journals published in various countries. Nowhere was there a compendium of literature that addressed issues of assessment and retraining. There was no place to turn if one wanted to move from a standard neuropsy chological evaluation to the retraining of skill deficits revealed in the evaluation. We have attempted to edit a book that represents what we had hoped to find in the literature and could be used by professionals in clinical psychology, clinical neuropsychology, rehabilitation medicine, physical therapy, speech therapy, and other disciplines that address rehabilitation of brain-damaged adults-a book that addresses assess ment and rehabilitation issues and is sufficiently detailed to offer the reader a starting point in developing behavioral assessment and re habilitation programs. The book contains conceptual foundations, re views of research, descriptions of successful rehabilitation programs, and relatively detailed approaches to the retraining of specific skills. A shift from an assessment-based practice to one encompassing both prescriptive assessment and treatment has become a recognized transition in the neuropsychological literature and was best articulated in an article by Gerald Goldstein in March of 1979.
The present article examines the neuro-psychological profiles of brain-damaged, conduct-disordered, and normal control children using the the Luria-Nebraska Children's Battery. The subjects consisted of twenty-one normal controls, twenty-three brain-damaged children based on an established diagnosis of brain damage and twenty-one DSM III conduct disorder diagnosis and current psychiatric hospitalization for that condition. All subjects were tested using an IQ measure and the Luria. One-way analysis of variance revealed significant difference between groups on all Luria summary scales. Analysis of covariance did not significantly alter Luria summary scale means. Parwise comparisons were made to indicate direction of significant differences or lack of such between groups. A stepwise discriminant analysis was quite successful in accurately predicting brain-damage and normal control group membership.
In this volume of the series Human Brain Function: Assessment and Rehabilitation we cover the area of how brain function is assessed with behavioral or neuropsycholog ical instruments. These assessments are typically conducted by clinical neuropsy chologists or behavioral neurologists, and so we made an effort to present the somewhat differing approaches to these two related disciplines. Clinical neuropsy chologists are psychologists who typically utilize standardized tests, while behav ioral neurologists are physicians who generally assess brain function as part of the clinical neurological evaluation. Both approaches have much to offer. The basic assumption of neuropsychological assessment is that the brain is the organ of behavior, and therefore, the condition of the brain may be evaluated with behavioral measures. Neuropsychological tests are those measures found by re search to be particularly sensitive to alterations in brain function. An adequate neuropsychological test is a procedure that can be related to some objective mea sure of alteration in brain function. Over the years, these objective measures have changed, but generally involve documentation through direct observation of brain tissue, or through histological, pathological, neuroimaging, or other laboratory procedures. The methods described in the first two volumes of this series describe the neuroimaging procedures that are often used in the validation of neuropsycho logical tests.
Neuropsychology has become an increasingly active participant in forensie issues over the past decade. This has been the result of increased recognition by psychologists of the potential role they can play in evaluating patients involved in lawsuits and the increasing sophistication of lawyers who have recognized that damages can go beyond claims of physical and motoric impairment. However, this increase in involvement has not always been matched by a more sophisticated recognition of how the client (whether plaintiff or defendant) can best be served by the neuropsychologist. I have personally seen or reviewed many cases in which the psychologists involved did not effectively present their case. This partially occurred because they failed to recognize the difference in presentations aimed at clinical audiences and those aimed at a legal proceeding. It also occurred because they failed to recognize that the standard of proof necessary is very different in a hospital and in a courtroom. Finally, it occurred because they rarely recognized what the unique role of the psychologist can be in either countering or supporting the testimony of medical specialists. The purpose of this volume is to bring some light on these questions. The presentations here are write-ups of the work presented at the Third Annual Conference on the Luria-Nebraska Neuropsychological Battery held in Omaha during May, 1985. All of the papers emphasize the role of the Luria-Nebraska but the ideas can be used with almost any test.