THE NEUROPSYCHOLOGY OF EVERYDAY LIFE: ASSESSMENT AND BASIC COMPETENCIES

FOUNDATIONS OF NEUROPSYCHOLOGY

Barbara Uzzell, Series Editor 1. Ellis, D.W., Christensen, A.L., eds.: Neuropsychological Treatment After

Brain Injury, ISBN No. 0-7923-0014-9. 2. Tupper, D.E., Cicerone, K.D., eds.: The Neuropsychology oj Everyday

Life: Assessment and Basic Competencies, ISBN No. 0-7923-0671-6.

THE NEUROPSYCHOLOGY OF EVERYDAY LIFE:

ASSESSMENT AND BASIC COMPETENCIES

Edited by DA VID E. TUPPER Director of Clinical Services New Medico Rehabilitation and Skilled Nursing Center of Troy Troy. New York Clinical Assistant Professor Department of Psychiatry Albany Medical College Alban y. New York

KEITH D. CICERONE Clinical Director The Center for Head Injuries Johnson Rehabilitation Institute Edison, New Jersey

KLUWER ACADEMIC PUBLISHERS

BOSTON DORDRECHT LONDON

Distributors for North America: Kluwer Academic Publishers 101 Philip Drive Assinippi Park Norwell, Massachusetts 02061, USA

Distributors for all other countries: Kluwer Academic Publishers Group Distribution Centre Post Office Box 322 3300 AH Dordrecht, THE NETHERLANDS

Library of Congress Cataloging-in-Publication Data

The Neuropsychology of everyday life: assessment and basic competencies / edited by David E. Tupper and Keith D. Cicerone.

p. cm. - (Foundations of neuropsychology; FNPS2)

ISBN-13: 978-1-4612-8808-4

DOl: 10.1007/978-1-4613-1503-2

e-ISBN-13: 978-1-4613-1503-2

1. Neuropsychology. 2. Clinical neuropsychology. I. Tupper, David E. II. Cicerone, Keith D. III. Series.

[DNLM: I. Activities of Daily Living. 2. Neuropsychology. WI F099K v. 2/ WL 103 N49358] QP360.N49491990 152-dc20 DNLMIDLC for Library of Congress

Copyright 1990 by Kluwer Academic Publishers

Softcover reprint of the hardcover 1 st edition 1990

90-4063 CIP

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher, Kluwer Academic Publishers, 101 Philip Drive, Assinippi Park, Norwell, Massachusetts 02061.

CONTENTS

Contributing Authors Vll

Foreword IX

JOSEPH D. MATARAZZO

Preface X111

I. RELEVANCE OF CLINICAL NEUROPSYCHOLOGY TO EVERYDAY FUNCTION: TRANSITIONS FROM A DIAGNOSTIC TO AN ECOLOGICAL SCIENCE

1. Introduction to the Neuropsychology of Everyday Life 3 DA VID E. TUPPER AND KEITH D. CICERONE

2. A Review of the Ecological Validity of Neuropsychological Tests 19 MARY B. ACKER

3. Integrating Neuropsychological and "Real-Life" Data: A Neuropsychological Model for Assessing Everyday Functioning 57

RICHARD I. NAUGLE AND GORDON J. CHELUNE

4. Use of Demographic Information in Neuropsychological Assessment 75 LAETITIA L. THOMPSON AND ROBERT K. HEATON

5. A Functional Assessment System for Real-World Rehabilitation Outcomes 99

WILLIAM J. HAFFEY AND MARK V. JOHNSTON

6. Assessment of Functional Communication 125 LEILA L. HARTLEY

7. Clinical Memory Assessment: Matching the Method to the Aim 167 ALAN SUNDERLAND

8. Quality-of-Life Assessment in Neuropsychology 185 A. JOHN MCSWEENY

9. Assessment of Cognitive Competency 219 PAUL L. WANG

II. NEUROPSYCHOLOGICAL ANALYSES OF COGNITIVE AND PRACTICAL COMPETENCIES

10. Impact of Memory Disorder on Everyday Life: Awareness of Deficits and Return to Work 231 DANIEL L. SCHACTER, ELIZABETH L. GLISKY, AND SUSAN M. MCGLYNN

11. Buttering a Hot Cup of Coffee: An Approach to the Study of Errors of Action in Patients with Brain Damage 259 NATHANIEL H. MAYER, EDWARD REED, MYRNA F. SCHWARTZ, MICHAEL MONTGOMERY, AND CAROLYN PALMER

12. A Behavioral Approach to Activities of Daily Living 285 WILLIAM J. WARZAK AND JACQUELIN KILBURN

13. Neuropsychological Aspects of Motor Vehicle Operation 307 C. ALAN HOPEWELL AND A. H. VAN ZOMEREN

Index 335

CONTRIBUTING AUTHORS

Mary B. Acker, Ph.D., 1774 El Codo Way, San Jose, CA 95124 Gordon]. Chelune, Ph.D., Department of Psychiatry and Psychology (P57),

Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44106 Keith D. Cicerone, Ph.D., Center for Head Injuries, Johnson Rehabilitation

Institute, 2048 Oak Tree Rd., Edison, NJ 08820 Elizabeth L. Glisky, Ph.D., Department of Psychology, University of

Toronto, Toronto, Ontario, Canada M5S 2J5 William]. Haffey, Ph.D., Executive Director, Rehabilitation Services, Sharp

Health Care, 7901 Frost St., San Diego, CA 92123 Leila L. Hartley, Ph.D., The Galveston Institute of Human Communication,

1528 Post Office Street, Transitional Learning Community, Galveston, TX 77550

Robert K. Heaton, Ph.D., Department of Psychology, University of California, San Diego, San Diego, CA

C. Alan Hopewell, Ph.D., Dallas Neuropsychological Institute, 9400 N. Central Expressway, Suite 1200, Dallas, TX 75231

Mark V. Johnston, Ph.D., Research Department, New Medico Head Injury System, 78 Maplewood Shops, Old South St., Northampton, MA 01060

Jacquelin Kilburn, M.A.T., O.T.R., Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor, MI48109

Nathaniel H. Mayer, M.D., Drucker Brain Injury Center, Moss Rehabilitation Hospital, 12th St. and Tabor Rd., Philadelphia, PA 19141

vii

viii Contributing authors

Joseph D. Matarazzo, Ph.D., Department of Medical Psychology, L351, Oregon Health Sciences University, 3181 S. W. Sam Jackson Park Rd., Portland, OR 07201

Susan M. McGlynn, Ph.D., Department of Psychology, University of Toronto, Toronto, Ontario, Canada M5S 1A1

A. John McSweeny, Ph.D., Department of Psychology, Medical College of Ohio, C.S. #10008, Toledo, OH 43699

Michael Montgomery, Drucker Brain Injury Center, Moss Rehabilitation Hospital, 12th St. and Tabor Rd., Philadelphia, PA 19141

Richard I. Naugle, Ph.D., Department of Psychiatry and Psychology (P57), Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195-5189

Carolyn Palmer, Ph.D., Drucker Brain Injury Center, Moss Rehabilitation Hospital, 12th St. and Tabor Rd., Philadelphia, PA 19141

Edward Reed, Ph.D., Drucker Brain Injury Center, Moss Rehabilitation Hospital, 12th St. and Tabor Rd., Philadelphia, PA 19141

Daniel L. Schacter, Ph.D., Department of Psychology, University of Arizona, Tucson, AR 85721

Myrna F. Schwartz, Ph.D., Neuropsychology Research Laboratory, Drucker Brain Injury Center, Moss Rehabilitation Hospital, 12th St. and Tabor Rd., Philadelphia, PA 19141

Alan Sunderlund, Ph.D., Stroke/Neurological Rehabilitation Unit, Frenchay Hospital, Bristol, BS16 1LE, England

Laetitia L. Thompson, Ph.D., Neuropsychology Laboratory, University of Colorado School of Medicine, 4200 E. 9th Ave., Denver, CO 80262

David E. Tupper, Ph.D., New Medico Rehabilitation and Skilled Nursing Center of Troy, 100 New Turnpike Rd., Troy, NY 12182

A.H. van Zomeren, Ph.D., Afd. Neuropsychologie Rijksuniversiteit, Groningen, The Netherlands

Paul L. Wang, Ph.D., Department of Psychology, Mount Sinai Hospital, 600 University Ave., Suite 1501, Toronto, Ontario M5G 1X5, Canada

William J. Warzak, Ph.D., Department of Pediatrics and Psychology, C. Louis Meyer Children's Rehabilitation Institute, University of Nebraska Medical Center, 444 South 44th St., Omaha, NE 68131-3795

FOREWORD

For a period of some fifteen years following completion of my internship training in clinical psychology (1950-1951) at the Washington University School of Medicine and my concurrent successful navigation through that school's neuroanatomy course, clinical work in neuropsychology for me and the psychologists of my generation consisted almost exclusively of trying to help our physician colleagues differentiate patients with neurologic from those with psychiatric disorders. In time, experience led all of us from the several disciplines involved in this enterprise to the conclusion that the crude diag­nostic techniques available to us circa 1945-1965 had garnered us little valid information upon which to base such complex, differential diagnostic decisions.

It now is gratifying to look back and review the remarkable progress that has occurred in the field of clinical neuropsychology in the four decades since I was a graduate student. In the late 1940s such pioneers as Ward Halstead, Alexander Luria, George Yacorzynski, Hans-Lukas Teuber, and Arthur Benton already were involved in clinical studies that, by the late 1960s, would markedly have improved the quality of clinical practice. However, the only psychological tests that the clinical psychologist of my immediate post-Second World War generation had as aids for the diagnosis of neurologically based conditions involving cognitive deficit were such old standbys as the Wechsler­Bellevue, Rorschach, Draw A Person, Bender Gestalt, and Graham Kendall Memory for Designs Test. Given that in those days our hospital colleagues in

ix

x Foreword

neurology and psychiatry had little else to help with the difficult diagnostic challenges we and they faced daily, these old standbys, crude and inaccurate as they might have been, were, in the minds of all involved, better than nothing.

Fortunately, the widespread dissemination circa the middle 1960s by Ralph Reitan of what experience was proving were the more relevant tests developed by his mentor, Ward Halstead, plus the annually increasing numbers of psy­chologists working full time in medical schools, many of whom were affiliating with the newly being established Departments of Neurology, helped usher in an era in which by the early 1970s such differential diagnosis by clinical neuropsychologists between neurologic and psychiatric disorders became both more reliable and valid. In fact, during the past two decades in large teaching hospitals throughout the land there has been almost universal acceptance by neurologists, neurosurgeons, psychiatrists, and that subset of clinical psychologists who are consultants to them that, appropriately supple­mented, the Halstead-Reitan or Luria neuropsychological batteries of tests were, and are, infinitely better than any other available psychological test for diagnosing the presence or absence of a brain disease or disorder and, when present for many such cases, even its probable location.

However, for an annually increasing percentage of these cases in which we successfully were called in consultation before the middle 1980s, the improve­ment, in brain imaging techniques (CAT, MRI, PET, etc.) that occurred during the decade of the 1980s shifted clinical practice away from reliance for diagnosis on reasonably good neuropsychological batteries such as the Halstead­Reitan, to these latter, more highly sensitive and accurate imaging techniques. Thus, today the exceptions for which such neuropsychological batteries still remain the diagnostic instrument of choice involve to a great extent individ­uals who exhibit only the "softer" signs of cognitive deficit-for example, injuries (associated with subjectively defined memory and personality prob­lems) resulting from automobile and other types of head trauma that are not discernable by use of even our best imaging techniques and that increasingly involve litigation.

Such changes in the focus of my own practice are consistent with what my colleagues also report. Early on during the past decade they and I were refer­red increasing numbers of patients who showed no evidence of brain injury when examined by our best imaging techniques or by standard clinical neuro­logic examination but who reported an array of subjective symptoms of such injury. However, despite the precision of today's imaging techniques, the numbers of such patients with even soft signs are not growing, but, rather, the consultation requests I and others are receiving increasingly involve patients with unquestionable, clear-cut laboratory and clinical evidence of brain injury and for whom many of us are asked by attorneys (as frequently for the plain­tiff as for the defense) to offer help not in diagnosis but in the assessment of the degree of the specificfunctional deficits associated with everyday living (e.g.,

Foreword xi

driving a car, returning to work) as well as for help in identifying a program geared toward rehabilitating or reinstituting some of that injured individual's cognitive and social adaptive functions that both attorneys agree currently are impaired.

In common with other practitioners, I have found that both my education and experience have left me unprepared to make this shift from the responsi­bilities I feel I relatively comfortably and successfully have been meeting as a specialist in assessment for the past two decades to those associated with a new role, namely, as a consultant to physicians, families, attorneys, Workers' Compensation personnel, and other constituents who increasingly are asking me to be more precise regarding the functional deficits involved and to help them find rehabilitation programs with the potential to return to a previous level of social-occupational functioning an individual who all agree has be­come impaired following an injury to the brain.

Thus, when I received the Contents from the editors of this book with the request that I contribute this Foreword, I happily accepted in the hope that I would find in the chapters, which were then being commissioned, some of that information I so sorely needed, as my practice, in common with that of other neuropsychologists of my generation, had moved from differential diagnosis to the assessment of specific cognitive and functional impairments to referrals for programs and technologies geared toward rehabilitation of patients exhibiting such impairments.

Now that I have read all the contributed chapters I am not disappointed, nor do I feel that other readers will be. The reason is that the editors and authors have brought together in two volumes much of the literature, cur­rently scattered hither and yon, with a good potential to move us from the binary-diagnostic decision of the era of the 1950s and 1960s that involved, "Yes there is, no there isn't evidence of a brain injury" to today's more clini­cally relevant questions such as, "Given that there is a brain injury, which specific functional competencies related to everyday living are intact and which are impaired?" and "Which are the cognitive and social skills training pro­grams currently available in our country with the potential to help in the rehabilitation of individuals with such deficits?"

Because of the short history of such ventures into rehabilitation, taken in toto, both the editors and chapter authors appear to me appropriately modest in the claims they are making from their literature reviews (and in their dis­cussions) of the newly emerging rating scales, questionnaires, tests, and other approaches that show promise for the assessment of relevant indices of every­day, real-life functioning, as well as in their descriptions of the intervention and rehabilitation programs that have become available for treatment of the cognitive and social impairments involved. Nevertheless, however modest their current stage of development, having descriptions of these newer as­sessment and rehabilitation approaches so easily available in two volumes

xii Foreword

cannot help but increase the quality of the contributions of practitioners of the young, still developing practice of clinical neuropsychology.

Joseph D. Matarazzo, Ph.D. Oregon Health Sciences University

PREFACE

During the last several years there has been a rapidly evolving emphasis and concern for applied issues in neuropsychology. Much of this emphasis has come from the establishment and acceptance of neuropsychology as a mature discipline, in recognition of its fundamental roles in clinical diagnosis, the study of specific neurobehavioral disorders, and the understanding of basic brain-behavior relationships. Neuropsychology as a discipline is now in a position to examine more complex and professionally related questions and issues. These new issues, also currently a major focus in other areas of pro­fessional psychology, include the relationships between neuropsychological test results and complex human performances, the prediction of everyday behaviors and their dysfunctions from neuropsychological instruments, the social-environmental manifestations of specific neurological disabilities, and the relevance of neuropsychological deficits to psychosocial functioning and adaptation in dynamic real-world contexts.

This volume and its soon-to-be-published companion attempt to provide a comprehensive review and synthesis of some of these seminal issues in the continued development of applied neuropsychology. The books survey cur­rent knowledge regarding basic theory and methodological concerns, and provide reviews of more traditional neuropsychological relationships be­tween test performance and basic competencies. In addition, they develop an appreciation for more functionally related measures and concerns in covering such newly evolving research areas as functional assessment devices, practical

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xiv Preface

cognitive functioning and intelligence, the everyday behavioral competencies of various neurologically disordered clientele, and more psychosocially rel­evant applications in educational, vocational, and rehabilitative contexts.

Some may call the appearance of this two-volume set premature; some may call its appearance delayed. For us as editors, naturally, we feel that it appears at a particularly fruitful and interesting time for neuropsychology and the study of brain-behavior relations. It appears at a time when inves­tigators and practitioners alike are struggling with issues deep at the heart of neuropsychology's core-the interrelationship of abilities thought to be related to the function of the brain, and aspects of our functioning in the everyday realities of life.

The Neuropsychology oj Everyday Life: Assessment and Basic Competencies addresses the relevance of neuropsychological assessment information for predicting everyday behaviors. Chapters in this volume cover methodologi­cal considerations about the ecological validity of neuropsychological tests, perspectives on clinical integration and prediction of criterion behaviors, and the development of a variety of new, more "functional" assessment measures. This volume also describes underlying cognitive abilities in func­tional communication, everyday memory, and everyday actions as well as in complex goal-directed behaviors such as activities of daily living and driving. Its companion volume then addresses two specific issues related to the neuro­psychology of functioning in everyday life. Specifically, one section of the companion volume covers life-span developmental neuropsychology, with chapters directed at major disorders and issues that represent pivotal concerns for real-life outcome and show developmental change. Cognitive disabilities affecting the rehabilitation of brain injury in everyday task performance are covered in another section, emphasizing everyday living skills and psycho­social functioning during neuropsychological rehabilitation.

Chapter authors are preeminent in their respective topical areas and pro­vide the high level of scholarship and expertise needed to refine further these critical issues in neuropsychology. The books should serve as a landmark reference in the clinical neuropsychological study of more ecologically relevant professional concerns and in the development of more sophisticated prac­titioners in research and service delivery. Along with both clinical and exper­imental neuropsychologists, cognitive psychologists, rehabilitation specialists, and others interested in brain-behavior issues as they impact on everyday functioning will find the books of significant interest and use.

We would like to acknowledge our gratitude to all of our contributors who are the "real" people who have produced this two-volume set. We would also like to thank our editors at Kluwer, who have assisted us every step of the way. Finally, we would like to thank our families, who persevered as much as we have with the completion of these books.