This is a summary of the required literature from lecture 1-7 of the course Innovations in Clinical Neuropsychology at Leiden University. Lecture notes are not included, literature lecture 8 is not included.
Literature Summary Innovations in Neuropsychology
Week 1
Artikel 1: Application of Technology in Neuropsychological Assessment – Parsey &
Schmitter-Edgecombe (2013)
Introduction
In recent years increasing numbers of researchers and clinicians have started to use various
technologies to improve the efficiency, reliability, and cost-effectiveness of neuropsychological
assessment.
- Rapid advances (vorderingen) in technology, including improved computer programming,
have allowed many assessment measures to be administered, scored, or interpreted without
the direct interaction of a clinician.
- Cohorts with greater exposure to computers perform better on computer-based assessments
than those with less computer experience.
- It is important to consider whether neuropsychological assessment should adapt to
technological developments so as to maintain status with the experiences of clients.
Cognitive assessment using computers
Definition Bauer et al.: Any instrument that utilizes a computer, digital tablet, handheld device, or
other digital interfaces instead of a human examiner to administer, score, or interpret tests of brain
function and related factors relevant to questions of neurologic health and illness.
- Within the US military, computerized batteries such as the Automated Neuropsychological
Assessment Metrics (ANAM) have been used for both pre-and post-deployment assessment.
- Clinical sports psychologists have used computerized batteries such as ImPact or Cogsports
to assess for mild traumatic brain injury and to inform return-to-play decisions.
- Neuropsychologists who work with cognitively impaired populations likely use at least one
assessment measure that relies on a computer for administration, scoring and/or
interpretation.
Computerized versions of neuropsychological tests like Tower of Hanoi, WCST and Stroop have
similar and sometimes improved reliability compared to the original paper-and-pencil task.
- Normative data that exist for traditional versions of tests cannot simply be applied to
computerized versions because performance on traditional and computer-based
administrations are not directly comparable.
- Attempts to address the gap in the application of technology to improve neuropsychological
assessment are done. This requires internal measures designed to capture underlying
cognitive performances.
o Time sensitive parameters such as reaction time or inspection time can be measured
more accurately using computers.
o Many computerized tests use algorithms for administration purposed. This can be
used to improve sensitivity to a particular disorder by targeting hallmark symptoms,
which may assist neuropsychologists in differential diagnoses.
Virtual reality encompasses a wide variety of technologies and devices to assess manipulation of
objects in a virtual space and time.
, - VR technologies differ in the type of immersion (diepgang/onderdompeling) used:
o Non-immersive three-dimensional computer-screens with a mouse, joystick, or
sensory-based gloves
o Semi-immersive large screen displays using shutter glasses
o Full immersive environments with a green screen and head-mounted display
- Similar to computer-based assessment, VR-based assessment involved integrating
computerized versions of traditional paper-and-pencil based tests into the participant’s
approach to task completion in a simulated environment that may better represent everyday
life.
- Virtual reality tasks have been used to assess the cognitive variables of attention, memory,
and executive functioning.
- Because the VR approach could change the fundamental nature of a task, one should not
assume that the same cognitive constructs are being measured by similar traditional and VR-
based measures.
Is neuropsychological testing conducted in a plain room with limited distractions an accurate
portrayal of real-world abilities?
- Adding controlled distractions to testing could improve ecological validity.
- The Virtual Reality Cognitive Performance Assessment Test (VRCPAT) is a 15-minute battery
that correlates with memory, attention, processing speed, and executive functioning.
- External stimuli in a virtual environment could be used to gather behavioral data of
distractibility and attentional lapses that may otherwise go unmeasured in traditional
neuropsychological evaluation.
- Assessment for ADHD in a Virtual Classroom better classified children with ADHD compared
to continuous performance tests.
o These data of real-time distractibility during testing may provide a more thorough
and/or more ecologically valid assessment of cognitive performance for children with
ADHD.
o Such additional measures could better inform diagnoses as well as treatments for
behaviorally focused disorders.
The ability to incorporate complex environments into testing scenarios has allowed for measurement
of real-world cognitive abilities that are otherwise constrained to abstract tasks in the laboratory.
- Because environments are controlled by the experimenter, distractions or interruptions can
be implemented to assess higher function and target cognitive deficits that characterize
specific disorders.
- Driving simulators provide an opportunity for obtaining basic information about driving
abilities in a safe environment, however, driving simulators may be better used in
combination with other assessments of cognitive and physical functioning for a more
comprehensive assessment of skills needed for driving.
- Virtual Errands (taken) Test (VET): assesses planning abilities associated with multi-tasking.
- Virtual Multiple Errands Test (VMET): measures strategy and interweaving of task
information in addition to general memory and executive skills.
o VMET has distinguished among different age groups of cognitively healthy adults, as
well as participants who have experienced stroke or Parkinson’s disease from healthy
controls.
Computer-based and virtual reality assessments: conclusions and future directions
,Strengths of computer-based and virtual reality assessments:
- Comparable reliable and valid to other neuropsychological testing measures when used with
appropriate normative data.
- Algorithmic design can be used to tailor for specific populations
- Provide increased ease and standardization of administration, reduction in errors during
scoring and interpretation, and readily accessible assessment without significant time
devoted to preparation of materials.
- Clinical application of VR has provided new opportunities for assessment, including
customization for target populations, specific cognitive domains, and unique settings.
- VR allows for measurement of simulated everyday tasks in a safe and controlled
environment.
- The opportunity for researchers and clinicians to assess the influence of environmental
stimuli on cognitive performance may provide a more ecologically valid assessment of
everyday skills.
Weaknesses and limitations of computer-based and virtual reality assessments:
- General technological issues, such as variations in computer hardware, and currently limited
information on psychometric and normative properties for different clinical populations.
- Performance on technology-based assessments may be influenced by knowledge of
computers or other technology.
- Limitations unique to VR are dominated by physiological concerns (motion sickness).
- Subject to greater individual variability.
- VR assessments are relatively high-cost technologies that require regular maintenance.
How can technology-based measures add value to neuropsychological assessment data?
- Advances in technology offer the opportunity to gain valuable information from assessment
that is not obtained through paper-and-pencil measures, such as algorithmically defined
approaches to a particular test, evaluation of pauses, perseverations, and domain-specific
errors, and/or response times in very specific measurements.
- Using technology could improve the psychometric properties of neuropsychological
assessments, including better inter-rater reliability in scoring procedures, more consistent
administration procedures across clinics, and ultimately more confidence in final reporting of
findings.
- Infiltration of technology into everyday life has become so significant that differences in
familiarity with computers can affect performance on standardized cognitive tasks.
- Ideally supplementary measures will provide additional information to more accurately
diagnose attentional disorders, and in turn inform effective treatments for deficits on a
spectrum.
What are the major factors to be considered when developing or implementing technology-based
assessments?
- The influence of cohort effects, cost-effectiveness, construct validity, and standardization
procedures.
- Technology-based assessments may promote shorter evaluation times while gathering more
cognitive and behavioral data than a traditional neuropsychological assessment.
- Equipment standardization may be necessary in developing technology-based assessments
with consistent results across administration sites.
, - Normative bases should include base rate influences of individual variability when
developing new assessments.
Ecological momentary assessment (EMA) is a data collection approach using telephone-, PDA-, or
tablet-administered self-report questionnaires.
- Used to obtain subjective measures multiple times per day.
- Advantage: researchers can gather data in ‘real time’ which may result in less bias than in-
clinic data resulting from recollective self-report.
Artikel 2: The Technology Crisis in Neuropsychology – Miller & Barr (2017)
It had become increasingly clear that neuropsychology has essentially remained stagnant and
reluctant to intergrade technology in practice.
A brief historical review and statement of the problem
Neuropsychology testing continues to rely primarily on paper-and-pencil tasks.
- Psychological tests were initially produced and distributed by psychologists, starting with
James McKeen Cattell and his development of The Psychological Corporation in de 1920s.
- Many believed that neuropsychological testing was about to undergo a significant paradigm
shift following the large-scale sales and distribution of low-cost microcomputers to scientists
and the public in the 1980s.
- Limited factor: focus on the technological challenges, concerns about clinicians and subjects
lacking familiarity with the new technology, and the possibility of a diminishing role for
examiners who are trained in the evaluation and interpretation of the test results. Instead of
focusing on the advantages.
- Limited factor: the relative lack of innovation in the tests that were offered for use in
computer administration.
Advantages of technological integration, and how might we use it?
The most comprehensive profiles of human behavior will likely emerge from an integrated approach
that draws from one or more technological resources.
Laboratory testing
- The most straightforward approach is to simply incorporate technology into our current
assessment methods and digitize existing tests by porting them to a tablet or computer.
- However, technology could be leveraged more effectively if development efforts also
focused on generating new data points from the standard administration of current tests.
- Verbal fluency tasks could be developed that no longer require manual recording of
responses and instead rely on an audio recording and speech recognition technology to
automatically record latency, pauses, grammatical errors, consistency, and evaluate patterns
of responding in addition to traditional scoring metrics.
- Perhaps the most obvious point for additional behavioral data is reaction time.
- Assessing episodic memory seems somewhat less amenable (verbeterbaar) to technology
integration in comparison to other cognitive domains.
- Assessing nonverbal learning and memory is perhaps even more challenging.
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