DeanWoodcock Neuropsychological Assessment System

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Dean-Woodcock Neuropsychological Assessment System
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Neuropsychological Screening Using the
Dean-Woodcock Neuropsychology Assessment System

• Raymond S. Dean, Ph.D.,ABPP,ABPN
• Ball State University
• Scott A. Decker, Ph.D.
• Georgia State University

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Overview

• History Trends in Neuropsychology
• Relevance of WJ-III for neuropsychology
• History Utility of Sensor Motor Exam
• Dean-Woodcock Sensory Motor Battery
• Administration, Scoring Interpation
• Clinical Studies

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A RATIONALE FOR NEUROPSYCHOLOGICAL ASSESSMENT

• History of Neuropsychological Assessment
• Brain-Behavior Relationships-Theory
• Development of Actuarial Approach
• Advances in Neuroimaging
• Changing Need for Evaluation
• 1. Diagnosis
• 2. Functional Assessment
• 3. Baseline Assessment
• 4. Treatment Planning(ADA IEP)

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The Need for Neuropsychological Assessments

• Neuropsychological assessments contribute unique
  information regarding the functional strengths
  and weaknesses of patients necessary in diagnosis
  of disorders and for accurate prognoses and
  rehabilitation planning that brain imaging cannot
  provide (Volpe, 2003)
• Neuropsychological assessments provide
  information regarding the presence, severity and,
  at times, location of the brain damage (Stringer
  Green, 1996).

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Interpretive Techniques

• Functional Level / Descriptive
• Right-Left Differences
• Pattern Analysis
• Pathognomonic Signs

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The Dean-Woodcock Neuropsychological System

• The D-WNB was designed to provide information
  concerning cognitive ability, achievement,
  memory, language, and executive functioning as
  well as a more reliable and in-depth assessment
  of sensory and motor functions (Hill et al.,
  2000)
• The D-WNB includes
• The Dean-Woodcock Emotional Status Examination
• The Dean-Woodcock Structured Neuropsychological
  Interview
• The Woodcock-Johnson Tests III of Cognitive
  Abilities
• The Woodcock-Johnson Tests III of Achievement
• The Dean-Woodcock Sensory Motor Battery
• Completion of a MMPI-2, MMPI-A, or PIC is
  OPTIONAL but recommended

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Functioning Why Assess Sensory-Motor?

• A major component of neuropsychological batteries
  is the assessment of sensory-motor functioning,
  which looks at the skills that allow individuals
  to receive and interpret sensory input and direct
  voluntary motor movements
• Sensory-motor skills have significant
  implications regarding neurological functioning,
  assessment of them provides clinicians with
  information about the patients neurological
  functioning and many pathognomic signs (Volpe,
  2003)
• Localized damage to sensory or motor
  structures may manifest as specific behavioral
  deficits or pathognomic signs (Hill et al.,
  2000).

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Measures of Sensory-Motor Skills

• Historically, measures of sensory and motor
  functions have been considered clinical measures
  in that the administration is not standardized
  (Archeneaux et al., 1997)
• Lack of standardization in the presentation of
  sensory and motor measures exposes the data to
  several factors which may contaminate the results
  (Archeneaux et al., 1997)
• Although professionals assessing these functions
  are generally highly trained, the
  non-standardized procedures may result in
  observer bias that may increase the probability
  of a variety of errors such as false positives
  (Cohen et al., 1988)

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Measures of Sensory-Motor Skills

• In an effort to increase standardization of
  measurement of sensory and motor functions, the
  Dean-Woodcock Sensory-Motor Battery (D-WSMB) was
  developed
• The Dean-Woodcock Sensory-Motor Battery is a
  standardized measure of sensory-motor skills that
  is part of a new neuropsychological measure, the
  Dean-Woodcock Neuropsychological Battery (D-WNB)

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Dean-Woodcock Sensory Motor Battery

• The Dean-Woodcock Sensory Motor Battery (DWSMB,
  Dean Woodcock, 2003) was created to address the
  psychometric and theoretical shortcomings of
  other measures, as well as to provide an easy to
  administer comprehensive measure of sensory and
  motor skills
• Subtests which measure sensory functions, such as
  visual, auditory, and tactile perception, and 10
  subtests which measure cortical and subcortical
  motor functioning.
• The scores obtained on subtests from the DWSMB
  can be compared to a normative sample of over
  1,000 individuals, ranging from 4 to plus 90
  years of age which yields derived W-scores.
• The DWSMB goes beyond the traditional cutoff
  approach to produce W-difference scores. The
  greater specificity of W-scores allows
  consideration of a few errors that could be
  indicative of sensory-motor impairment and also
  provides scores that can be used for normative or
  ipsative analysis

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D-WSMB

• Traditional sensory and motor tests have a lack
  of nationally representative normative samples,
  reliance on compilations of norms from multiple
  sources, and a paucity of data on reliability and
  validity (Woodward, Ridenour, Dean, Woodcock,
  2002)
• The importance of valid and reliable assessment
  measures is magnified for sensory and motor
  tasks, since even one error may be seen as a
  pathognomic sign of cerebral dysfunction
• Even the Halstead-Reitan Neuropsychological
  Battery, the most widely used neuropsychological
  battery, has been faulted for its standardization
  and norms. However, the battery was never
  standardized on a representative, stratified
  sample of healthy subjects. As with other
  procedures lacking appropriate standardization
  and a set of widely accepted norms, there is much
  variability both in how HRB data are obtained as
  well as in their interpretation. With so many
  available norms, it is possible to choose ones
  based on desired outcomes. (pg. 673, Lezak,
  Howieson, Loring, 2004).

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D-WSMB

• Commonly used measures of sensory-motor skills
  tend to rely on upper extremity sensory and motor
  assessment, and do not sufficiently evaluate
  lower extremity motor functioning that can
  reflect subcortical dysfunction, such as gait,
  station, coordination, and vestibular dysfunction
• Sensory-motor skills are predictive of higher
  order cognitive processing and academic skills,
  such as reading, writing, and mathematics
• Reitan and Wolfson (2003) indicated that, the
  close dependence of sensory-motor functions on
  the biological status of the nervous system
  permits measured deficits to be related to brain
  impairment, as contrasted with the much greater
  dependence of higher-level brain functions on
  environmental opportunities, educational
  advantage, and so forth (Reitan Wolfson, 2003,
  p. 13).

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The Dean-Woodcock Sensory-Motor Battery

• The D-WSMB includes 18 subtests that were adapted
  from the numerous neurologic and
  neuropsychological sensory and motor measures
  (Hill et al., 2000).
• Eight sensory tests that assess visual, auditory,
  and tactile acuity and perception.
• Three tests of primarily subcortical functioning
• Five tests of predominately cortical functioning

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IMPORTANT FEATURES OF THE DEAN-WOODCOCK SENSORY
MOTOR BATTERY

• Wide age range(4-90 years)
• Breadth of content
• Discrepancy procedures
• Linguistic accommodations
• Standardized- Ease of Administration and Scoring
• Spanish and English Versions Included
• Use of W diff scores allow Integration with
  WJ-III
• 50 minute Administration
• Levels of Interpretation
• Scores Based Normals

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Continuum of Progress in Theories and
Intelligence Batteries
Multiple (Incomplete)
Multiple (Complete)
Interacting Cog/NonCog
General (g)
Dichotomous
Binet
WISC KABC/KAIT
WJ SB4 CAS DAS WISC III
WJ-R
CHC Theory
Gt
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NEUROPSYCHOLOGICAL FUNCTIONS FROM WJ-III INCLUDED
IN THE DEAN-WOODCOCK

• General Intellectual Ability/Performance
• Executive Functioning/Fluid Reasoning
• Memory/Learning
• Verbal Comprehension-Knowledge
• Quantitative Ability
• Academic Achievement
• Processing Speed
• Auditory Processing
• Visual Processing

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COMPONENTS OF THE D-W NEUROPSYCHOLOGICAL
ASSESSMENT SYSTEM (Continued)

• VII Sensory Functions
• Visual Acuity
• Confrontation
• Naming Pictures
• Auditory Acuity
• Tactile Exam
• Object
  Identification
• Finger
  Identification
• Tactile
  Localization
• VIII Motor Functions
• Gait and Station
• Romberg
• Construction
• Finger to Nose
• Hand to Thigh
• Mime Movements
• Left-Right
  Movements
• Finger Tapping

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Test Administration

• Theory and Test Administration
• Functional Systems (e.g., Vision)
• Neuropsychological Functions
• Neurodevelopmental Functions
• Structural damage/toxic effects
• Maturational Lag
• Environmental deprivation
• Apotosis and pruning

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Test 1 Lateral Preference

• Measure of handedness or hand preference
• Rating scale
• 1Left Always to 5 Right Mostly
• Common Errors
• Not using stimulus booklet
• Cortical Motor System
• Organization of Cortical Motor Systems

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Handedness
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Test 2 Near-Point VA

• Tests visual acuity
• Use E line for subjects unable to name letters
• Hold card 14 inches from eye
• Use eye occluder
• Check for vision correction (glasses)

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Test 3 Visual Confrontation

• Tests visual fields
• Nasal and temporal fields
• RL Simultaneous
• Score 0 or 1
• 1 if R1, L1
• 0 if R or L 0

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Pattern of performance based on neuroanatomical
structure of visual system
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Test 4 Naming Pictures

• 21 drawings of objects
• Stimulus book
• Common mistakes
• Fail to query
• Ceiling rule 3 highest incorrect

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Visual Pathways
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Test 5 Auditory Acuity

• Simple auditory detection
• Most common mistakes
• Scoring 1 for each correct response
• If R and L correct, than Both 1 (not 2)
• Maintaining 3 inches distance

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Test 6 Tactile Exam-Palm Writing
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Tactile letters / numbers

• Most common error
• Blindfold subject
• Writing numbers
• Use standardized writing guidelines

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Test 7 Object ID

• Astereognosis
• Do not allow subjects to see objects
• Do not allow subject to tap object
• Query some items

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Test 8 Finger ID

• Finger agnosia
• Identify fingers while blindfolded

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Test 9 Tactile Simultaneous Localization

• Part 1 Hands Only
• Part 2 Hands and Cheeks
• Recording scores
• Both 1

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Test 10 Gait and Station

• Rating scale of Gait
• 4 is highest score (Normal Gait)
• Monitor Subject

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Test 11 Romberg

• Gait without use of vision
• Rating scale
• Stand close to subjects with arms in supporting
  position

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Test 11 Romberg

• Gait without use of vision
• Rating scale
• Stand close to subjects with arms in supporting
  position

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Test 12 Construction

• Visual-motor construction
• Draw cross, draw clock
• Stimulus book for cross

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Visual Disorders

• Agnosia inability to visually identify
• Hemianopia half loss of visual field
• Scotoma small lesions, spots in visual field
• Optic Ataxia deficit in visually guided hand
  movements
• Prosopagnosia facial agnosia
• Alexia inability to read
• Neglect

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Test 13 Coordination

• Part A
• Touch tip of nose than examiners finger
• Examiner moves finger to 20 different positions
• Rating scale
• Part B Hand Thigh
• Slap hand on thigh
• Common Error 20 times not 20 seconds

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Test 14Mime Movement

• Ideomotor dyspraxia (knowledge movement)
• Show me how
• 1 point for correct response
• 0 if
• Includes additional actions or sequences
• Omits actions
• Uses hand or arm as object (development)

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Test 15 Left-Right Movement

• Left-Right confusion
• Developmental trends
• Observation important (hesitancy, confusion, etc.)

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Test 16 Finger Tapping

• Use tapper or calculator
• Norms based on calculator (less expensive)
• Use appropriate calculator
• Common Errors
• Wrong norms (male and female)

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Test 16 Finger Tapping

• Use tapper or calculator
• Norms based on calculator (less expensive)
• Use appropriate calculator
• Common Errors
• Wrong norms (male and female)

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Test 18 Grip Strength

• Dynamometer (not included)
• Adjust to fit hand while standing and pointing to
  floor
• Score is average for 3 trials

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Overview of score calculation

• Convert raw score to W-score on scoring table
• Record W-score on interpretive page
• Find age appropriate Ref-W
• Subtract W from Ref-W (W-Ref-W W-Diff
• Calculate Impairment Index by adding all W and
  all Ref-W and subtracting and dividing by total
  number of tests
• Record functional levels (use R L)

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Levels of Impairment
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Interpretive Descriptions (p. 98)
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Interpretive Techniques

• Functional Level / Descriptive
• Right-Left Differences
• Pattern Analysis
• Pathognomonic Signs