Clinical Neuropsychology: A Window to Understanding Brain and Behavior Relationships

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Clinical NeuropsychologyA Window to
Understanding Brain and Behavior Relationships

• State Farm Insurance
• April 12, 2004
• Antonio E. Puente
• Department of Psychology
• University of North Carolina at Wilmington
• Wilmington, North Carolina 28403
• www.uncw.edu/people/puente
• www.clinicalneuropsychology.us
• puente_at_uncw.edu

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APA Membership
 
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APA Membership by Division

• Approximately 150,000 members
• Approximately 50 different divisions
• Top three divisions are
• Clinical Psychology
• Clinical Neuropsychology
• Independent Practice

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What is Clinical Neuropsychology?

• Study and practrice of the relationship between
  brain (nervous system?) and behavior, especially
  in neurological patients
• Approximately 4-5,000 (out of 150,000)
• Doctorate with post-doctorate training is minimum
  requirement

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History Organizational

• American Psychological Association (APA)
• Division of Clinical Neuropsychology (40)
• National Academy of Neuropsychology (NAN)
• International Neuropsychological Society (INS)

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History Informational

• Publications
• Books (Goldstein, 1974)
• Journals (ACN, JCEN, TCN, Neuropsychology, NR)
• Online
• Trends
• Assessment (1970s-)
• Rehabilitation (1990s-)
• Forensic (1995-)
• Other Sub-specialties (2000-)

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History Clinical Activities

• Assessment
• Individual Tests (Wecshler Intellingence Scales)
• Fixed Battery (Halstead-Reitan Vs.
  Luria-Nebraska)
• Flexible Approach (Boston)
• Rehabilitation
• Cognitive Rehabilitation
• Medical Compliance and beyond
• Forensic
• Social Security
• Workers Compensation
• Personal Injury
• Death Penalty

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Current Status Review of the Surveys

• Brief History of Surveys
• Hartlage others
• DeLuca Putnam
• Current Survey Methodology
• Sweet Peck (and others 2002)
• Knauss, Schatz, Puente (2004)

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Organizational Membership(All Doctoral Licensed
Clinicians)
Percent
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Type of Doctoral Degree (All Doctoral Licensed
Clinicians)
Percent
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Field of Doctoral Degree(All Doctoral Licensed
Clinicians)
Percent
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Work Setting(All Doctoral Licensed Clinicians)
Percent
13
Board Certification Status(Doctoral Licensed
Clinicians)
Percent
14
Weekly Professional Activities by Organization
Percent
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Weekly Professional Activities by Organization
Percent
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Time-Related Case Activities(All Doctoral
Licensed Clinicians)
Minutes
Hours billed Private11.1 (SD5.0)
Institution8.2 (SD3.3) Only scoring is not
significant between groups covarying amount
of forensic practice did not eradicate group
differences
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Use of Testing Assistants(All Doctoral Licensed
Clinicians)
Percent
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Professional Activity(in order of prevalence)

• Determination of Diagnosis
• Determination of Effects of Deficits
• Treatment Planning
• Documentation of Baseline Functioning
• Educational Evaluation/IEP
• Forensic Activities (civil criminal)
• Disability/Workers Compensation
• Monitoring Cognitive Recovery
• Pre/Post Medical Procedure
• Independent Medical Examinations

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Overall Summary

• Personnel
• Clinical Activities

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Forensic Issues

• Effort
• Effort versus Malingering
• Second Opinions
• Data are Data
• Limits of Neuro Knowledge
• Limits of Neuro-radiological Knowledge
• Limits of Neurological Knowledge
• Limits of Neuropsychological Knowledge

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Forensic Issues

• The Problem of the Expert Witness
• The Problem of Causality
• In general
• In North Carolina

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Viewing the Patient as a System

• Premorbid
• Accident
• Immediate Residuals
• Long Term Residuals
• Impact to a Social System
• Coping and Alternative Living and Vocational
  Opportunities

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Summary

• Continued Growth
• Excellent Source of Information
• Vibrant and Unpredictable