Role of Clinical Neuropsychology in the Management of the Aphasic Patient

Abstract

Like other professionals, the neuropsychologist may be involved in research work, clinical work, or both. In research and clinical work with brain-damaged patients, the neuropsychologist's tools are typically behavior. Because this Seminar is aimed at speech and language clinicians, this paper will attempt to explain clinical neuropsychology. It will be obvious that many of the principles, such as an information processing approach, are used by research neuropsychologists as well as speech pathologists. Clinical neuropsychology is the study of the behavioral manifestations of brain damage in humans. A great number of neurologic and behavioral variables must be considered. Neurologic variables include lesion locus, etiology, mode of onset, static or progressive damage, and time lapse between testing and onset of complaints. Patient variables (such as age, education, language background, handedness, and concurrent medical problems) and task variables (such as validity, reliability, and task difficulty) must also be considered. In research, these variables can be controlled somewhat by specifying strict selection criteria so statistical differences between groups can be attributed to a single factor, but even in research studies important variables have been overlooked (Parsons and Prigatano, 1978). In a clinical situation, the problem is even more difficult. It is dangerous in a single patient to infer a certain location of damage based on performance on a single test. Clinically, the neuropsychologist examines the functions of a particular area or system with a variety of tests and makes diagnostic inferences based on the pattern of performance on these tests. As we learn more about the relationship between certain types of errors and the locus of brain damage, qualitative analysis becomes more useful in solving this dilemma. For instance, there are numerous examples of how patients with right versus left hemisphere damage per form poorly on constructional tasks, but these patients make different types of errors and emphasize the clinical import of qualitative analysis (Goodglass and Kaplan, 1979; Lezak, 1976, Walsh, 1978).