An Introduction to Clinical An Introduction to Clinical NeuropsychologyNeuropsychology

New Hanover Regional Medical Center March 6, 2003

Antonio E. Puente Department of Psychology, UNCW Private Practice, Wilmington

Outline of PresentationOutline of Presentation

Defining Clinical Neuropsychology Neuropsychological Assessment Neuropsychological Intervention Sample Cases & Resources

Type of Doctoral Degree (All Doctoral Licensed Clinicians)

0

10

20

30

40

50

60

70

80

90

PhD (n=1225) PsyD (n=143) EdD (n=24)

Percent

Field of Doctoral Degree(All Doctoral Licensed Clinicians)

0

10

20

30

40

50

60

70

Clinical Couns. Neuro. School Ed. Psy. Comb.

Percent

Work Setting(All Doctoral Licensed Clinicians)

0

5

10

15

20

25

30

35

40

PrivatePractice

Institution Comb. Other

Percent

Board Certification Status(Doctoral Licensed Clinicians)

0

10

20

30

40

50

60

70

80

Board Certified(n=271)

Not Board Certified(n=1053)

Percent

Weekly Professional Activities by Organization

(All Doctoral Licensed Clinicians, exc. Part time)

01020304050607080

Clinical Pract.

Teach. Research($)

Res. (No $)

Non-ClinAdmin.

NAN D40 Both Unknown

Percent

Weekly Professional Activities by Organization

(% for All Doctoral Licensed Clinicians, exc. Part time)

01020304050607080

Supervision Forensic

NAN D40 Both Unknown

Percent

Hours Per Week Per Clinical Activity(Full-time and Full-time plus Doctoral Licensed

Clinicians)

3.32.1

13.73.7

2.12.5

4.90.6

2.22.1

0 5 10 15

DX Interv Nbeh Ex Npsy Test Psy TestF/ Up Ass. TX (BD) TX (No BD) CogRehTx plan Superv

Evaluation Time by Evaluation Goal(Hrs. for All Doctoral Licensed Clinicians; 5th & 95th%ile in

parens.)

6.3

4.4

4.2

4.8

9.3

0 2 4 6 8 10

Determ DX (n=1022) (1-16)

TX Plan (n=914) (.5-12)

Pre/ Post (n=566) (1-10)

Baseline (n=784) (1-10)

Forensic (n=790) (1-20)

(Except forensic, those using assistants test more hours (e.g., for determination of diagnosis, 6.6 hrs vs. 5.8 hrs, p=.017.) However, hours billed are similar.

Time-Related Case Activities(All Doctoral Licensed Clinicians)

319

260

050

100150200250300350

Private Institution

Hours billed: Private=11.1 (SD=5.0); Institution=8.2 (SD=3.3)* Only scoring is not significant between groups; covarying amount of forensic practice did not eradicate group differences

Minutes

The Purpose of a The Purpose of a Neuropsychological EvaluationNeuropsychological Evaluation

Origin to Disposition Educational Forensic

Competency Social Security Worker’s Compensation Personal Injury Capital Felony

Clinical Surgical Interventions Treatment Decisions

Psychopharmaceutical Psychotherapeutic Cognitive Rehabilitation Pain Management Physical Intervention Medical Compliance

Components of a Components of a Neuropsychological EvaluationNeuropsychological Evaluation

Record Review Interview (including collateral) Neuropsychological Testing Summary and Disposition

Sample Neuropsychological Sample Neuropsychological TestsTests

Attention (Cancellation tests) Visuomotor (Trail making) Fluency (FAS) Communication (Boston) Problem Solving (Category) Learning & Memory (WMS) Intellectual (WAIS) Academic Achievement (WRAT) Personality & Affective (MMPI Tests of Effort (Rey)

(see Camara, Nathan, & Puente, 2000, Professional Psychology, for a complete list of neuropsychological and psychological tests currently in use)

Components of a Components of a Neuropsychological Neuropsychological

InterventionIntervention

Psychotherapy Cognitive Rehabilitation Biofeedback Vocational Intervention Health Behavior Management

Sample Neuropsychological Sample Neuropsychological InterventionsInterventions

Psychotherapy Individual vs Family/Group Problem-Focused Time-Limited

Cognitive Rehabilitation Problem-Solving Learning & Memory

Biofeedback EMG

Sample Forensic CasesSample Forensic Cases

Competency Social Security Workers Compensation Personal Injury Capital Felony

Sample Clinical CasesSample Clinical Cases

Pain Head Injury Dementia Coronary Bypass Stroke “Degenerative” Disorders

ResourcesResources

  web

www.Clinicalneuropsychology.us www.uncw.edu/people/puente www.div40.org. www.nanonline.org