Neuropsychonline Weblog

We have developed a differential diagnosis program, “Dx of Congenital Syndromes and Anomalies” based closely on the text “Smith’s Recognizable Patterns of Human Malformation, 5th Edition”. After you select, define and submit your patient’s symptoms from the interactive interface, you receive a report showing the three most likely syndromes, given the symptoms selected. It is strongly recommended that you purchase the book (Amazon.com) as a reference if you plan to utilize this application. This program is a screening device and cannot make a conclusive diagnosis.

The NPO-BMSE was designed to provide a more comprehensive, but still brief, evaluation of mental status that is more in concert with a neuropsychological perspective. In addition, we wanted to be able to generate an automated report from the NPO-BMSE that would provide more meaningful information to the clinician concerning the patient’s capabilities and also serve as a starting point for further clinical procedures.

The NPO-BMSE must be administered away from the computer and the data then entered into the NPO-BMSE interface at any later time. An examiner must prepare for the NPO-BMSE by printing the forms and stimulus sheets needed for the exam prior to meeting with the patient (this can be done once and copied for use with many patients). The forms are completed during the examination and then the clinician can go back online to the NeuroPsychOnline web site to enter the data and receive back a formal report. Significant past medical information from the patient’s history and about the current medical condition is included in the data collection for the purpose of building a more useful database.

The NPO-BMSE was designed to collect data regarding a patient’s functional capability in these areas:

1 ) Orientation
2 ) Attention Skills
3 ) Executive Skills
4 ) Memory Skills
5 ) Visuospatial Skills
6 ) Speech and Language Skills
7 ) Motor Functioning and
8 ) Sensory Functioning.

Administration of the NPO-BMSE should take about 15 to 20 minutes. The administration manual, test materials and forms are in PDF format (all contained in one Zip file) and accessible from our website for Professional Members.

Example of a NPO-BMSE report:

_______________________________

NeuroPsychOnline - Brief Mental Status Examination - Report

2009-10-17
Personal Information:

Name:___________ John Doe
Education:________ 16 years
Sex:_____________ male
Highest Degree:___ BS
Date of Birth:_____ 8-13-1958
Age:_____________ 51
Handedness:______ right

Test Results:

John Doe’s responses on the NPO-BMSE produced an overall score of 41 of 69 possible points. An average score is 63 with an average range of 61 to 65. John’s score places him in the severely impaired level of functioning.

John’s responses indicated that he was oriented for person and place but not for time. He made errors on the following questions:

1. ‘What is the day?’
2. ‘What day of the week is today?’
3. ‘Approximately what time is it right now?’

John’s performance on test items requiring auditory attention skills indicated that auditory attention skills were poor for this session. Performance on test items requiring visual attention skills indicated that visual attention skills were mildly impaired and may have affected performance on other areas of functioning that require visual attention skills.

John’s performance on test items requiring executive skills such as mental organization, sequencing ability, the ability to mentally manipulate information and abstract thinking indicated that executive skills were moderately impaired.

On a verbal memory task, John recalled, after a 5 minute delay, 1 of 3 words verbally presented earlier. On a visual memory task, he recalled 2 of 3 shapes visually presented earlier.

John’s performance on test items requiring visuospatial skills such as visual perception, visual analysis and synthesis, visuomotor production and visual closure indicated that visuospatial skills were severely impaired and most likely affected performance on other areas of functioning that require good visuospatial skills.

John’s performance on test items requiring speech and language skills such as ability to repeat words and phrases, read, write, follow instructions and comprehend abstract phrases indicated that speech and language skills were mildly impaired and may have affected performance on other areas of functioning that require good speech and language skills.

Motor skills for both hands appear to be within normal limits.

Tactile sensation for the both hands appears to be within normal limits. John’s ability to recognize objects solely from feel was mildly impaired for right hand and mildly impaired for left. John’s proprioceptive sensation for passive finger positioning was good for right hand and good for left.

This is a mental status screening test and should not be considered a comprehensive evaluation of this person’s cognitive functioning. John appeared significantly impaired on this screening examination and definitely should undergo more extensive cognitive or neuropsychological examination to further define impairment.

_________________________
Examiner

_______________________________

The BEA provides a comprehensive, computer administered examination for symptoms of aphasia. While the computer administers the examination items, the examiner plays the key role in the test administration in terms of managing the test presentation and rating the patient’s vocal and written responses. Responses entered directly into the computer, by the patient, via the mouse, are scored by the program. The examiner, then, must obviously be knowledgeable of speech/language function and the signs and symptoms of aphasia. A personalized narrative report is computer generated and includes diagnostic considerations.

Excerpt from a BEA report:
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John Doe made errors on 7 of 37 subtest areas measured by the Brief Examination for Aphasia (BEA) yielding a BEA impairment index of 10. This places him one standard deviation below average on this test. Analysis of the individual subtest scores shows that 4 subtests revealed mild impairment, 3 subtests revealed moderate impairment and 0 revealed severe impairment.

He was not echolalic.

There were no signs of paraphasic or neologistic speech.

Formal testing showed moderately impaired confrontational naming skills. Testing of ability to point to objects named showed no errors.

From general observation comprehension of verbal communication appeared good. A formal test of ability to follow orally presented instructions showed no problem but ability to follow written instructions was mildly impaired.

The ability to repeat both words and phrases was intact.

John was able to match block printed words to their script written versions. His ability to match words to objects was mildly impaired. John was able to read alphabet characters, words and phrases without error. He was asked to read a paragraph that was in a story format. A reading comprehension test based upon the content of the story showed moderate impairment.

John was mildly impaired in his ability to recognize words verbally spelled to him but showed good ability to spell words.

Copying text, writing text from dictation and composing/writing proper sentences were all without error.

Drawing objects on verbal request and drawing objects from visual model (copying) were both good.

Reproducing (i.e. whistle, hum or sing) single tones and reproducing simple melodies were both good.

Sequential counting forward and backward was good. The ability to count objects was good. The ability to read numbers was good. The ability to write numbers from dictation was good. Appreciating the value of numbers in a larger versus smaller number test was intact. The ability to work orally presented arithmetic problems on paper was good. The ability to work written arithmetic problems on paper was good. The ability to work orally presented arithmetic problems mentally was mildly impaired. The ability to work written arithmetic problems mentally was moderately impaired. The ability to express numbers in writing using words rather than digits was intact. John was able to setup an addition problem involving five numbers properly and he produced the correct response.

etc..
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The NeuroPsychOnline (NPO) Cognitive Rehabilitation Therapy System consists of six Tracks of exercises designed to improve the user’s cognitive skills. The Tracks are:

1. Attention Skills
2. Executive Skills
3. Memory Skills
4. Visuospatial Skills
5. Problem Solving Skills
6. Communication Skills

Each Track contains 12 Tasks (72 Tasks altogether), arranged in an order so that the most basic of cognitive skills are addressed first in therapy. As the user progresses, the Tasks evolve to become more complex and challenging. In addition, 69 of the Tasks contain four levels of difficulty and three contain three levels.

A therapist subscriber can operate the therapy system on an automated or a manual basis. The automated mode consists of a predetermined therapy protocol in which the patient is systematically presented with the entire therapy program in a hierarchy that we use at the Neuroscience Center and which was utilized in our research. The manual mode allows the therapist to select from a menu the exercise they want to do with a patient, in a face-to-face session, and/or set up as a prescription that includes the Tasks that the therapist wants the patient to do at home between therapy sessions. To do the latter therapists must assist their patient in converting their registration from a patient seen in the office only to a patient subscriber. There is a link under the Administration Menu within the Cognitive Rehabilitation Therapy section that will facilitate this procedure.

A prescription that the therapist could set up for a patient subscriber to do at home could contain from one to six Tasks at a time. Only one Task within a particular Track can be assigned in a prescription. A patient’s advancement through levels and also through Tasks is dependent on their performance on the Tasks. They must meet performance criteria to pass a run and they must pass on three consecutive runs to totally pass a level. Totally passing a level means that particular level will not be presented again. The patient is automatically advanced, by the system, to the next level or Task if they perform well enough on a Task. However, the therapist can always control, manually, how a patient advances through the system if they want to deviate from the established protocol.

Each task is set up in a game like format. To do therapy the patient simply plays the game and tries to do the very best they can. We have tried to make the Tasks fun to do so that therapy will be a more enjoyable experience, however, even the Tasks that are not so much fun must be completed in order for the patient’s skills to develop properly. If a patient already has some skill in a certain area and they get assigned a Task in that area they should pass through it fairly rapidly and move on to the next level.

We conduct comprehensive Therapist Training Workshops on a regular basis that teach our intended method of conducting cognitive rehabilitation therapy with the Neuropsychonline system.

The Visual Fields Screening Test is administered separately to each eye starting with the left. Options are presented that allow you to skip either eye. The patient is directed to stare intently at a series of 1 digit numbers being continuously displayed at the center of the screen. Then the patient simply clicks the mouse button immediately, every time he/she detects that a small white spot is being displayed somewhere on the screen. A response by the patient is added to the data pool only if the patient is able to correctly identify the last number that was displayed at the center of the screen at the time he/she clicked the mouse button. The program produces a visual field map, for each eye tested, based upon the patient’s reaction times. To save the map the clinician must click on a Print button to have the map printed.

Welcome to our NeuroPsychOnline Weblog! We have decided that this may be the best way to provide you vital information about NeuroPsychOnline (NPO) and keep you up to date with what we are doing with the system. As we are new to the blog world you may see changes on a daily basis as we learn more about working within this environment. The information will be archived automatically and will be searchable. Over time we should accumulate a helpful compendium of information for your use. In addition, there will be numerous feedback opportunities included that will be invaluable to our further development.
We will also be including a blog on our patient subscriber interfaces, in a newsletter format, that will be directed toward making the patient’s experience with our therapy system more comfortable and more rewarding for them..