Cady K. Block

Cloze probability and completion norms for 498 sentences: Behavioral and neural validation using event-related potentials

Three decades after their publication, Bloom and Fischler’s (1980) sentence completion norms continue to demonstrate widespread utility. The aim of the present study was to extend this contribution by expanding the existing database of high-constraint, high cloze probability sentences. Using the criteria established by Bloom and Fischler, we constructed 398 new sentences and presented these along with 100 sentences from their original list to be normed using a sample of 400 participants. Of the 498 sentences presented, 400 met criteria for high cloze probability—that is, .67 or higher probability of being completed by a specific single word. Of these, 321 sentences were from the new set and an additional 79 were from Bloom and Fischler’s set. A high degree of correspondence was observed between responses obtained by Bloom and Fischler for their high-constraint set. A second experiment utilized an N400 event-related potential paradigm to provide further validation of the contextual constraint for the newly generated set. As expected, N400 amplitude was greater for sentences that violated contextual expectancy by ending in a word other than the newly established completion norm. Sentence completion norms are frequently used in cognitive research, and this larger database of high cloze probability sentences is expected to be of benefit to the research community for many years to come. The full set of stimuli and sentence completion norms from this study may be downloaded from http://brm.psychonomic-journals.org/ content/supplemental.

Psychotherapeutic treatment of survivors of traumatic brain injury: Review of the literature and special considerations

Abstract Primary objective: To provide an overview of useful clinical information for healthcare providers involved in traumatic brain injury (TBI) rehabilitation, including current methods used with survivors of TBI, therapeutic considerations in light of this population’s cognitive, emotional and social difficulties and issues regarding the therapeutic working alliance from both survivor and provider perspectives. Research design: Non-systematic clinical review. Method: The literature was intended to be comprehensive to reflect both past and present contributions to the field. To that end, citations were included from seminal and current texts as well as relevant original and review articles from 1985–2012 in PubMed and PubMedCentral online research databases. Main outcomes and results: This article highlights the usefulness of psychotherapy for treatment of psychiatric symptoms in the TBI population, reviews available modalities and offers considerations and suggestions to facilitate and improve treatment. Conclusions: Although challenging and perhaps frustrating at times, psychotherapy with this population can be validly attempted and ultimately very rewarding for both the survivor and therapist. Future research should seek to perform controlled studies to examine therapeutic efficacy and compare gains by injury severity in the hopes of creating best practice guidelines for practitioners.

Neuropsychological and neuroanatomical sequelae of chronic non-malignant pain and opioid analgesia

BACKGROUND The pervasive disease of chronic pain is a common challenge for the clinical rehabilitation professional. Concurrent with physical and emotional symptoms, pain-related cognitive impairment has been reported. Although opioid analgesics are frequently prescribed, concern exists that opioids possess adverse cognitive effects of their own. OBJECTIVES To review the neuropsychological and neuroanatomical sequelae of chronic non-malignant pain and opioid therapy, to clarify roles and benefits of neuropsychological assessment in a chronic pain population, and to provide recommendations for clinical practice and future research. METHODS This non-systematic review sought to provide a comprehensive synthesis of relevant neurobiology, neuroimaging, neuropsychological, and rehabilitation research literatures. We included citations from seminal and current texts as well as relevant original and review articles from 1980-2012 in PubMed and PubMedCentral online research databases. DISCUSSION AND SUMMARY/CONCLUSIONS To date, evidence from opioid studies suggests only mild deficits in specific cognitive domains (e.g., memory, attention/concentration) and only under specific conditions (e.g., dose escalations). Additionally, neuroimaging and neuropsychological evidence suggests that pain itself results in cognitive sequelae. Methodological improvements in future research will allow for better delineation of the contributing effects of pain and opioids, with an overall goal of improving evidence-based clinical treatment recommendations.

Discriminating cognitive screening and cognitive testing from neuropsychological assessment: implications for professional practice

Abstract Objective: To provide clarification on the distinction between cognitive screening, cognitive testing, and neuropsychological assessment and highlight practical implications. Method: Non-systematic brief clinical review. Results: There is a present lack of explicit distinction between the various levels of measurement of cognitive functioning with regard to goals, indications for use, levels of complexity, and outcome. There is also a lack of guidance regarding the identification of who should be responsible for the administration and interpretation at each level. Conclusions: There is a growing awareness of the importance of cognitive health and disability, and of the importance of measurement of cognitive functions across the lifespan. For example, cognitive screening has been mandated by the Patient Protection and Affordable Care Act of 2010, and language contained within new psychiatric diagnostic criteria and healthcare regulatory changes reflect increased consideration of the importance of measurement of cognition. Changes such as these necessitate greater clarity on this important issue as it bears implications for professional practice, which ranges from education and training competencies, practice standards, and the way that neuropsychologists clarify and advocate for the value of specialty referrals for comprehensive assessment in a competitive and ever-changing healthcare market.

Work–life integration in neuropsychology: a review of the existing literature and preliminary recommendations

Abstract Objective: The purpose of the current review paper is to identify and describe challenges to work–life integration in neuropsychology, and from this review extrapolate an initial set of recommendations and present a set of scenarios in which the recommendations might apply in the hopes of improving quality of life for current and prospective neuropsychologists. Specific areas of focus include diversity, early and mid-career transitions, and potential barriers to advancement in specific practice settings. Method: A broad review was conducted of extant literature on work–life integration. There is scant scientific literature in this area that is specific to neuropsychologists, or even psychology as a whole. Subsequently, the majority of this review was collected from more developed literatures in business and medical fields. The authors then provided recommendations based on experiences in their respective careers. Attempts were made to promote generalizability of recommendations for neuropsychologists in different settings. Results: Evidence supports a potentially adverse impact on quality of life and overall life satisfaction when work and personal lives conflict. Conclusion: This manuscript identifies some of the potential risks when work and life responsibilities are not well integrated. It is anticipated this will serve as a catalyst for future studies on work–life integration in the field of neuropsychology, specifically.

Misconceptions and Misattributions About Traumatic Brain Injury: An Integrated Conceptual Framework.

The objective of the present narrative review was to provide a conceptual framework to address common misconceptions in the field of traumatic brain injury (TBI) and enhance clinical and research practices. This framework is based on review of the literature on TBI knowledge and beliefs. The comprehensive search of the literature included seminal and current texts as well as relevant articles on TBI knowledge and education, misconceptions, and misattributions. Reviewed materials ranged from 1970 to 2013 and were obtained from PubMed and PubMed Central online research databases. Research findings from the reviewed literature were integrated with existing social and cognitive psychological concepts to develop a framework that includes: (1) the identification antecedents of TBI‐related misconceptions and misattribution; (2) understanding of how inaccurate beliefs form and persist as the result of pre‐ and postinjury cognitive operations such as informational cascades and attribution biases; and (3) a discussion of ways in which these beliefs can result in consequences in all domains of a survivors life, including physical and mental health, stigma, and discrimination. This framework is intended to serve as a first stage of development of a model that will improve treatment endeavors and service delivery to individuals with TBI and their families.

The trainee leadership blueprint: opportunities, benefits, and a call to action

Abstract Objective: Leadership experiences are vital not only to individual long-term career success but also the development, direction, and operation of higher spheres including professional organizations and the field of clinical neuropsychology itself. Method: The present paper presents a blueprint guide for neuropsychology trainees on available opportunities and resources for increasing their involvement in professional governance and developing leadership skills. First, we present a discussion of the benefits of leadership and professional service, including the acquisition of interpersonal skills and new professional competencies, the prospect of recognition and advancement, and the opportunity to participate in advocacy efforts. Then, we present an overview of existing opportunities for involvement, followed by the provision of specific, actionable items for trainees, mentors and leadership committees, and for neuropsychology organizations to ensure continued trainee engagement. Conclusions: These resources can serve as a guide for trainees and early career neuropsychologists seeking to acquire leadership proficiencies, and the recommendations aspire to promote advancement for trainees, professionals, and organizations alike.

The Interaction Between Medical Burden and Anticholinergic Cognitive Burden on Neuropsychological Function in a Geriatric Primary Care Sample

Poorer neuropsychological function is associated with increased medical burden (MB) and the use of more anticholinergic medications. However, the interaction between MB and anticholinergic cognitive burden (AB) on neuropsychological performance is unknown. In a sample of 290 elderly primary care patients, those with a greater level of AB demonstrated poorer Total Index performance on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Further, an interaction effect was noted such that there was a greater anticholinergic effect on RBANS Total, Attention, and Delayed Memory Index scores for participants with fewer MB. Participants with more MB demonstrated poorer performance irrespective of their level of AB. These results indicate that MB effects may be overshadowed by anticholinergic effects in older patients.

Validation of ANAM for cognitive screening in a mixed clinical sample

ABSTRACT The Automated Neuropsychological Assessment Metrics (ANAM) is a library of computer based tests designed to measure cognitive function at a single time-point or longitudinally for detection of cognitive change. This study sought to validate ANAM as a cognitive screening tool for presence of confirmed neuropsychological diagnosis in an outpatient setting. Retrospective data analysis was conducted for 139 patients referred for outpatient neuropsychological assessment. Clinical diagnosis was made independent of ANAM test results and resulted in a diagnostic mix of both neurologic and psychologic etiologies. ANAM scores predictive of presence of confirmed diagnosis were identified using multiple logistic regression and the predictive ability of the resulting model was quantified using receiver operator characteristic analysis. Sensitivity and specificity for the ANAM when combined with anger and depressive symptom scores were 71% and 91%, respectively, with a positive predictive value of 97.5 and negative predictive value of 40.4. This combined approach provided the greatest accuracy for individual tests as well as the composite score of the ANAM in identifying those who received a subsequent clinical diagnosis. Although data should be replicated in larger samples, these results suggest that ANAM may have predictive value and may be a useful screening tool for identifying those who would likely benefit from neuropsychological services.

Neuropsychology and Rehabilitation Services in the United States: Brief Report from a Survey of Clinical Neuropsychologists

OBJECTIVE To provide a brief presentation of preliminary data on rehabilitation services provided by clinical neuropsychologists within the United States. METHOD This survey utilized data extracted from a larger international research study conducted in 39 countries including N = 173 professionals who reported to engage in neuropsychological rehabilitative services within the past year (63.6% female, 44.36 ± 11.83 years of age) took part in the study. RESULTS Neuropsychologists providing rehabilitation services in the United States in the past year were more likely to provide individual versus group therapy, likely to employ technology (e.g., personal computers, mobile phones/smartphones) as part of treatment services, see a range of diagnostic groups most prominently traumatic brain injury and stroke/vascular conditions, and work to address a range of both cognitive (e.g., memory, attention/concentration, and executive functioning) and psychological (e.g., emotional/behavioral adjustment and well-being, awareness of disability/disease) issues. CONCLUSIONS Prior published surveys suggest that clinical neuropsychologists have a growing involvement in rehabilitation services within the United States but with little clarity as to the actual characteristics of actual professional activities and practices. The present study aimed to provide such information and hopefully will be helpful in promoting additional systematic studies in this area.Objective To provide a brief presentation of preliminary data on rehabilitation services provided by clinical neuropsychologists within the United States. Method This survey utilized data extracted from a larger international research study conducted in 39 countries including N = 173 professionals who reported to engage in neuropsychological rehabilitative services within the past year (63.6% female, 44.36 ± 11.83 years of age) took part in the study. Results Neuropsychologists providing rehabilitation services in the United States in the past year were more likely to provide individual versus group therapy, likely to employ technology (e.g., personal computers, mobile phones/smartphones) as part of treatment services, see a range of diagnostic groups most prominently traumatic brain injury and stroke/vascular conditions, and work to address a range of both cognitive (e.g., memory, attention/concentration, and executive functioning) and psychological (e.g., emotional/behavioral adjustment and well-being, awareness of disability/disease) issues. Conclusions Prior published surveys suggest that clinical neuropsychologists have a growing involvement in rehabilitation services within the United States but with little clarity as to the actual characteristics of actual professional activities and practices. The present study aimed to provide such information and hopefully will be helpful in promoting additional systematic studies in this area.