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ORIENTATION AND ATTENTION - A clinical neuropsychologist is a professional psychologist trained in the science of...

ORIENTATION AND ATTENTION
I. Awareness
1. Awareness Interview – evaluates orientation and apperception of deficits
II. Time
1. Temporal Orientation Test – negative numerical values assigned to errors, starting at 100, below 95 significant
2. Time Estimation – estimate passage of one minute, up to 21-22 second error average
3. Discrimination of Recency – which of 2 cards most recently presented, verbal and picture formats (associating mostly frontal functioning)

    1. left damage – more difficulty verbal

    2. right damage – more difficulty pictorial

III. Place
IV. Body Orientation – disorientation of personal space (autopagnosia) associated with left frontal
1. Personal Orientation Test – touch own and examiner named body part, name touched body part, imitate touch, touch according to schematic, name seen and felt objects
a. left damage – greater difficulty following verbal directions
b. right damage – more likely to ignore left side of body or left presentation
V. Finger Agnosia – most evident middle three fingers, involves left angular gyrus or right hemisphere
1. Finger Localization – identified what one finger touched in view and not in view, identify two fingers touched
2. Tactile Finger Recognition (Halstead Reitan) – identify finger touched by number
VI. Right-Left Orientation

  1. Right-Left Orientation Test – own or examiner’s body; right-sided lesions makes difficult to reverse and do on examiner

  2. Standardized Road-Map Test of Direction Sense – traces a dotted path and verbally describes pathway taking; reflects mostly left frontal damage, with difficulty in mental rotation

  3. Laterality Discrimination Test – speeded task of laterality judgment and spatial perception (i.e., pictures of right or left side of body)

VII. Space

  1. Distance estimations – associated mostly with right occipital lesions

  2. Mental Transformations In Space – associated with parietal lobe lesions

  3. Mental Re-orientation – associated with right posterior lesions (e.g., Puppet Test)

  4. Space Thinking – is second picture same or opposite

  5. Spatial dyscalculias – misplacement or neglect of number placement, rows

  6. Topographical orientation – from revisualization of familiar routes (bilateral posterior lesions)

  7. Topographical Localization – locate prominent cities on country map (bilateral posterior lesions)

  8. Fargo Map Test – US geography and areas of personal familiarity

  9. Route finding – way around familiar objects or learn new routes (e.g., Rivermead)

VIII. Reaction Time – finger pressing after an auditory or visual signal; also found on CPT tests;
slowed in TBI, MS, attentional disorders, depression, elderly
IX. Vigilance – the ability to monitor the environment over extended periods for infrequent target stimuli, sustain and focus attention
1. Continuous Performance Test (Conner’s; Gordon Diagnostic System game-like)
X. Short-term Storage Capacity – attention span/span of apprehension and processing ability

  1. Digit Span Forward (Memory span) – often expressed as 7+2

  2. Point Digit Span – does not require speech for response

  3. Letter span – slightly less than for numbers

  4. Hebb’s Recurring Digit Test – digit series with every third repeated, see how quickly learn repeated sequence

  5. Knox Cube Imitation Test – visuospatial attention span on four blocks

  6. Corsi Block Tapping Test – from nine blocks spread on board; certain sequences repeated and learning of repeated sequence evaluated (e.g., WMS Spatial Span; based on Recurring Digit Test)

  7. Sentence Repetition – span of meaningful verbal material and linguistic cnstruction, of increasing length

  8. Silly Sentences

  9. Target Test – sequence tapped out on nine black dots (for children, from Halstead-Reitan)

XI. Working Memory – ability to temporarily hold and manipulate information in short-term memory/ immediate memory and operations performed simultaneously (mental tracking)

  1. Digit Span Backward – associated with left hemisphere damage and visual field defects

  2. Reversing serial order – spelling and common sequences

  3. Mental Control (WMS) – serial subtraction, alphabet, count forward by 3’s

  4. Sequential Operations Series – alphabet reversal, serial subtractions

  5. Alpha Span – recall lists of unrelated words in alphabetical order

  6. Alphanumeric Sequencing – alternate letters and numbers

  7. Letter-Number Sequencing – greatly influenced by education

  8. N-Back Test – when stimulus is same as one present “n” steps back

  9. Paced Auditory Serial Addition Test – divided attention (average correct 72% at slowest, 45% at fastest)

  10. Stroop Tests – concentration focused and inhibition/suppression of habitual response (also low in depressed and anxious patients)

  11. Brief Test of Attention – auditory divided attention, counting numbers and disregarding letters

XII. Complex Attention

  1. Digit Symbol-Coding (DS) – psychomotor performance; sensitive to brain damage

  2. Symbol Digit Modalities Test – visual scanning, tracking, and motoric speed assesses; symbols are printed and numbers to be written (reverse from WAIS DS); discriminates dementia and depression (allows for spoken response)

  3. Trail Making Test – sequencing, divided attention and flexibility (originally part of the Army Individual Test Battery)

  4. Color Trails – non-alphabetic, number and color alternative to TMT

  5. Everyday attention

  6. Test of Everyday Attention/Memory – map searching, telephone directory, lottery number broadcast

  7. Dichotic Listening (words or music; Broadbent) – indicator of language lateralization and evaluates divided attention and vigilance; usually there is a right ear advantage because of left hemisphere dominance

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