NEUROPSYCHOLOGICAL

TESTS
HALSTEAD REITAN
 HALSTEAD REITAN BATTERY
• This tests was developed by ward Halstead and his student
Ralph Reitan in the early 1940.

• This tests helps to determine the location and specific brain

lesions.

• observations of persons with cerebral lesions

• brain-damaged individuals had a wide range of deficits and

that a single test would not be able adequately to identify
and evaluate the severity of their deficits.

• developed a series of 10 tests that ultimately formed the

principal basis for his concept of biological intelligence.
 THE 10 TESTS IN HRB

Tactual
Finger-
Category test performance Rhythm test
oscillation test
test

Speech sounds Trail making Critical flicker Aphasia

perception test test frequency screening test

Sensory-
Time sense test
perceptual test
CATEGORY TEST
 The Halstead Category Test

• is a nonverbal test that measures a person’s ability to formulate abstract

principles
• The test consists of 208 stimuli that are shown on slides.
• Each test item suggests a number ranging from one to four. The patient is
instructed to determine or guess a particular number based on their
conceptualization of the abstract principle represented by the slide.
• After the patient decides on a particular response, he or she must
depress one of four levers on the instrument, which are numbered from
one to four.
• depressed the correct number, a door chime will ring.
• depresses one of the incorrect numbers, a buzzer will sound.
• Based on this feedback, correct or incorrect, the patient must determine
the underlying principle in each of seven different subtests.
• The scoring for this test consists of the total number of errors made by the
patient.
Tactual performance test
Tactual performance test
 Tactual performance test
• A form board containing ten cut-out shapes, and ten wooden
blocks matching those shapes are placed in front of a
blindfolded individual.
• Individuals to use only their dominant hand to place the
blocks in their appropriate space on the form board.
• The same procedure is repeated using only the non-
dominant hand, and then using both hands.
• Finally, the form board and blocks are removed, followed by
the blindfold. From memory, the individual is asked to draw
the form board and the shapes in their proper locations.
• The test usually takes anywhere from 15 to 50 minutes to
complete. There is a time limit of 15 minutes for each trial, or
Seashore Rhythm Test
 Seashore Rhythm Test
• Thirty pairs of tape-recorded, non-verbal sounds are
presented. For each pair, individuals decide if the two
sounds are the same or different, marking "S" or "D"
respectively on their answer sheets. The pairs are grouped
into three subtests.

• This test is also called the Seashore Rhythm Test, and is

based on the Seashore Tests of Musical Ability. It evaluates
auditory attention and concentration, and the ability to
discriminate between non-verbal sounds.
• The test helps detect brain damage, but not the location of
damage. Adequate hearing and visual abilities are needed
to take this test. Scoring is based on number of correct
Finger-oscillation test
 Finger-oscillation test

• Individuals place their dominant hand palm down, fingers

extended, with the index finger resting on a lever that is
attached to a counting device.
• Individuals are instructed to tap their index finger as quickly
as possible for ten seconds, keeping the hand and arm
stationary.
• This trial is repeated five to 10 times, until the examiner has
collected counts for five consecutive trials that are within
five taps of each other.
• Before starting the test, individuals are given a practice
session. They are also given brief rests between each 10-
 Speech sounds perception test

• Sixty tape-recorded nonsense syllables containing the

sound "ee" (for example, "meer" and "weem") are
presented.
• After each syllable, individuals underline, from a set of four
written syllables, the spelling that represents the syllable
they heard.
• This test evaluates auditory attention and concentration and
the ability to discriminate between verbal sounds.
• It provides some information regarding specific areas of
brain damage, and may also indicate attention deficits or
hearing loss.
Trail making test
 Trail making test
• This test consists of two parts. Part A is a page with 25 numbered circles
randomly arranged. Individuals are instructed to draw lines between the
circles in increasing sequential order until they reach the circle labeled
"End." Part B is a page with circles containing the letters A through L and
13 numbered circles intermixed and randomly arranged.
• Individuals are instructed to connect the circles by drawing lines
alternating between numbers and letters in sequential order, until they
reach the circle labeled "End."
• If individuals make mistakes, the mistakes are quickly brought to their
attention, and continue from the last correct circle. The test takes
approximately five to 10 minutes to complete.
 Critical flicker frequency

• Patients note when a flickering light becomes steady.

• the test measures visual perception.
 Aphasia screening test
• Aphasia is the loss of ability to understand or use written or
spoken language, due to brain damage or deterioration.
• In this test, individuals are presented with a variety of
questions and tasks that would be easy for someone without
impairment.
• Examples of test items include verbally naming pictures,
writing the name of a picture without saying the name aloud,
reading printed material of increasing length, repeating
words stated by the examiner, simple arithmetic problems,
drawing shapes without lifting the pencil, and placing one
hand to an area on the opposite side of the body.
 Time sense test

Patients judge, without looking the time it is takes for the

second hand of a watch to make several revolutions.
The test measures memory and spatial perception.
 Sensory-perceptual test

• This test detects whether individuals are unable to perceive stimulation

on one side of the body when both sides are stimulated simultaneously.
• It has tactile, auditory, and visual components involving the ability to
(a) specify whether touch, sound, or visible movement is occurring on the
right, left, or both sides of the body;
(b) recall numbers assigned to particular fingers (the examiner assigns
numbers by touching each finger and stating the number with the
individual's eyes closed);
(c) identify numbers "written" on fingertips while eyes are closed; and
(d) identify the shape of a wooden block placed in one hand by pointing to
its shape on a form board with the opposite hand.
 • Reliability

• The reliability and validity of neuropsychological

tests may affected by many factors Mood states
especially anxiety and depression.

• Result may be confused by medication effects.

 LURIA–NEBRASKA
NEUROPSYCHOLOGICAL
BATTERY
• The Luria–Nebraska
Neuropsychological Battery (LNNB) is a
comprehensive neuropsychological test
battery that integrates the
neuropsychological assessment
procedures of the late Professor
Alexander Romanovich Luria
This procedure was first reported in 1978 in the form of two initial validity studies.

Historically, Chirstensen, a student of the prominent Russian neurologist and neuropsychologist, A. R.

Luria, published a book called Luria’s neuropsychological investigation.

The book was accompanied by a manual and a kit containing test materials used by Luria and his
co-workers.

Although some of Luria’s procedures had previously appeared in English, they had never been
presented in a manner that encouraged direct administration of the test items to the patients. The
material published initially did not contain information relevant to standardization of these items.

There was no scoring system, norms, data regarding validity and reliability, or review of research
accomplished with the procedure as a standard battery.

This work was taken on by a group of investigators under the leadership of Charles J. Golden.
Thus, in historical sequence, Luria adopted or developed these
items over the course of many years.

Christensen published them in English but without

standardization data.

Finally Golden and collaborators provided quantification and

standardization.

Since that time, Golden’s group as well as other investigators have

produced a massive amount of studies with what is now known as
the Luria Nebraska Neuropsychological Battery.
The battery was published in 1980 by Western Psychological
Services and is now extensively used in clinical and research
applications.
An alternate form of the battery is now available, as is a children’s
version.
 The battery contains 269 A score of 0 indicates normal
items, each of which may be performance. Some items may A score of 2 indicates clearly
scored on a 2- or 3- point receive a score of 1, indicating abnormal performance.
scale. borderline performance.

Thus, the higher the score, the

poorer the performance. The
scores for the individual items
The raw score for each scale is may be based on speed,
These two scores are counted
the sum of the 0, 1 and 2 item accuracy, or quality of
as individual items.
scores. response. In some cases, two
scores may be assigned to the
same task, one for speed and
the other for accuracy.

For example, one of the items

is a block counting task, with When quality of response is
separate scores assigned for scored, the manual provides
number of errors and time to both rules for scoring and, in
completion of the task. In case the case of copying tasks,
of time scores, blocks of illustrations of figures
seconds are associated with representing 0, 1 and 2 scores.
the 0, 1 and 2 scores.
The 269 items are divided into 11 content scales, each of which may be
administered individually.

Since these scales contain varying number of items, raw scale scores are
converted to T score with a mean of 50 and a standard deviation of 10.

These T scores are displayed as a profile on a form prepared for that

purpose.

In the alternate form of the battery, the names of the content scales have
been replaced by abbreviations.

Thus, we have Motor, Rhythm, Tactile, Visual, Receptive Speech, Expressive

Speech, Writing, Reading, Arithmetic, Memory, and Intellectual Processes
scales, which are referred to as the C1 through C11 scales in the alternate
form.
 11 CLINICAL SCALES

Tactile And
Motor Rhythm And Visual
Kinesthetic
Functions, Pitch, Functions,
Functions,

Receptive Expressive
Reading, Writing,
Language, Language,

Memory, Intellectual
Arithmetic,
And Processes.
In addition to these 11 content
The Pathognomonic scale
scales, there are three derived
contains from throughout the
scales that appear on the
battery found to be particularly
standard profile form: the
sensitive to the presence or
Pathognomonic, Left and Right
absence of brain damage.
Hemisphere scales.

The left and right hemisphere

scales are derived from the They therefore reflect
Motor and Tactile scale items that sensorimotor asymmetries in the
involve comparisons between the two sides of the body.
left and right sides of the body.
Several other scales have been developed by Golden and
various collaborators, all of which are based on different
ways of scoring the same 269 items.

These special scales include new (empirically derived) right

and left hemisphere scales, a series of localisation scales a
series of factor scales and double discrimination scales.

The new right and left hemisphere scales contain items from
throughout the battery and are based on actual comparisons
among patients with right hemisphere, left hemisphere, and
diffuse brain damage
• The localisation scales are also empirically derived,
being based on studies of patients with localised brain
lesions. There are frontal, sensorimotor, temporal, and
parieto-occipital scales for each hemisphere.
• The factor scales are based on extensive factor analytical
studies of the major content scales.
• The new right and left hemisphere scales contain items
from throughout the battery and are based on actual
comparisons among patients with right hemisphere, left
hemisphere and diffuse brain damage. The new right and
left hemisphere, localisation factor scales may all be
expressed in T scores with a mean of 50.
• There are also two scales that provide global indices of
dysfunctions, and are meant as equivalents to the
Halstead impairment index.
• They are called the Profile Elevation and Impairment
Scales.

• A children's version of the battery, called the Luria-

Nebraska Neuropsychological Battery for Children
(LNNB-C), appropriate for children aged eight to
12, is also available.
The Luria Nebraska procedure involves an age and
education correction.

It is accomplished through computation of a cutoff

score for abnormal performance based on an equation
that takes into consideration both age and education.

Typically, a horizontal is drawn across the profile at the

computed critical level point. The test user has the
option of considering scores above the critical level,
which may be higher or lower than 60, as abnormal
• The probability of brain damage is
assessed by comparing an
individual's score on each of the
battery's 11 clinical scales to a
critical level appropriate for that
person's age and education level.
• For example, if a person has five
to seven scores above the critical
level, they most likely have
some sign of neurological
impairment.
• Eight or more scores above the
critical level indicate a clear
history of neurological disorder.
 NIMHANS
NEURPOSYCHOLOGICAL
BATTERY
• There are two approaches of NIMHANS Neuropsychological
Battery.
• The first approach was proposed by Dr. C.R Mukundan (1979).
• This battery is based on Luria’s principles of cerebral
localization and lateralization of higher mental functions.
• This battery consists of several Western tests and a few
indigenous tests standardized on the Indian population.
• This is a loosely packed battery from which appropriate tests can
be chosen according to diagnostic needs and used along with
other tests to form an integrated interpretation. The various tests
included are
 TESTS FOR ELICITING FRONTAL
LOBE DYSFUNCTION
1) Attention
5) Deficits in working memory
– Spontaneous arousal of attention – Test of mental control
– Distraction – Delayed response tests
– Excessive broadening/ narrowing of 6) Deficits of ideational and design
attention fluency test
2) Tests of visual search 7) Deficits in visuospatial planning
– Visual scanning of numbers tasks
– Visual scanning of pictures – Bender gestalt test
– Visual exploration test – Alexander passalong test
3) Mental set- Psychomotor – Object assembly test
perseveration – Maze tests
4) Psychomotor deficits 8) Frontal Amnesia
– Test of Optic-kinaesthetic organisation
9) Expressive speech disturbances
10) Changes in voluntary activity,
– Test of optic-spatial organisation
personality and affect
– Kinetic melody disturbance
 TESTS FOR ELICITING
TEMPORAL LOBE DYSFUNCTION
1) Deficits of visual integration
– Block design test
– Object assembly test
2) Verbal and Visual learning and memory functions test
– The verbal learning and memory functions test
– Visual learning and memory functions test
3) Benton’s visual retention test
4) Test of comprehension
5) Presence of nominal aphasia
6) Presence of conduction aphasia
– Sentence repetition test
7) Recent history of cognitive, emotional and personality changes
 TESTS FOR ELICITING
PARIETAL LOBE DYSFUNCTION
1) Tests for visuospatial perception
– Bender gestalt test
– Block design test
– Spatial comparison test
– Spatial comparison using verbal report of differences
2) Presence of
– Apraxia (ideomotor, ideational and constructional)
– Agnosia (Visual object agnosia, prospagnosia, finger agnosia,
autotopagnosia, hemisomatagnosia, simultagnosia, visual
inattention,
astereognosia and left-right disorientation)
• The second approach was developed by Dr. Shobhini
Rao et.al in 2004.
• This approach is more quantitative and the tests are
organised on the basis of various neuropsychological
functions.
• Performance on neuropsychological tests is influenced
by socio-demographic variables such as age, education,
and the test-taking attitude of the population.
The various tests included are:
Tests of Speed: can be categorised into
1) Motor speed - Finger tapping tests and
2) Mental speed -Digit Symbol Substitution Test
Tests of Attention:
3) Focused attention-Colour trails test
4) Sustained attention- digit vigilance test
5) Divided attention- the triads test
Tests of executive functions:
6) Phonemic fluency-controlled oral word association test (COWA)
7) Category Fluency-Animal names test
8) Design fluency-design fluency test
Working memory:
9) N back test (Verbal working memory and Visual working memory)
10) Self ordered pointing test
Planning
11) Tower of London test
Set shifting
12) Wisconsin card sorting test (WCST)
Response inhibition
13. Stroop test-NIMHANS version
Verbal comprehension
14) Token test
Tests of verbal Learning and memory:
15) Rey’s Auditory verbal learning test
16) Logical memory test
Visuo constructive ability
17) Complex figure test
18) Design learning test