Neuropsychology in the United States can be divided into two main subdivisions: clinical and experimental. These subfields are both concerned
with brain-behavior relationships, but they differ
in their objectives and methods.
American clinical neuropsychology emphasizes
comprehensive approaches to applied problems concerning the psychological effects of brain damage
in humans. It is mainly concerned with quantitative techniques applied to problems of diagnosis,
and there has been no systematic attempt to build
a working theory of the brain's functional organization in relationship to psychological processes.
Reitan (1966) has described the psychological effects of brain lesions, using a quantitative test bat-
University of Moscow
Moscow, USSR
National Institutes of Health
Bethesda, Maryland
tery. Clinical neuropsychologists assess intellectual, sensory-motor, and personality deficits, relating these to brain lesions and sometimes to brain
damage in the broader sense, including impaired
physiological function. Clinical neuropsychology,
in the American tradition, has its roots centered
in academic psychology, behavioral science, neurology, and especially psychometric measurement.
Neuropsychologists representative of this branch
in the United States include, for example, A. Benton, N. Butters, M. Lezak, R. Reitan, and A. Smith.
These scientists both conduct research on humans
and perform clinical-diagnostic studies of brain impairment, directly applying knowledge gained (e.g.,
rehabilitation planning). Sometimes their work
even extends to doing therapy with the brain-injured patient.
Experimental neuropsychology's primary objective is to discover fundamental principles of brainbehavior relations regardless of their practical applications. The basic assumption is that carefully
controlled experimental situations will reveal relationships of greater generality than will direct
study of naturally occurring situations. Most of
the research in this field is performed on animals.
Experimental neuropsychologists, in general, do
not orient their research toward the direct solution of applied problems. Representative of this
camp are such scientists as K. H. Pribram, R.
Sperry, and D. Bowden.
The battery of tests Reitan uses was originally developed from Halstead's attempts to quantify biological intelligence (Halstead, 1947). The test
battery was developed on the basis of empirical experience with individual subjects to reflect the following methods of inference: (a) level of performance, (b) specific deficits of pathognomonic
signs, (c) differential scores or patterns of ability,
and (d) comparison of the functional efficiency of
the two sides of the body. It began as a battery
of seven tests selected for their power to discriminate between patients with frontal lobe lesions
and those with other types of lesions or normal
subjects (Halstead, 1947; Reitan & Davison,
1974).
Reitan's "blind assessment" approachthat is,
interpreting results from the Halstead-Reitan battery administered to a patient without prior knowledge of the patient's presenting complaints, medical history, or neuroradiological testsemphasizes
the use of a standard battery of tests. These tests
are designed to reflect, as far as possible, the full
range of psychological deficits associated with
brain lesions, and they attempt to yield accurate
prediction of cerebral dysfunctions in patients.
Reitan (1974) puts it as follows:
The validity of neuropsychological assessment . . . depends
on the validity with which inferences can be made regarding the brain. Further, such evidence of validity cannot be referred to regarding statistical probability levels of
group differences, but must be valid for the individual subject in question. The best way to accrue evidence that
validity standards of this type can be met is to put neuropsychological data to the test of individual prediction in
the form of 'blind' assessments, (p. 201)
The Halstead-Reitan battery consists of the following tests: (a) the Category Test, a test of abstracting ability in which the subject's task is to
figure out the principle relating stimulus subtests
and signal his answer by pressing the appropriate
key on a keyboard; (b) the Tactual Performance
Test, which measures the total time required for
the blindfolded subject to complete a memory task
with the right hand, the left hand, and both hands,
the number of correct figures localized from memory, and the number of figures recalled; (c) the
Seashore Rhythm Test in which the patient is
asked to discriminate between like and unlike pairs
of musical beats; (d) the Speech-Sounds Perception Test, which is an auditory test that assesses
the subject's ability to discriminate between similar-sounding consonants; and (e) the Finger Tapping Test. Added to the above six standardized
tests (but not part of the formal test battery) are
the following: the Trail-Making Test, a visual,
conceptual, and visuomotor tracking test highly
vulnerable to the effects of brain injury; the
Aphasia Screening Test (Halstead & Wepman,
1959); a sensory-perceptual examination that tests
for finger agnosia, skin-writing recognition, and
sensory extinction in the tactile, auditory, and
visual modalities; the Wechsler-Bellevue Intelligence Scale I (or the Wechsler Adult Intelligence
Scale); and the Minnesota Multiphasic Personality Inventory. Administration time for the complete battery runs from 6 to 8 hours.
A distinctive feature of Reitan's handling of the
examination data of the Halstead-Reitan battery
has been his reliance on test scores for predicting
the nature, site, and presence of the lesion (Wheeler
& Reitan, 1963). Reitan uses the Halstead tradition of utilizing "cutting scores," that is, established test-score norms for deciding the level of
severity of the impairment, and the Halstead Impairment Index for making gross diagnostic discriminations. Halstead set the cutting score for
the Impairment Index at a proportion of .50, with
proportions of .40 and lower characterizing the
control subjects. Predictions about the site of the
lesion and its nature (diffuse or focal, static or
changing) are based on statistically identified relationships between test scores. The actuarial approach has generated development of computerized
interpretations of Halstead-Reitan test protocols
and modified versions of it plus other tests (Russell, Neuringer, & Goldstein, 1970; Adams, Rennick, & Rosenbaum, Note 1). Efforts to use the
Halstead-Reitan battery for localizing lesions have
had mixed results. This test battery does elicit
differential performance patterns between patients
with left- and right-hemisphere lesions. However,
these right-left hemisphere differences do not occur with sufficient consistency to warrant basing
clinical decisions on the Halstead-Reitan test scores
alone (Wheeler & Reitan, 1963).
A useful .battery should provide the information the examiner wants. If the examiner decides
to rely primarily on one battery of tests for unselected clinical patients, then it must be a multipurpose battery that will aid in diagnosis, give a
baseline, and supply data for future planning and
treatment of patient needs. There is not, at present, any such American test battery that satisfies
all of these criteria. Although standardization procedures are the heart of reliability assessment at
the present stage of neuropsychological understanding, not enough is known to dogmatize any
set of procedures with a full-scale standardization
(Lezak, 1976).
USEFULNESS AND LIMITATIONS OF THE HALSTEADREITAN TEST BATTERY
The Halstead-Reitan Neuropsychological Test Battery affords one of the more reliable psychological
means of identifying patients with brain-behavior
disturbance, since it has been standardized to give
validity from patient population to patient population. In the American tradition of quantitative
psychological measurement, given the validity of
results, one can generalize back to the population
tested for making accurate predictions, in certain
cases, as to the syndrome's nature and site. Predic-
on the study of the defective mechanisms of memory (Luria, 1976b), neurolinguistics (Luria,
1976a), etc., involved at the basis of different
brain syndromes described (Luria, 1966a, 1966b,
1973). Soviet neuropsychological research has
demonstrated conclusively that higher forms of
human psychological activity and human behavioral acts take place with the participation of all
parts and levels of the brain, each of which makes
its own special contribution to the work of the
functional systems as a whole (Luria, 1970a,
1970b). In the present state of the art of clinical
neuropsychology, it has become necessary to correlate the discoveries obtained by modern techniques of neuroradiology with the neuropsychological data concerning the nature of the disturbance
observed in order to put the clinical neuropsychological method on a valid foundation.
ADVANTAGES OF SOVIET METHODS
in use. Although far from thinking that quantitative measurement is the only true criterion for data
collection in science, Soviet neuropsychologists
have asserted that "the time has come for mathematical analysis of the vast amount of material
gathered as a result of observations over the last
forty years, observations that lie at the basis of
neuropsychological syndromes of local brain lesions
and that give these syndromes their essential reliability" (Luria & Artemieva, 1970, p. 111).
tive reaction. In the former example, the parietooccipital region is involved, and in the second
"echopractic" example, a frontal defect could likely
be the area of involvement.
Other difficulties arise in attempting to resolve
this simple problem. Having reproduced one
posture, the patient, for example, may then be unable to shift from the movement given. In our
work, we term this pathological inertness. Difficulties such as this can be the result of pathological
perseveration of the movement. In such cases, the
symptom is one of a quite different nature than
previously considered. We can hypothesize that
perhaps some pathological processes of the anterior
parts of the hemispheres are involved.
If we have inferred from the above initial observation that defects of complex hand movement
are due to difficulties in kinesthetic afferent activity in the first of a series of experiments, we then
move on to a series of other tests that include
movements for which complex kinesthetic activity
is not required. Instead, the spatial organization
of movements is required. One such example of
motor action is a test in which a simple movement
of the patient's hand has to be oriented in space;
the patient must put his palm in a horizontal,
frontal, or sagittal position. Another example
using a more complex test (Head's Test) requires
the patient (sitting vis-a-vis the examiner) to reproduce some complicated movements, for example,
lifting the right hand when the examiner lifts his
right or lifting the left hand when the examiner
lifts his left.
If the patient fails these tests, and if a breakdown in optico-spatial processes is suspected on
medical grounds as the source of the defect, then
the next step is to examine how far the patient can
go in problem solving that requires the use of
inner coding schemes or quasi-spatial schemes at
the symbolic level. Difficulties in evaluating the
positions of the hands of a watch, in determining
the relations of directions on a geographical map,
or even in computing and decoding some complex
logico-grammatical constructions (e.g., "a circle
under the triangle," "brother's father," and/or
"father's brother") can yield additional information concerning the derangements of simultaneous
spatial (or quasi-spatial) neural schemes usually
associated with injuries of the infero-parietal
parts of the major hemisphere. If the patient is
able to overcome the tendency of "mirroring"
movements (reproduction of the position of the
examiner's hands) or if there are no sustained deAMERICAN PSYCHOLOGIST NOVEMBER 1977 965
Summary
The basic approaches to neuropsychology in the
United States and the USSR differ both in primary
orientationthe former being quantitative and the
latter, qualitativeand in theoretical foundation
diagnosis of brain lesions and for treatment recommendations. This especially holds true for the
young psychologist lacking a wide enough background and experience with neuropsychological interpretation.
Some areas that have recently been given attention by Soviet neuropsychologists are as follows: (a) neurolinguistics, (b) human developmental processes (in a child's brain), (c) righthemisphere functional activity, and (d) the neuropsychology of memory mechanisms. Work in our
Moscow laboratory has been underway for the
last 15 years in the above areas. If neuropsychology is to flourish as a science in the future, further
baseline data consisting of recorded clinical and experimental observations, as well as anatomical and
electrophysiological data, are needed. Important
questions needing answers are as follows: How
does the brain effect control over its own behavior?
How does it make a decision to behave the way it
does during certain psychological activities? How
is the brain able to compensate when partially (or
fully) arrested in functions by a brain tumor?
How does an infant brain develop into a fully intact adult one? The senior author has spent over
40 years pioneering new frontiers, adding insights
into some of these areas, and posing questions, all
of which have led to a model of the working brain
based on functionally organized blocks. It is now
the task of future generations of neuropsychologists
to replicate this work, to expand upon how the
psychological and physiological processes are involved in the working brain for a better scientific
understanding of brain-behavior activity, and
hopefully, to prevent or treat brain-behavior disturbances whenever possible.
REFERENCE NOTE
1. Adams, K., Rennick, P., & Rosenbaum, G. Automated
interpretation of the neuropsychological battery: An
ability-based approach. Paper presented at the meeting
of the International Neuropsychological Society, Tampa,
Florida, February 1975.
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