A Neuropsychological Assessment is a comprehensive assessment of cognitive (brain) processes designed to evaluate neurological disorders such as known or suspected traumatic brain injury (TBI), concussion or other head injury, in order to understand the etiology and evolution of cognitive disorders. Neuropsychology is the unique integration of genetic, developmental, and environmental history with testing data to better understand brain functioning through a comprehensive assessment of a person’s cognitive and personality functioning. This can provide information that can specify the origin and development of a neurological disorder and provide customized recommendations or specific
impairments. These tests are typically performed by trained Doctors of Psychology who have additional training in clinical Neuropsychology.
A neuropsychological assessment provides information for all doctors involved in the management and treatment of a patient’s care through a comprehensive, systematic testing of cognitive functions, including:
According to the Official Disability Guidelines (ODGs), neuropsychological testing should only be conducted with reliable and standardized tools by trained evaluators, under controlled conditions, and findings interpreted by trained clinicians. Moderate and severe TBI are often associated with objective evidence of brain injury on brain scan or neurological examination (e.g., neurological deficits) and objective deficits on neuropsychological testing, whereas these evaluations are frequently not definitive in persons with concussion/mTBI. Neuropsychological testing is one of the cornerstones of concussion and traumatic brain injury evaluation and contributes significantly to both understanding of the injury and management of the individual.
Neuropsychological evaluations and testing, along with other related testing, serve as vital tools to provide information to doctors for various purposes, including:
Neuropsychological Evaluation and Testing is a critical and necessary service utilized in the determination of Maximum
Medical Improvement (MMI) and impairment rating (IR) evaluations According to the Texas Department of Insurance,
Division of Workers Compensation (TDI-DWC) impairment rating training for certification, the presentation for TBI, which includes concussions, states what Neuropsychological testing is required, not a neurocognitive screening. The presentation slides state:
The information from a full Neuropsychological evaluation with testing provides the necessary information for an appropriate impairment rating as well as established validation of the results and this quantifies the results so that the Doctor performing the impairment rating can appropriately determine which of the nine (9) categories for cerebral/forebrain impairment as outlined in Chapter 4 of the AMA’s Guidelines to the Evaluation for Permanent Impairment, 4 th edition, the state-required textbook for assessing impairment ratings in Texas. In the Texas Workers’ Compensation system, impairment ratings for cognitive or neurobehavioral conditions must follow the AMA’s Guidelines to the Evaluation for Permanent Impairment, 4 th edition, which explicitly require standardized, multi-domain neuropsychological testing with embedded validity measures. A screening tool cannot quantify impairment across required cognitive domains, cannot separate psychiatric/emotional factors from neurologic injury, and does not meet the forensic reliability or methodological standards necessary for an impairment rating. Without a full neuropsychological evaluation, the impairment rating would not be defensible, accurate, or compliant with TDI-DWC requirements.
This is why a full Neuropsychological evaluation with testing are applicable and necessary in order to qualify and quantify (provide validity) each category in order to determine the severity of each applicable category so that the accurate impairment rating percentage can be assigned by the certifying provider in order to be compliant with TDI-DWC requirements. It is not the standard to have a neurocognitive screening conducted instead of a neuropsychological evaluation and testing performed.
