Friday, March 6, 2015

How about getting the computer to do the WAIS?

Prof Arthur Shores alerted me to two computerized tools that he believes are under utilised in Australia. One of them is MAB II. I have to admit that while the name rings some distant bells, I have not looked at this test before.

And I should have.

This test is incredibly similar to the WAIS, with the following subtests:

Verbal: Information, Comprehension, Arithmetic, Similarities, Vocabulary
Performance: Digit Symbol, Picture Completion, Spatial, Picture Arrangement, Object Assembly

It is for adults 16+ and has a multiple choice response format. It has been used by the NASA and in selection of pilots, as well as in research.

It computes VIQ, PIQ and FSIQ and can be administered individually, in groups or on a computer. It appears to be an analogue to WAIS-R, with no separate WMI and PRI indexes, but it seems to do what it does quite well:

The normative group consisted of 1600 subjects (2200 for WAIS-IV), in 9 age groups (13 for WAIS-IV)

Test-retest reliability is .95 for VIQ, .96 for PIQ and .97 for FSIQ
For WAIS-IV it is .95 for VCI, .85 for PRI and .95 for FSIQ

Internal consistency is .87, while WAIS has internal consistencies in the .90s, so it scores somewhat worse there.

What I really wanted to know is how close it is to WAIS, but haven't found it on the internet apart from the statement from the test creators that said:

Correlations between the MAB II and a widely used individual IQ measure are:
Full Scale = .91
Performance correlation = .79
Verbal correlation = .94
I have a sneaking suspicion that they refer to WAIS-R, but cannot be sure.

I also want to know how I managed not to know that there is a reasonable computerised IQ test around. Shame on me.

I'm sure that this test won't work in all situations, and that we'll naturally default to WAIS for most of our clinical needs. But I believe that there are assessments that can be done using MAB II instead. I would argue, for example, that it beats short forms of the WAIS.

Arthur sent me several articles in which MAB II has been used, together with MicroCog (this one is for another post) to track some relatively subtle cognitive changes. This seems like a good test.

I have not (yet!) bought it, so cannot comment on the ease of use. Do people use it? How smooth is it? What populations do you use it with? Please let us know in the comments

Cheers,

Izabela

Thursday, March 5, 2015

Reading difficulties

Just a quick mention of interest to those of us who work in learning difficulties:

Fitzroy Readers are now available as an app.

This is a good series of readers that use the phonic approach.
If you want to read more, here is further info: www.fitzprog.com.au/articles.aspx#1


Also, my npinoz request for information about computerised testing was very fruitful and I've learned about some really useful tools: look out for posts in the near future.

cheers,
Izabela

Friday, February 27, 2015

Computerised testing and the elderly

I have recently read a thorough review of computerized testing in dementia by one of our colleagues: Nicola Gates.
Gates, N.J., Kochan, N.A. (2015). Computerized and on-line neuropsychological testing for late-life cognition and neurocognitive disorders: are we there yet? www.co-psychiatry.com, Vol 28 (2), which you can access (for a price, alas) at http://journals.lww.com/co-psychiatry/Abstract/2015/03000/Computerized_and_on_line_neuropsychological.15.aspx
It is a must-read for all of us who work in dementia, even though her conclusions are pretty much negative. It seems that there are no good tools in this area yet. Some are adapted from the military or sports psychology and don't do what we need them to do in dementia assessments. Others are computerised versions of paper-and-pencil tests, which are not comparable to the original tests, and which do not have new normative data. And, of course, the elderly, especially those with a dementing illness, are the one client group that is really the worst suited to computerised assessment: some of them have never used computers, others are wary of them, and yet others have motor and sensory problems that affect testing.

There were some tests that received reasonable billing in the article, and I reviewed them for this post. These were:

- Memory Orientation Screening Test in its iPad administration (highly comparable to the paper-and-pencil test)
This test is billed as 'neuropsychological testing administered by a computer with qualified health care professional interpretation and report'. There are 3 versions available in the app store, costing $3.79, $12.99, and $64.99, but it is not clear what the difference is between each version. After a short search I think that the difference is in the quality of output information. The test itself is a replacement for the Mini-Mental and includes: memory for 3 words, orientation questions, naming and remembering 12 common objects (called 'sequential memory' for some reason) and clock drawing. It claims 85-89% sensitivity and 76-87% specificity in screening dementia, outperforming both MMSE and Mini-Cog. So this is a nice tool, it is just pretty useless to us, being a pretty basic screening tool. Pity.

- Cognitive Assessment for Dementia (CADi) on the iPad that has large concurrent validity with the Mini-Mental and good internal consistency
This one sounded good, so I tried to download and and test it, but found only a Japanese language version in the app store. Hoping that an English version exists, I downloaded it, but had no luck. I think the authors were Japanese, and I am not sure if an English version of this test exists.
- Self-administered Cognitive Function Test (CFT) which showed good concurrent validity with paper-and-pencil tests in correlational analysis. However, there was no information on test-retest reliability, which Nicola notes is a problem in a test that is supposed to be used for self-monitoring over time.
This one can be accessed on http://cft.foodforthebrain.org/. I dutifully went through it, and was declared unlikely to have dementia. It consists of a good task of visual memory and quite clever analogues to Symbol Search and Coding. Also, it has a pre-test screen that checks facility with the use of a computer (one has to mouse-click on some targets as fast as one can). While it is a nice example of a good computerised test, it is not going to be in any way useful for our practice.
So, as to computerised tests and the elderly, we are not there yet.

The only computerised test that I do use in this group is the iPad-based Mini-Mental from the PAR (handy if you want to be meticulous with copyright compliance), but I cannot say that it is particularly good either.

I think that computerised testing of adults and children is a much better proposition, but I'll write about it this in other posts.

Cheers,
Izabela

Wednesday, January 28, 2015

Computerised testing - a nice collection of tests for learning difficulties

I have been looking at computerized neuropsychological tests lately. For three very important reasons:
  1. Computers do a much better job of administering some tests, e.g. those of speed of processing and attention. I think that our insistence on human-administered tests may mean that we use substandard tools for some jobs.
  2. I think that neuropsychologists need to start using computerised tests a lot more - our expertise is in test interpretation, and we don't have to personally administer each and every test that we interpret - it is not the most efficient use of our time, and
  3. I am booooored - how many times a week can you do the same thing (admittedly in different clinical context, but still)?
I'll get into the tests I have used or still use on another occasion, but today I want to share a new set of tests I've just discovered. They focus on learning difficulties and are produced by a British company - Lucid Research (http://www.lucid-research.com).

For example, there is a fully computerized working memory test (named Recall), normed on over 1000 kids aged 7-16 years (though while most age groups are around 100 kids, there are only 21 kids in the 16 - 16:11 group). The program tests verbal short term memory, visual short term memory and working memory (a task of which has both visual and verbal content, but is probably more verbal in nature). Simple, but definitively worth a look.

They also have a selection of tests screening for cognitive issues that may cause reading problems. For example Rapid screen looks at phonological processing, short-term auditory memory (they name it working memory, but it isn't really), phonic decoding skills and visual-verbal integration memory. All this in 15 minutes of testing without intense input from the administrator. Nice.

While Rapid is a quick screener, there are also in-depth diagnostic tests of reading difficulties. For example LASS 8-11 (yes, LASS, there is also LADS - quite British, this) has verbal span, visual span, reading words, nonwords and sentences, phonological processing, spelling and a quick general ability screen. A nice little test to add to the battery for those of us who deal with learning difficulties.

Has anybody used the tests and could provide their experience and impression in the comments?

Cheers,
Izabela

Thursday, January 15, 2015

T-shirts again

I started the year with a lot of admin and now have a pack of new assessments that need to be written up. So for light relief I went searching for brain-related t-shirts.

I've checked http://www.zazzle.com/, which used to have some nice ones and have been most impressed by how their collection has expanded. From brain images, MRI scans and chemical structure of neurotransmitters to t-shirts with slogans such as 'Area 25 made me do it'.

There is also a wide selection of t-shirts for our clients, including such beauties as: 'Concussions will mess with your head', 'Not today, darling, I had a craniotomy', or  'I have chemobrain, what is your excuse?'. Also and iPhone cover that says 'Keep calm and listen to the neuropsychologist'. I'd get a few if I was doing neuropsych rehabilitation.

Sadly, there is also a selection of t-shirts and gadgets with Stroop test.

I'm contemplating buying a t-shirt with 'I can't brain today, I have the dumb' that is just perfect for some  days. And a mug with 'Trust me, I am a neuropsychologist' to use at work.

cheers,

Izabela

PS: I am building up to some serious posts on computerised assessment tools. I'd appreciate guest posts from people who use them in their practice.

Sunday, October 26, 2014

Something every geeky neuropsychologist should have

With thanks to Les Posen who forwarded the link.

A New Zealand company Brainform offers 3D prints of your own brain from MRI scan files. $430 full scale, $140 half-size. Just the cortex, mind you, no subcortical structures included. No cerebellum either, which the website explains by saying:
"Partly because it looks like a scrotum, partly because the cortex is the most interesting to look at, and partly because sometimes the details of it don't segment out from scans that well."

If you don't have an MRI scan, you can always participate in research that requires an MRI - the site offers a free service linking clients with researchers that are looking for participants (this is also worth knowing if you are looking for subjects). If you don't feel like getting a scan, you can get a stock brain for $360 full scale or $100 half size.

I'm so tempted,

Izabela

A video of a symposium on brain plasticity and healing - with ridiculous number of celebrities

Two days ago University of Alabama had a very interesting symposium. They invited Dalai Lama to discuss brain plasticity with Michael Merzenich  -  who can well be called a father of the whole discipline. To top it up, the symposium was moderated by Dr Norman Doige, the author of the book The Brain that Changes Itself. This is celebrity cast on steroids. I'm looking forward to watching it tonight.

The video of the symposium can be found on: https://www.youtube.com/watch?v=zJlmRISL-QA&list=UUOMZCCUBnjdhjhtNAUfkGqg

A warning - the video appears to be almost 3 hours long, although the comment on the front suggests that the event starts at the 26 minute mark.

cheers,

Izabela