Monitoring Neuropsychological Functioning 293broad range of cognitive processes that constitute neuropsy-
chological functioning. Sufficiently broad measurement to
warrant neuropsychological inferences awaited the develop-
ment of test batteries designed for this purpose.
Neuropsychological Test Batteries
The inception of broadly based and multifaceted test batteries
for assessing neuropsychological functioning can be credited
to the efforts of Ward Halstead (1908–1969), who in 1935
established a laboratory at the University of Chicago for the
purpose of studying the effects of brain damage. Halstead’s
observations convinced him that brain damage produces
a wide range of cognitive, perceptual, and sensorimotor
deficits that cannot be identified by any single psychological
test. He accordingly devised numerous tasks for measuring
various aspects of cerebral functioning. In subsequent collab-
oration with one of his graduate students, Ralph Reitan, he
gradually reduced the number of these tasks to seven for
which empirically determined cutoff scores showed good
promise for distinguishing normal from impaired brain func-
tioning. This set of tasks became formalized as the Halstead-
Reitan Neuropsychological Test Battery (HRB) in the 1950s
and continues to have a major place in neuropsychological
assessment (see Reitan & Wolfson, 1993). Developed origi-
nally with adults, the HRB was later extended down-
ward for children age 9 to 15 (Halstead Neuropsychological
Test Battery for Children and Allied Procedures) and age 5
to 9 (Reitan-Indiana Neuropsychological Test Battery for
Children).
The primarily quantitative approach to neuropsychological
assessment represented by the HRB stimulated considerable
research and attracted to assessment practice a substantial
contingent of brain-behavior scientists who might not other-
wise have become directly involved in clinical work. Also
exerting a lasting influence on assessment methods was
a qualitative approach to identifying neuropsychological im-
pairment, which stemmed from the work of Alexander Luria
(1902–1977) in the Soviet Union. Luria believed that more
could be learned from behavioral features of how people
deal with test materials than from the scores they earn, and
he accordingly emphasized measures designed to maximize
opportunities for respondents to demonstrate various kinds
of behavior he considered relevant in diagnosing brain
dysfunction.
In Luria’s approach, conclusions are based less on psycho-
metric data than on an examiner’s observations and inferences.
Although Luria’s testing methods and his theoretical formula-
tion of functional systems in the brain date from the 1930s, it
was not until his work was first translated into English in the
1960s that his seminal contributions to neuropsychology first
became widely appreciated. The initial organization of his
procedures into a formal test manual was published in the
1970s (Christensen, 1975), and further standardization and
validation of his measures during the 1980s resulted in publi-
cation of the Luria-Nebraska Neuropsychological Battery
(LNNB; Golden, Purisch, & Hammeke, 1985).
The face of neuropsychological assessment and the uses to
which it is put have gradually changed since the early work
that led to the Halstead-Reitan and Luria-Nebraska batteries.
Consistent with the underlying premise of both batteries that
identification of brain dysfunction requires assessment of a
range of cognitive functions, many specifically focused mea-
sures of concept formation, memory, psychomotor, language,
and other related capacities were designed for use instead of
or as supplements to these batteries. The specific measures
most commonly used by contemporary neuropsychologists
include the Wechsler Memory Scale, the Boston Naming Test,
the Verbal Fluency Test, the Wisconsin Card Sorting Test, the
California Verbal Learning Test, the Rey-Osterreith Complex
Figure Test, the Stroop Neuropsychological Screening Test,
and two components of the HRB, the Finger Tapping Test
and the Trail Making Test (Butler et al., 1991; Camara et al.,
2000; for further information concerning these and other neu-
ropsychological assessment instruments, see Lezak, 1995;
Spreen & Strauss, 1998).
Along with benefiting from the availability of increasingly
refined measures, neuropsychological examiners began as
early as the 1950s to move beyond what had been their orig-
inal focus in applied practice, which was helping to deter-
mine whether a patient’s complaints were “functional” in
nature (i.e., psychologically determined) or “organic” (i.e.,
resulting from central nervous system dysfunction). Instead
of inferring from test data merely the likelihood of a patient’s
having a brain lesion, skilled neuropsychologists became
proficient in identifying which side of the brain and which
lobe were likely to contain the lesion. Over time, however,
the development of sophisticated radiographic techniques for
determining the presence, location, and laterality of brain
damage rendered neuropsychological tests all but superflu-
ous for this purpose, except as screening measures. Concur-
rently, on the other hand, contemporary neuropsychological
assessment became increasingly valuable in professional
practice by reverting to the purpose Halstead originally had
in mind back in the 1930s: namely, evaluating an individual’s
strengths and weaknesses across a broad range of perceptual,
cognitive, language, and sensorimotor functions.
With its current focus on the measurement of functioning
capacities, neuropsychological assessment provides useful
information concerning what people can be expected to do in