motor functions, rhythm functions, tactile func-
tions, visual functions, receptive speech, expressive
speech, writing functions, reading skills, arithmetic
skills, memory, and intellectual processes. Studies
assessing the battery’s reliability and diagnostic
validity have been supportive (e.g., Golden,
Hammeke, & Purisch, 1978; Golden, Purisch, &
Hammeke, 1985). The Luria-Nebraska shows
substantial agreement with results obtained from
the Halstead-Reitan method (Goldstein & Shelly,
1984; Kane, Parsons, Goldstein, & Moses, 1987;
Sears, Hirt, & Hall, 1984). A children’s version per-
formed as well as the WISC-R in discriminating
psychiatric and neurological cases (Carr, Sweet, &
Rossini, 1986) and was also able to reliably diagnose
attention deficit disorders in children (Lahey, Hynd,
Stone, Piacentini, & Frick, 1989).
The main advantage of the Luria-Nebraska is
that it takes only about 2.5 hours to complete,
compared with the 6 hours sometimes required to
complete the Halstead-Reitan battery. However,
some clinical neuropsychologists believe that the
Luria-Nebraska is limited because of its standardiza-
tion and rationale (Goldstein, 1997). Specifically,
many of the reliability and validity studies are
based on small numbers of patients, and some critics
feel that the Luria-Nebraska does not adequately
translate A. R. Luria’s theories and methods into a
neuropsychological assessment instrument (Lezak
et al., 2004).
Variables That Affect Performance
on Neuropsychological TestsA number of patient variables may influence neuro-
psychological test scores (Howieson & Lezak,
2010). Because test scores differ according to the
biological sex, age, and educational level of the
patient, appropriate norms should be used in inter-
pretation. In addition, test scores will be influenced
by handedness, by premorbid ability (before brain
trauma or injury), by the chronicity of the neuro-
logical condition, and by the presence of other
(nonneurological) physical conditions (e.g., a
peripheral arm injury might affect performance on
the Strength of Grip test of the Halstead-Reitan
battery). Finally, motivational variables (arousal,
level of cooperation) will also affect scores. For
example, a patient who is taking medication that
has a sedative effect will probably not be able to
perform optimally.
A motivational variable that deserves additional
comment ismalingering. Detecting faking or malin-
gering on psychological tests can be difficult for
even the most astute clinician. There is controversy
about how often malingering occurs in neuropsy-
chological assessment. Recognizing that it may
occur and improving clinicians’abilities to detect
it are both very important, especially given the clin-
ician’s growing presence as an expert witness in
court cases of various kinds (see Chapter 19). Sev-
eral approaches have been suggested to address
malingering on neuropsychological tests, ranging
from the development and use of an objective
malingering index (Reitan & Wolfson, 1996) to
the use of strategies to evaluate test scores (Rogers,
Harrell, & Liff, 1993). For example, Rogers et al.
(1993) suggest that failure of very easy test items,
differential performance on difficult versus easy test
items, and below-chance performance on
alternative-choice test items should raise suspicions
of malingering.INTERVENTION AND
REHABILITATIONIssues of neurological impairment usually revolve
around two principal questions. First, what is the
nature of the deterioration or damage? For exam-
ple, is it a perceptual loss or a cognitive loss? Sec-
ond, is there any real brain damage that can account
in some way for the patient’s behavior? More spe-
cifically, is the damage permanent, or can recovery
be expected after an acute phase? Is the damage
focal or diffused throughout the brain? In general,
focal damage results in more specific, limited effects
on behavior, whereas diffuse damage can cause
wide effects. Referral sources often need to know
whether the damage will be progressive (as in dif-
fuse brain involvement or in damage caused byNEUROPSYCHOLOGY 529