Applications: Child Neuropsychology

A knowledge-based decision support system for clinical neuropsychologists.

The Information Problem

Waiting lists for clinical neuropsychologists are long. It can sometimes take up to six months to get an appointment for an assessment – time that could be better spent in treatment and remediation.

The supply of neuropsychologists cannot be quickly increased, as training can involve up to 12 years of university. Much of this training takes place through the medical equivalent of an apprenticeship – the clinical rounds. The knowledge of the diagnostic and interpretive process to be learned is experiential and has not been formalized.

Existing Practice

A neuropsychological assessment involves the systematic examination of cerebral skills and abilities (e.g., tactile, motor, language, visual-spatial, problem-solving, memory, etc.). The client is assessed using a series of neuropsychological assessment techniques. The test results are scored, compared to normative data, and analyzed for both level and pattern of performance (e.g., pre- and post-surgery, etc.). The test results are then interpreted to determine the individual's neuropsychological strengths and weaknesses in the various ability-related areas and the brain area(s) thought to be involved. Recommendations for remediation, treatment, and/or further assessment are determined. A comprehensive report is then written and disseminated. Feedback is given to all appropriate personnel and remediation while treatment programs are put into place. The client's progress is monitored for as long as necessary. Clearly, a neuropsychological assessment is a very lengthy process and an exceptionally complex task.

A New Approach

A number of attempts to write traditional computer programs for performing aspects of the assessment process have been made. The scope of these applications were extremely limited and the accuracy of the resultant systems was far too low to consider these systems for field use.

Knowledge-based systems were proposed as a possible solution. The clinical neuropsychologist very quickly understood the Acquire^® knowledge acquisition methodology and a very large and complex knowledge base was built complete with customized clinical report writing capabilities within a year of part-time involvement of Dr. D.L. Russell, a clinical neuropsychologist.

The Knowledge-based System

The child neuropsychology knowledge-based system (CNKBS) was originally developed to address some of the issues that clinical neuropsychologists are currently faced with. That is, to assist clinicians and researchers by giving valuable second opinions on cases, writing first draft clinical reports, and providing an environment for students to practice and improve their diagnostic and interpretive skills. Whereas CNKBS was initially built to provide diagnoses of presence/absence of brain dysfunction, lateralization, and localization information (i.e., brain area information only), the complexity and scope was quickly expanded.

Currently, conclusions are reached regarding the child's abilities and skills (both strengths and weaknesses), the level of dysfunction of each of the brain areas (including presence/absence of brain dysfunction, lateralization, and localization information), and the possible recommendations for remediation. This enables the CNKBS to deal with a wide variety of brain impairments in children.

Conclusion

By integrating the CNKBS into existing neuropsychological practices, it is possible to streamline the process and increase the capacity of existing neuropsychological services. The CNKBS reduces the neuropsychologist's time on the interpretation and report writing aspects of the procedure by as much as half. With additional psychometric staff and the CNKBS, neuropsychologists can significantly increase the throughput of clients. This reduces waiting lists, enables remedial programs to begin earlier and increases the time a neuropsychologist can spend on consultation, remediation and feedback. The CNKBS provides a consistent, high quality service.