Neurological Disorder Assessments

Assessment of Neurological Disorders is not easily measured. Assessors usually incorporate a number of measures, use different test procedures and allow various adaptations to tests and responses. Depending on the particular disorder children may require assessment in many different areas such as:

Diagnostic Tools:

Neuropsychology:
The study of how the functions of your brain and nervous system affect the way you think and behave.

Neuropsychologist:

Specialist in understanding and treating problems that occur following damage to the brain.
• Neuropsychologists usually work in a private practice or in an institutional setting such as hospitals or clinics.

 

Neurological assessment:
 A tool for evaluating how much a child’s performance may be influenced by unusual functions of the brain and nervous system. It helps school psychologists systematically measure a child’s skills and determine the best learning environment for the child.

A complete neuropsychological assessment requires gathering and analyzing information about the child’s development physically, socially and psychologically as well as the child’s education. This information comes from a variety of sources:

•  Parents observations
• Formal observation, for example, watching the child copy designs, pronounce words or figure out an arithmetic problem.
• Some standardized assessment measures with established validity and reliability already exist- for example, asking a child to generate rules from examples or to state socially accepted behaviours for given situations

The two most common tests used to assess neuropsychological disorders are:

 

• The Halstead-Reitan Neuropsychological Test Battery (which includes the revised Wechsler Intelligence Scale for Children)
• The Luria-Nebraska Neuropsychological Battery.
• The earlier a child sees a neuropsychologist the better, and further diagnosis can be examined.

 
MOTOR ASSESSMENTS:

Physician or Occupational Therapist

Motor assessments are initially performed in specialised clinics or hospitals, and should be done as soon as possible as to determine possible treatment and on going therapy. Periodic on-going assessments can be done at schools or at home.

The motor system evaluation is divided into the following:

 

• Body positioning
• Involuntary movements
• Muscle tone
• Muscle strength
• Mobility
• Considers physical status
• Functional aspects (how the child moves)

COMMUNICATION ASSESSMENTS:

Speech and language problems are generally assessed by a team of specialist such as:

• Psychologist
• Speech/language pathologist
• Physician
• Educator
• Neurologist

An in-depth assessment by a speech/language pathologist includes an assessment of the child’s:

• Hearing ability and hearing history
• History of speech-language development
• Oral-motor functioning and feeding history
• Expressive and receptive language performance (syntax, semantics, pragmatics, phonology)
• Social development
• Quality/resonance of voice (breath support, nasality of voice)
• Fluency ( rate and flow of speech)

It is recommended that the in-depth assessment include both standardized tests and alternative assessment approaches.

• Standardized tests are important because of the objectivity and structure they offer to the assessment process, even though standardized test scores alone are insufficient to make a diagnosis.

• Alternative approaches, such as an analysis of samples of the child's speech and language, are important because many dimensions of communication are not easily measured using standardized tests (such as pragmatics, discourse, voice, fluency, oral-motor, and feeding).

These types of tests are performed in specialised clinics.

 

VISION ASSESSMENT:

Optometrist- Eye clinic

• Conventional testing:  Standard vision test. If the student is non-verbal or does not recognize a standard alphabet chart, the optometrist will test the child's ability to follow or track and object.
• Child is able to use picture cards and select correct picture.

Ophthalmologist: Eye surgery clinic

  When a child does not respond to conventional testing diagnosticians use Electro diagnostic procedures.

• Electro diagnostic procedures assess the electrical activity of the optic pathway and occipital cortex of the brain.
• The presence of electrical activity indicates that an active pathway exists.

HEARING ASSESSMENT: 

Audiologist- Hearing centre

• Pure tone audiometry: Sweep test to determine the child’s threshold of hearing. (the level of which the child first detects a sound).
• Speech audiometry: Used to assess the child’s ability to detect and understand speech.

With neurological disorders it is difficult to distinguish if a child is not responding to a sound because they cannot hear it or because they are inattentive. Audio logical assessment is divided in to two groups:  Electrophysiological and behavioural:

•  Electrophysiological procedures include electroencephalography (EEG) – measures responses to auditory stimuli by measuring the brainwaves.
• Acoustic impedance audiometry: assesses conductive hearing losses by measuring the movement of the eardrum and middle ear muscles and bones in response to auditory stimulation.

Behaviour testing includes observation of behaviour,

• reflex audiometry – A startle movement as a result of a loud sound.
• play audiometry- Used in children over two, using a game in which the child performs an activity in response to the sound.
  

CEREBRAL PALSY: 

• motor assessment/vision/hearing assessment.
• observation of movements and not meeting developmental stages 

 Educational Assistant (EA) Red Flags:

Physical changes:

• More/less muscle spasms.
• Often students with CP experience seizure. Some symptoms include: change in alertness, may look like the student is day dreaming, shaking, body stiffness etc. If a seizure lasts more than 5 minutes, or is repetitive (one after the other) seek medical help.
• During a seizure, make sure the affected limbs are safe, but do not restrain. Dangling feet/arms could get hurt.
• Watch for the student struggling with fine/ gross motor skills (grasping, eating, holding) and intervene before frustration sets in.
• Choking: Some individuals with CP may have problems swallowing, if this is the case always observe the individuals carefully while they are eating.
• Blisters/redness under braces: Braces may be to tight or irritating the skin.

Emotional changes:

•  Frustration/anger: The student may become frustrated if they cannot perform a task or play with their peers.
• Social issues: Students may become out casted by peers/ bullied, or withdraw themselves.
• Depression
• Anxiety
• Behaviour disorders

Non-Diagnostic Tools: 

•  Extensive EA observation and documentation, especially in the area of movement (decrease/increase), and emotional changes.
• The EA should to be able to recognize when the student is having a seizure. Seizures look different from individual to individual. For a student with Athetoid CP, it may be more difficult to recognize the signs. EAs must be aware of typical seizure signs, loss of consciousness, staring into space, non responsive, jerking movements in contrast to the usual involuntary movements of the student. Through extensive observation/documentation, any unusual movements which resemble a seizure should be taken seriously.
•  Output of urine if a catheter is present.
•  Any decrease in appetite.
• Watch for learned helplessness: encourage as much independence, allow the student to reach their full potential.

Information on different types of seizures:
Different Types of Seizures Video
Seizure First Aid: You Can Do It!
Noah's Absent Seizure

SPINA BIFIDA: 

 Physician/Obstetrician- Ultrasound lab

• Spina Bifida is detected by ultrasound, usually by the fourth week of gestation.
• Spina Bifida Occulta is diagnosed using an x-ray after birth (most people with SB Occulta do not know they have it).
•  Spina Bifida Meningocele can be corrected by draining the fluid in the sac.
• Spina Bifida Myelomeningocele (the severest type) can also cause hydrocephalus (water on the brain). A shunt can be surgically inserted to drain the fluid.

Educational Assistant (EA) Red Flags

Behaviour/emotional changes:

Social problems- withdrawing from peers/bullied
• Psychological issues/ emotional issues- depression
• Unusual irritability

Physical changes:

• Seizures- a seizure that lasts more than 5 minutes and occurs one after the other without regaining consciousness is considered a medical emergency.
• Decrease in movement
• Headaches
• Vomiting
• Lethargy
• Infection in the area of the shunt (if present)- swelling, redness
• Self injurious behaviour- Lack of skin sensation may cause S.I.B
• Redness or blisters under braces.
• Fever- infection

Non-Diagnostic Tools:

• EA observation/documentation
•  As well as all of the above, the EA should be aware of learned helplessness, students with SB tend to become dependent on parents, teachers and EA's. Allow the student to be as independent as possible. This way it does not allow for any unnecessary regression, and helps the student reach their own full potential.
• Output of urine (if catheter is needed)- Individuals using a catheter are prone to urinary tract infections. Low output of urine and fever could mean a U.T.I.

FETAL ALCOHOL SPECTRUM DISORDER:

• FASD is usually diagnosed by a Doctor or diagnostician.
•  An early diagnosis is essential to allow access to interventions and resources that may mitigate the development of subsequent “secondary disabilities” (e.g., unemployment, mental health problems, trouble with the law, inappropriate sexual behaviour, disrupted school experience) among affected people.

Diagnosis of FASD is based on four primary criteria:

• Growth deficiencies that stunt prenatal and/or postnatal growth.
• Permanent brain damage resulting in neurological abnormalities, delay in development, intellectual impairments and learning or behavioural disabilities.
•  Facial anomalies, including short eye opening and thin upper lip.
•  Maternal use of alcohol.

Diagnosticians use a 4-digit code to rate FAS in the above areas in terms of the level of impairment, beginning with 1-no evidence of impairment and going to 4-definite/severe evidence of impairment. The four digit code can result in 256 possible combinations in each category, defined by severity and impact on the student.

Educational Assistant (EA) Red Flags:

Since a child with FASD has an array of characteristics it is important for the EA to document any related behaviour in order to be able to monitor any significant changes, and be able to recognize a red flag situation. Some possible red flags to watch out for are:

Behaviour/Emotional changes: More/less

• Aggressive.
• Withdrawn.
•  More temper tantrums.
•  Non-compliance etc.
• Peer/social issues- Students with FASD are at a higher risk (about 50%) for committing sex related offenses. A red flag would be a student with FASD harassing a member of the opposite sex or making unwanted advances.
• Poor attendance- Students with FASD are at a higher risk for abusing drugs/alcohol, which may lead to a decrease in attendance.
• Signs of depression/mental health problems.

Physical changes:

• Weight loss- poor nutrition at home/depression.
• Signs of physical abuse- bruises, cuts etc.
• Unusual lack of focus/swaying- under the influence of drugs/alcohol.
• Seizures.

Non-diagnostic Tools:

The most important non-diagnostic tool for continuing to assess a student with FASD is extensive observation, documentation/communication. The EA should always record any behavioural related occurrences in an ABC chart (antecedent, behaviour, consequence chart).  Record any emotional or physical changes within the student, and review it with the Special Education team. Communication between everyone involved is the most important non-diagnostic tool. 

 

TRAUMATIC BRAIN INJURY:
 Doctors and medical imaging technicians

• Using MRI and CT technologies to assess brain damage after a head injury.
• Usually done immediately after any trauma to the head.
• Performed in the hospital.
  

Educational Assistant (EA) Red Flags:

  Emotional/ Behavioural Impairments: 

• depression
• mood changes
• temper
• irritability 

Physical Impairments:

•  fatigue 
• headaches
• sensitivity to light and sound
• sensitivity to sound/noise

Impact on Environment:

• social isolation 
• withdrawal in interests 
• poor decision making
• sense of helplessness

Non-Diagnostic tools:
Some students with TBI experience problems with attention, concentration, retention, and memory difficulties when it comes to learning. The EA should observe and document any unusual changes to the students characteristics or physical well being, as any changes, even small ones could have underlying signs or signals that could lead to more serious complications.
 

Sources: Winzer Textbook
Use of Cognitive and Communication Strategies to Enhance Care Transitions for Persons with ABI