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2 Neuropsychological Assessment in the 21 st Century The Meyers Neuropsychological Battery (MNB) Scott Sindelar, PhD

3 Outline for this session Philosophy of MNB Development of MNB Norms Development Sensitivity and Specificity Internal Validity Checks LOC Dose Response CT/MRI Data Profiles The MNS Program

4 Philosophy of MNB MNB began as a longer battery of tests. Using Discriminate Function: Selected tests that were able to discriminate Normal vs TBI. Did original study years ago

5 Philosophy of MNB Goal was to find the best/shortest battery Sensitive to Brain Injury Commonly used Tests, that most NPs know Originally a 6 hour battery cut to 2.5 hrs Tests were selected not only for sensitivity but also ease of administration and scoring (i.e., Category vs. WCST)

6 Testing Order for MNB Short WAIS-III/IVIII/IV Forced Choice (FC) Rey Complex Figure (RCFT) - Copy Animal Naming 3 minute recall of RCFT COWA Dichotic Listening North American Adult Reading (NAART) Sentence Repetition 30 Minute Recall of RCFT Recognition Trial of RCFT (Break offered) AVLT JOL Boston Naming Finger Tapping Finger Localization Trails A & B Token Test AVLT 30 minute Recall AVLT Recognition Trial Category Test

7 Domains used by the MNB 1. Attention/Working Memory: Digit Span Forced Choice Animal Naming Sentence Rep AVLT 1 Arithmetic 2. Processing Speed/Mental Flexibility Digit Symbol Dichotic Both Trails A Trails B

8 Domains used by the MNB 3. Verbal Reasoning Similarities Information COWA Dichotic Left Dichotic Right Boston Naming Token Test 4. Visual Reasoning Picture Completion Block Design JOL Category RCFT Copy

9 Domains used by the MNB 5. Verbal Memory AVLT Total AVLT Immediate AVLT Delayed AVLT Recognition 6. Visual Memory RCFT Immediate RCFT Delayed RCFT Recognition

10 Domains used by the MNB 7 & 8: Motor and Sensory Finger Tapping Dominant Hand Finger Tapping Non-Dominant Hand Finger Localization Dominant Hand Finger Localization Non-Dominant Hand

11 WAIS-III III or WAIS-IVIV Picture Completion Digit Symbol Similarities Block Design Arithmetic Digit Span Information Ward 7 Subtest (Pilgrim, Meyers, Bayless, & Whetstone, 1999, Meyers 2013 in press)

12 Domains Assessed 1. Attention/Concentration/Working Memory 2. Processing Speed and Mental Flexibility 3. Verbal Reasoning (Executive ) 4. Visual Reasoning (Executive ) 5. Verbal Memory and New Learning 6. Visual Memory and New Learning 7. Dominant Motor and Sensory 8. Non-Dominant Motor and Sensory

13 Domain Consistency N = 936 Passed all validity checks No missing data Not involved in litigation Calculated Domain M s Regression used to predict Domain M s using all on other Domain M s

14 Domain Means Correlations Premorbid OTBM DTBM Attent/Work Mem Pro Spd/Mental Flex Verbal Reason Visual Reason Verbal Memory Visual Memory Dom Motor/Sensory Nond Motor/Sensory All were Significant p <.001

15 Domain M s Correlations (cont.) Premorbid OTBM DTBM Attent/Work Mem ProcSpd/Ment Flex Verbal Reasoning Visual Reasoning Verbal Memory Visual Memory Dom Motor/Sen Nond Motor/Sen All were Significant p <.001

16 Domains Regression Equations Attention & Working Memory (Verbal Reasoning) *.315 (Verbal Memory) *.273 (Processing Speed) *.193 Constant =

17 Domains Regression Equations Processing Speed/ Mental Flexibility Verbal Reasoning *.401 Visual Reasoning *.284 Attention & Working Memory *.230 Constant = 2.434

18 Domains Regression Equations Verbal Reasoning Processing Speed *.361 Attention & Working Memory *.354 Visual Reasoning *.243 Constant = 2.5

19 Domains Regression Equations Visual Reasoning Visual Memory *.322 Processing Speed/Mental Flexibility *.213 Verbal Reasoning *.208 Constant =

20 Domains Regression Equations Verbal Memory Attention & Working Memory *.738 Visual Memory *.388 Constant =

21 Domains Regression Equations Visual Memory Visual Reasoning *.698 Verbal Memory *.311 Processing Speed *.0909 Constant =

22 Regression Adjusted SE R R 2 of the Estimate Attent/Working Memory Processing Speed Verbal Reasoning Visual Reasoning Verbal Memory Visual Memory Dominant Motor

23 Core Battery of Tests AudiTech (St Louis) Dichotic Listening Psy Corp WAIS-III/IV, III/IV, MMPI-RF by publisher Psychological Assessment Resources (PAR) RCFT, Boston Naming, JLO, Category, PAI Public Domain Forced Choice, COWA, ANIMAL Naming, Sentence Repetition, Token Test, Trails A/B, Finger Localization, 1min estimation, AVLT Reitan Labs Finger Tapping Category Test

24 AYOC/AYOP You can add 1000 of your own favorite tests to the Cognitive section AND 1000 tests to the Psychological section The MNB is a core of tests, that has the database comparison, and Discriminant functions, and Neuronet

25 MNB Smoothed Normative Data In evaluating the norms, note there were variations in test norms, apparently due to age, & education. For example, AVLT norms Spreen & Strauss (1998) At Age = 30-39; 39; M = 11.4 (sd = 2.4) for Trial 6 At Age = 40; M = 10.4 (sd = 2.7) for Trial 6. Therefore, pt. scoring 10 a day before b-day, after b-day, score (i.e. 10) would improve from 44T to 48T, using linear norms.

26 MNB Smoothed Normative Data Using Heaton et al. (1991) classification system, pts score would improve from the Below Average to Average just by becoming a day older. A common problem with non-smoothed normative data.

27 MNB Normative Data Therefore, decided to smooth the norms. Done by selecting all pts. from dataset who: had a validity score of 0 or 1 (failures) were age 15 years or older 15 yrs old used for the adult version of the Trail Making Test this was done to keep consistency. The total sample size N = 1727 Age: M = 45.7 yrs (sd = 20.7) Education: 12.3 yrs (sd = 2.7) year of education. Gender: 779 females; 948 males Handedness: 1543 were RH and 184 were LH. Ethnic: 32 mixed; 22 African Americians; 1617 white; 2 Asian; 27 Native American; and 27 Hispanics.

28 MNB Normative Data A Regression equation was then calculated using the raw score and the variables, age, education, gender, handedness, and race to predict the T score previously calculated using the standard normative data for the tests.

29 MNB Regression Norms Not only does process smooth the data Also adds adjustments for age, education, gender, handedness, and ethnicity. In Normals these variables may not always be significant. In injured groups, variables take on additional impact on test performance.

30 MNB Normative Data Once the regression equations were calculated they were used to calculate a Regression T score for each test It was found that this procedure worked well for all test variables except Token Test (adult) due to excessive skew For Token Test, percentile scores were calculated and converted to T score equivalents.

31 MNB Normative Data With Regression Equations, with a raw score 10 on AVLT Imm. Recall In the example used, would change the data (for person tested 1 day before b day), at age 39 T Score equivalent would be 45T; a day after her b day 45T. Using the regression equation normative data, comparisons can be more reliable made over time. The individual subtests for the WAIS-III III or WISC-III III were not subjected to the Regression Equation method as only the Scale Scores were coded in the database, not raw scores. Therefore, the scores for these tests are based on normative data from the test manuals.

32 MNB Normative Data Adults Scale R R2 Significance Paired Samples t Test Trails A (1363), p=1.00 Trails B (1354), p=.930 Judgment (1263), p=.921 Finger Tapping DH (1599), p=.937 Finger Tapping NDH (1577),p=.977 Finger Localization DH (1201), p=.979 Finger Localization NDH (1196), p=.987 *Token Test (1534),p=.993 Sentence Repetition (1253),p=.968 Controlled Oral Word Association (1487),p=.982 Animal Naming (1366), p=.921 Boston Naming (1312), p=.000 Dichotic Listening Left (1198), p=.000 Dichotic Listening Right (1198), p=.014 Dichotic Listening Both (1198), p=004

33 MNB Normative Data Adults Forced Choice (1131), p=.287 AVLT (1470), p=.973 AVLT (1470), p=.940 AVLT (1470), p=.859 AVLT (1469), p=.981 AVLT (1469),p=.993 AVLT Total (1470), p=.949 AVLT Distractor (1467), p=.955 AVLT Immediate (1468), p=.918 AVLT Delayed (1470), p=943 AVLT Recognition (1470), p=.988 CFT Time (1657), p=.941 CFT Copy (1660), p=.958 CFT Immediate (1658), p=.938 CFT Delayed (1659), p=.946 CFT False Positive (1657), p=.979 CFT False Negative (1657), p=.956 CFT Recognition (1658), p=.996 Booklet Category (Victoria Version) (1290), p=981 * Because of the skewedness of the data percentile scores were computed and transformed to T Scores for this test.

34 MNB Data Children Child Regression Equation Test R R2 SignificancePaired Samples t Trails A (99),p=1.000 Trails B (99),p=.960 Judgment of Line (96),p=.942 Finger Tapping Dom (106),p=.986 Finger Tapping NonDom (106),p=.987 Finger Localization Dom (95), p=.914 Finger Localization NonDom (95), p=.892 Token Test (106), p=.819 Sentence Repetition (105), p=.930 Controlled Oral Word Associat (109), p=.133 Animal Naming (100), p=.910 Boston Naming (105), p=326 Dichotic Listening Left (99), p=.457 Dichotic Listening Right (99), p=.592 Dichotic Listening Both (99), p=.959

35 MNB Data Children Forced Choice (94), p=.003 AVLT (111), p=.855 AVLT (111), p=.648 AVLT (111), p=.768 AVLT (111), p=.630 AVLT (111), p=.983 AVLT Total (111), p=.963 AVLT Distractor (111),p=.948 AVLT Immediate (111),p=.923 AVLT Delayed (111),p=.887 AVLT Recognition (111),p=.968 CFT Time (111),p=.947 CFT Copy (111),p=1.000 CFT Immediate (111),p=.988 CFT Delayed (111),p=.977 CFT False Positive (111),p=.446 CFT False Negatives (111),p=.762 CFT Recognition (111),p=1.000 Booklet Category (92),p=1.000

36 MNB Recap Step 1. Took battery of well known NP Tests Tests with which most clinicians would be familiar Tests selected based on utility, ease of scoring, and to assess wide array of cognitive functions This battery is the result several preliminary batteries

37 MNB Recap Continued Step 2. Large database of pts. collected Step 3. Examined results for need to smooth Step 4. Data smoothed across battery ages ranged from 6 99 years old Separate norms for 6-14 and Adjust for age, ed, gender, ethnicity & handed

38 MNB Recap Continued Step 4. Recalculate database with new norms (Step 3) Now onto Step 5 Is this battery of tests valid?

39 MNB Step 5: Is this battery valid? Need to examine Reliability/Validity MSB Meyers, J. E., & Rohling, M. L. (2004). Validation of the Meyers Short Battery on Mild TBI patients. Archives of Clinical Neuropsychology, 19,, Study included 4 Groups

40 Validity of MNB 30 Medical Controls (Group 1) in hospital for non CNS problem (i.e. ingrown toe nails) All community dwelling No Hx of LD, DD, Substance abuse, TBI, or Mental Health problem, or anything that would disqualify as Normal.

41 Validity of MNB: 30 Medical Controls (cont.) Mean Age: 38.6 yrs (sd = 18.9) Mean Educ: 13.4 yrs (sd = 3.19) Gender: 15 females; 15 males Handedness: 29 were RH; 1 was LH Ethnicity: 29 white; 1 Native American

42 Validity of MNB Depressed Group (Group 2) 41 patients All on SSRI Mean Age: 46.0 yrs (sd = 15.0) Mean Education: 13.5 yrs (sd = 2.7) Gender: 20 females; 21 males Handedness: 38 were RH; 3 were LH Ethnicity: 1 mixed race; 40 white 29 completed MMPI-2 with M scores as follows L = 52.1 (sd=11.4), F = 60.5 (sd=11.7), K = 50.2 (sd=10.2) 1 = 63.8 (sd = 12.8) 2 = 70.8 (sd =14.5) 3 = 66.7 (sd = 16.0)

43 Validity of MNB Chronic Pain (Group 3) 32 pts who were being treated as outpt. for chronic pain. None involved in litigation at time of assessment None had previous litigation histories Pts. were injured in non-work-related related injuries or were injured on their own farms, or had chosen not to pursue Workman s compensation and were being treated at an outpatient pain clinic.

44 Validity of the MNB Chronic Pain Group Continued Mean Age: 40.7 yrs (sd = 14.2) Mean Education: 13.4 yrs (sd = 2.1) Gender: 20 females and 12 males Handedness: 29 were RH; 3 were LH Ethnicity: 31 white; 1 Native American

45 Validity of MNB Group 4: history of TBI 59 pts. All pts. seen at local hospital and rehab unit All pts. had identified LOC 20 min. or less other data (i.e., GCS or PTA) not often recorded however, LOC data available for all pts. LOC defined as Time to Follow Commands (e.g., Dikmen et al., 1995; Volbrecht et al., 2000)

46 Validity of MNB TBI group, continued Mean Age: 36.9 yrs (sd = 15.1) Mean Education: 12.6 yrs (sd = 2.1) Time Post Injury: 7.6 mo. (sd = 10.0) Gender: 14 females; 43 males Handedness: 51 were RH; 6 were LH Ethnicity: 2 mixed; 1 Hispanic; 54 white

47 Validity of MSB Test scores obtained for each of the study groups Normal Chronic Mild Controls Depressed Pain TBI NAART FSIQ Mean n SD Barona et. Mean al FSIQ n SD WAIS VIQ Mean n SD WAIS PIQ Mean n SD WAIS FIQ Mean n SD

48 Validity of MNB Validity assessed using a discriminant function analysis comparing Non-TBI pts. with the TBI pts. Resulted: 96% correct classification rate 99% specificity 90% sensitivity

49 Reliability of MNB Reflecting a general clinical sample, 63 persons with mixed diagnoses assessed more than once, with the first testing at least 6 mo. post injury Some in litigation, but all passed validity checks Group descriptive Age: Mean = 38.4 yrs (sd = 22.8) Education: Mean = 12.2 yrs (sd = 2.9)

50 Test Re-test Reliability 1st Test: Post Injury 21.6 mo. (sd = 22.8) Re-test: Post Injury 40.7 mo. (sd = 33.2) Time btwn Sessions: 19.1 mo. (sd = 16.6) range 2 to 91 mo., median 13 mo. Reliability r =.86

51 TBI vs. Stroke Volbrecht and Meyers (2000) were able to somewhat identify different levels of TBI injury severity from stroke patients with correct classification rate of 71.6%. The majority of the misclassifications were in discriminating severely injured individuals from severe stroke patients.

52 LOC and OTBM Rohling, Meyers, and Millis (2003) found that the length of loss of consciousness (LOC) for traumatic brain injured (TBI) patients was related to the level of expected cognitive impairment as measured by the overall test battery mean (OTBM). Results were nearly identical to those presented by Dikmen, Machamer, Winn, & Temkin (1995) using an expanded Halstead Reitan Battery. Core Battery of tests was same sensitivity as longer Expanded HRB

53 Internal Validity Checks Meyers, J. E., & Volbrecht, M. E. (2003). A Validation of Multiple Malingering Detection Methods in a Large Clinical Sample, Archives of Clinical Neuropsychology, 18,, Other publications

54 Internal Validity Check (0%FP Rate cutoff) Test/Method Cutoff RCFT: MEP <= 3 (1= Attent, 2=Encode, 3=Store, 4= Retrieve) Reliable Digits <= 7 Forced Choice <= 10 JOL <= 12 Token Test <= 150 Dichotic Listening Both <= 9 Sentence Repetition <= 9 AVLT-Recognition <= 9 FT-Estimated FT <= -10 * Others are being worked on

55 Internal Validity Checks A total of 796 participants in the study, ages ranged from 16 yrs to 86 yrs, with education ranging from 5 yrs to 23 yrs.

56 Internal Validity Checks 15 Groups Non-litigant groups Litigant groups

57 Internal Validity Check This method showed 83% sensitivity and 100% specificity. Also, there was a 0% false positive rate.

58 Validity / Malingering of Neuropsychological Tests 9 validity checks used (Combination of studies) Meyers, J. E. & Volbrecht, M. E. (2003). A Validation of Multiple Malingering Detection Methods in a Large Clinical Sample, Archives of Clinical Neuropsychology, 18,, 3, Meyers, J. E., & Diep, A. (2000). Assessment of malingering in chronic pain patients using neuropsychological tests. Applied Neuropsychology, 7,, Meyers, J. E., & Volbrecht, M. (1999). Detection of malingerers using the Rey Complex Figure and Recognition Trial. Applied Neuropsychology, 6,, 4, Meyers, J. E., Galinsky, A., & Volbrecht, M. (1999). Malingering and mild brain injury: How low is too low. Applied Neuropsychology, 6,, Meyers, J. E., & Volbrecht, M. (1998). Validation of reliable digits for detection of malingering. Assessment, 5,, Meyers, J. E., & Morrison, A. L., & Miller, J. C. (2001). How low is too low revisited: Sentence repetition and AVLT Recognition in the detection of malingering. (Submitted to Applied Neuropsychology). Meyers, J. E., & Volbrecht, M. E. (2001). A validation of multiple malingering detection methods in a large clinical sample. (under review at Archives of Clinical Neuropsychology)

59 Validity checks for Neuropsychological tests Frequency of failing validity checks for NON LITIGATING Groups < 1hr LOC 1hr <24 LOC 1-8 days LOC 9 days+ LOC Pain Normals

60 Validity checks for Neuropsychological tests Frequency of failing validity checks for LITIGATING groups <1hr LOC > 1 hr LOC Pain Malingering Actors

61 1. Dikmen et al., (1995) administered HRB to a sample of TBI patients. Similar patients from MNB. 1. TBI Dose Response a) First, determine if a dose-response TBI severity & deficits b) Second, are Dikmen et al. results generalizable to other TBI samples? 2. Analyses of the Meyers sample replicated Dikmen. a) A dose-response relationship between LOC & impairment found using effect sizes for Dikmen sample, as well as using regression-based normative T-scores for Meyers sample. 3. Both samples highly correlated with one another. a) Mean scores for the six LOC-severity groups for two samples resulted in a correlation coefficient r =.97, p <.0001.

62 TBI Dose Response Table 1 Injury severity using effect sizes (Hedges g) for Dikmen s sample. Severity Group n Mean SD Min. Median Max. Group 1: TFC < 1 hr (.13) Group 2: TFC = 1-23 hrs (.14) Group 3: TFC = 1-6 days (.22) Group 4: TFC = 7-13 days (.27) Group 5: TFC = days (.26) Group 6: TFC > 28 days (.41) Entire Sample (.80)

63 Table 2 Severity of injury information for the Meyers sample. Grp 1 Grp 2 Grp 3 Grp 4 Grp 5 Grp 6 All Pts. (n = 138) (n = 52) (n = 47) (n = 19) (n = 14) (n = 21) (N = 291) H p LOC (days) <.0001 Mean Median (sd) (.004) (.18) (1.5) (1.9) (3.7) (21.8) (14.4) PTA (days) <.0001 Mean Median (sd) (8.6) (10.9) (26.3) (55.1) (34.5) (74.0) (40.7) Mo. since TBI 61.2 <.0001 Mean Median (sd) (28.5) (18.8) (66.5) (71.1) (121.4) (136.3) (79.4)

64 Table 3 Injury severity using T scores for Meyers sample. Severity Group n M sd Minimum Median Maximum Group 1: LOC < 1 hr (5.0) Group 2: LOC = 1-23 hrs (5.7) Group 3: LOC = 1-6 days (6.6) Group 4: LOC = 7-13 days (7.1) Group 5: LOC = days (5.3) Group 6: LOC > 28 days (8.6) Entire Sample (7.2)

65 Table 4 Comparison between mean OTBM-T for Meyers sample and estimated OTBM-T for Dikmen sample, excluding the most severely impaired group. Severity Group Meyers Sample Dikmen Sample Group 1: LOC < 1 hr Group 2: LOC = 1-23 hrs Group 3: LOC = 1-6 days Group 4: LOC = 7-13 days Group 5: LOC = days Sample mean of six groups (sd) 39.2 (4.1) 38.9 (5.1) Correlation Coefficient a Slope of regression line (95% CI) -2.6 (+.6) -3.1 (+ 1.6) Intercept of regression line 47.0 (+ 2.0) 48.1 (+ 5.3)

66 F i g u r e 2 O v e r a l l T e s t B a t t e r y M e a n ( O T B M ) u s i n g T - s c o r e s f r o m t h e M e y e r s s a m p l e M a x y = x % ile y = x Overall Test Battery Mean-T % ile y = x % ile y = x % ile y = x % ile y = x M in y = x G r o u p 1 < 1 h r G r o u p h r s G r o u p d a y s G r o u p d a y s G r o u p d a y s G r o u p 6 > 2 8 d a y s S e v e r i t y o f T B I b a s e d o n L O C

67 CT/MRI Data Participant Demographic Information Variable Sample Sizes (N = 124) Gender Male 82 Female 42 Ethnicity Caucasian 119 Other 5

68 CT/MRI Diagnostic Groups Sample Size MVA/TBI 47 Blow to Head 32 LCVA 24 RCVA 21

69 CT/MRI 1. All were Right Handed. 2. All were followed by Dr. Meyers through hospitalization and rehabilitation. 3. None were involved in litigation. 4. All passed internal validity checks.

70 CT/MRI CT/MRI Location Left Frontal 59 Left Parietal 37 Left Temporal 34 Left Occipital 6 Right Frontal 40 Right Parietal 42 Right Temporal 31 Right Occipital 3

71 CT/MRI All were given MNB CT/MRI data coded for injury reported on MRI/CT at the time of injury Present = 1 Absent = 0 Some had injury in more than one place

72 Meyers and Rohling (2009) found an 84 % concordance with CT/MRI data.

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78 CT/MRI NP tests generally behaved as expected A more Systemic or Domain like approach better at explaining results Construct of Frontal-Executive Function not supported.

79 Comparison Database Current Database Can be used to compare your patient s performance to a reference group(s) Dicriminant functions

80 Profile Matching Look at the shape of the pattern, not necessarily the level of scores. Similar conditions have similar patterns This helps the clinician to Hypothesis Test for the DX.

81 Patterns Similar injuries have similar patterns 2 examples TBI different levels of injury Hypoxia Carbon Monoxide

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83 Commonality of Reduced O2

84 Discriminant Functions Individual discriminant functions can also help clinician to hypothesis test If it is TBI should generally match TBI groups. Normal VS TBI Depressed VS TBI PTSD VS TBI Etc.

85 Neuronet Can help clinician to decide what pattern is more similar to patient s data Objectively matches Must assume patient s data is one of the comparison groups We will discuss more about Neuronet a little later.

86 Group Normal s Demographic Description Right Handed Left Handed Neuronet Caucasi an Not Caucasi an Female Male TBI Depress ed Anxiety PCS PTSD Malinger ing/inva lid

87 Combined Had to combine Depression Anxiety PCS Normal Controls Into a single group as Neuronet identified these groups as similar and not able to be discriminated. Not an unusual finding

88 Neuronet Results Neural networks are often the tools of choice when predictive accuracy is required. While in most cases, 20 algorithms for comparison are sufficient, we examined 200 for this analysis and selected the best one. Further neural network analyses were performed, with one million algorithms compared, but none improved on the best of the batch of 200 previously mentioned.

89 Summary of what they did Data set Neuronet analysis 80% of cases randomly selected-produced the algorithm 20 % of case form first validation- 94% correct classification overall

90 Demographics of Soldiers Mean Age 29.3 (+6.87) years Ed (+1.4) years 92 Right Handed, 8 Left handed 5 Female, 95 Male Ethnicity: AA =13,Ca=63, Asian=5, Hisp=14, Pacific Islander=5

91 Diagnoses Classified Classification by Neuronet Clinician Diagnosis TBI PTSD Malingering (Normal, Anx, Dep, PCS) TBI 30 2 PTSD 1 19 Malingering 10 (Normal,Anx,Dep,P CS)

92 Conclusions Using standard MNB interpretation system we are consistent 90% of the time Or The neuronet is 90% accurate compared to clinician, in a military population

93 Conclusion The neural network produced accuracies of over 90% in this trial. Two other trials on the neuronet with new subjects produced accuracies of 90% or better Overall, this test appears to have been a success

94 MNB Interpretation Hypothesis test If it is a TBI what else should it match to? Should match other TBI patterns Does pt s data make sense given reported injury. Consider Dose Article Pattern tells you what the problem is.

95 Interpretation Pattern tells you what it is. OTBM tells you how bad it is. Domain scores tell you what functional difficulties patient will have. Individual tests tell you what rehab tasks would be helpful.

96 Review Took a battery of well known tests Developed Smoothed Norms Identified Validity, Reliability, Sensitivity and Specificity. Internal Validity Checks and Internal Consistency Used pattern matching to help make DX. Then developed Neuronet

97 Summary We have discussed: Make up of MNB Norms/ test selection etc PVTs Validity and Reliability of MNB test etc. Interpretative Method Patterns Discriminant functions RIM Matrix Neuronet analysis (new)

98 D1 Rim Matrix Rohling Interpretive Method

99 Slide 98 D1 Effect and power tell me if I've done enough testing on that domain. Effect size of.3 and more is good effect size; we want power to be lower than.74. Effect tells me that the testing shows that I have tested enough, that the range level is accurate. Cohen says.2 effect size is sufficient. Doc, 6/15/2012

100 Workings of the MNB Basic Information Tab

101 Wechsler Tab

102 MNB Tab

103 Rating Forms Tab

104 MMPI-A /MMPI-RF (raw)

105 MMPI-2

106 Summary Tab

107 Graph Compare

108 Overlays Tab

109 Report Tab

110 Pain Tab

111 Advanced Info Tab

112 AYOC

113 Premorbid Tab

114 Specialty Tests Tab

115 Performance Validity Tab

116 AYOP

117 Alternate Summary Tab

118 Import/Export

119 T Score Calculator

120 Full Graph

121 Tables

122 Performance Validity

123 Edit Working Files

124 PVM Frequencies

125 Rule Outs

126 Menu Mode Help Do general update at least monthly

127 ? Questions