Neuropsychology and Technology: How to Avoid Going the Way of the Dinosaurs

Neuropsychology and Technology: How to Avoid Going the Way of the Dinosaurs We live in an era of modern technology where technology permeates most aspects of daily life. Technological advances have been occurring at a rapid pace in recent history due in large part to innovations in computer technology. The world has gone from witnessing the birth of the first digital computer that took up an entire large room to using computers that can be held in our hands or worn on our wrists thanks to advances in electronic miniaturization. The world went from local to global information sharing with the development of the World Wide Web, and with the creation of more sophisticated search engines, there is now boundless information instantly available to the user. The world has seen the role of computers evolve from performing rather simple operations and calculations to machines capable of learning and using knowledge to reason and solve complex problems. Technology has benefited many aspects of society from our personal lives to scientific research to industry. While most of medicine has embraced this technological revolution and garnered the benefit from it, the field of Clinical Neuropsychology has been very slow to incorporate technology into its practice. Most practitioners continue to mainly use paper and pencil tests that really have not changed in form or conceptual sophistication over the decades (Rabin, Barr, & Burton, 2005). The Role of Technology in Clinical Neuropsychology edited by Kane and Parsons is the first of its kind, a textbook detailing past and current efforts to use technology to aid in neuropsychological assessment. The book is organized into five sections. The first section or the Introduction sets the stage for the rest of book by providing a general overview of the current state of technology in Neuropsychology with specific focus on computerized testing. The second section, Beyond Paper and Pencil Assessment, provides a summary of available computerized and tablet based tests as well as discussion of factors that can affect reliability and validity when moving from traditional paper and pencil to computerized tests. The importance of validation studies and updated norming for technology-based assessment is emphasized. There are chapters that discuss wearable sensors and the advantages of this technology in collecting behavioral data, novel virtual reality tasks that assess executive functioning, and different models for tele-neuropsychology and their supporting evidence. The third section, Domain and Scenario-Based Assessment, covers novel technological approaches to assessing specific cognitive domains, including chapters on attention and episodic memory, and chapters on multi-tasking and prospective memory as well as a detailed chapter on military based applications of virtual reality environments. There are also chapters that review factors that influence acceptance of assistive technology and review of smart environment technologies that allow for activity monitoring and possible support of clinical intervention. The fourth section, Integrating Cognitive Assessment with Biological Metrics, explores the use of technology-assisted training systems to guide skill training and assist in neurorehabilitation efforts. This is followed by a chapter on the use of neuroimaging in neuropsychology, including how volumetric and functional neuroimaging can be incorporated into and inform neuropsychological assessment. The final section of the book focuses on the ethical and methodological considerations related to incorporating technology into neuropsychological assessment. The breadth of topics covered in this book will appeal to the reader looking for an update on current applications of technology in neuropsychology. The organization of the book as a whole was effective, however, a few chapters seemed out of place with one chapter presenting more like a scientific journal article. Topics covered range from computerized testing to virtual environments to integrating neuroimaging into clinical practice to cognitive domain specific paradigms. Important issues such as the need for ecological validity, factors that affect reliability and validity in computerized testing, and obstacles to accepting technology are well presented. The different chapter’s present relevant research findings and correlations with traditional neuropsychological measures mostly in informative and easy to read tables. Colored pictures are used effectively to help illustrate VR environments and task paradigms, which is especially beneficial to readers with little to no experience in this area. There are some topics not covered in the book that might be of interest to the reader, such as how machine learning might be used in neuropsychological differential diagnosis or in optimizing the length of neuropsychological testing, or how cloud based computing and storage can be used to facilitate real-time global norm development and perhaps lead to a global normative database for clinicians to access and create norms based on specific demographic and clinical variables. Given the more widespread use of neuroimaging and involvement of neuropsychologists in imaging programs, additional chapters or at least additional discussion on the clinical applications of fMRI and DTI, including the role of the neuropsychologist and neuroimaging in the presurgical work-up of epilepsy and tumor patients, would have been welcomed. Additionally, discussion of cognitive enhancement through repetitive stimulation (e.g., TDCS, TMS) might also be of interest to the reader. The book succeeds on many levels but falls short of being a true neuropsychologists’ call to arms to embrace and utilize technology in clinical practice, which is much needed in our field. Neuropsychology is primed for a major paradigm shift capitalizing on technological advances but the book does not lay out specific recommendations or an actionable agenda to further this movement and promote change. The book would benefit from an inspiring chapter at the end that would energize the reader and excite them about the future of technology and neuropsychology with a more clear vision of where we as a field need to go and what we can do to help us get there. The book will appeal to a select group of neuropsychologists, students of neuropsychology, and individuals with an interest in technology and interfacing technology with cognitive assessment. Individuals with interest in test development using the various technological interfaces discussed in the book, such as tablet based testing and virtual reality environments, will find the book particularly relevant and informative. In summary, neuropsychology is an evolving field that historically has focused on localizing brain dysfunction but with the advent of neuroimaging has shifted more to assessing the impact of injury on cognitive function. With this shift, establishing the ecological validity of our tests is critical for the survival of our field. Using technology, such as virtual environments that can allow the patient to move around real world scenarios and test cognitive functions like memory in everyday activities like shopping while never leaving the exam room are now possible. Using tablets to assess cognitive functions in situations that normally limit our ability to test, such as in the operating room during awake brain surgery, or using cloud computing to gather voluminous real-time data to norm testing measures or to gather norms on populations that are underrepresented is now possible. Neuropsychology needs to embrace technology and The Role of Technology in Clinical Neuropsychology helps set the stage for this paradigm shift by offering the reader a summary of progress to date and important issues to consider as we hopefully continue to evolve and progress in this area. Reference Rabin , L. A. , Barr , W. B. , & Burton , L. A. ( 2005 ). Assessment practices of clinical neuropsychologists in the United States and Canada: A survey of INS, NAN, and APA Division 40 members . Archives of Clinical Neuropsychology , 20 , 33 – 65 . Google Scholar CrossRef Search ADS PubMed © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Clinical Neuropsychology Oxford University Press

Neuropsychology and Technology: How to Avoid Going the Way of the Dinosaurs

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Publisher
Oxford University Press
Copyright
© The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
ISSN
0887-6177
eISSN
1873-5843
D.O.I.
10.1093/arclin/acx119
Publisher site
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Abstract

We live in an era of modern technology where technology permeates most aspects of daily life. Technological advances have been occurring at a rapid pace in recent history due in large part to innovations in computer technology. The world has gone from witnessing the birth of the first digital computer that took up an entire large room to using computers that can be held in our hands or worn on our wrists thanks to advances in electronic miniaturization. The world went from local to global information sharing with the development of the World Wide Web, and with the creation of more sophisticated search engines, there is now boundless information instantly available to the user. The world has seen the role of computers evolve from performing rather simple operations and calculations to machines capable of learning and using knowledge to reason and solve complex problems. Technology has benefited many aspects of society from our personal lives to scientific research to industry. While most of medicine has embraced this technological revolution and garnered the benefit from it, the field of Clinical Neuropsychology has been very slow to incorporate technology into its practice. Most practitioners continue to mainly use paper and pencil tests that really have not changed in form or conceptual sophistication over the decades (Rabin, Barr, & Burton, 2005). The Role of Technology in Clinical Neuropsychology edited by Kane and Parsons is the first of its kind, a textbook detailing past and current efforts to use technology to aid in neuropsychological assessment. The book is organized into five sections. The first section or the Introduction sets the stage for the rest of book by providing a general overview of the current state of technology in Neuropsychology with specific focus on computerized testing. The second section, Beyond Paper and Pencil Assessment, provides a summary of available computerized and tablet based tests as well as discussion of factors that can affect reliability and validity when moving from traditional paper and pencil to computerized tests. The importance of validation studies and updated norming for technology-based assessment is emphasized. There are chapters that discuss wearable sensors and the advantages of this technology in collecting behavioral data, novel virtual reality tasks that assess executive functioning, and different models for tele-neuropsychology and their supporting evidence. The third section, Domain and Scenario-Based Assessment, covers novel technological approaches to assessing specific cognitive domains, including chapters on attention and episodic memory, and chapters on multi-tasking and prospective memory as well as a detailed chapter on military based applications of virtual reality environments. There are also chapters that review factors that influence acceptance of assistive technology and review of smart environment technologies that allow for activity monitoring and possible support of clinical intervention. The fourth section, Integrating Cognitive Assessment with Biological Metrics, explores the use of technology-assisted training systems to guide skill training and assist in neurorehabilitation efforts. This is followed by a chapter on the use of neuroimaging in neuropsychology, including how volumetric and functional neuroimaging can be incorporated into and inform neuropsychological assessment. The final section of the book focuses on the ethical and methodological considerations related to incorporating technology into neuropsychological assessment. The breadth of topics covered in this book will appeal to the reader looking for an update on current applications of technology in neuropsychology. The organization of the book as a whole was effective, however, a few chapters seemed out of place with one chapter presenting more like a scientific journal article. Topics covered range from computerized testing to virtual environments to integrating neuroimaging into clinical practice to cognitive domain specific paradigms. Important issues such as the need for ecological validity, factors that affect reliability and validity in computerized testing, and obstacles to accepting technology are well presented. The different chapter’s present relevant research findings and correlations with traditional neuropsychological measures mostly in informative and easy to read tables. Colored pictures are used effectively to help illustrate VR environments and task paradigms, which is especially beneficial to readers with little to no experience in this area. There are some topics not covered in the book that might be of interest to the reader, such as how machine learning might be used in neuropsychological differential diagnosis or in optimizing the length of neuropsychological testing, or how cloud based computing and storage can be used to facilitate real-time global norm development and perhaps lead to a global normative database for clinicians to access and create norms based on specific demographic and clinical variables. Given the more widespread use of neuroimaging and involvement of neuropsychologists in imaging programs, additional chapters or at least additional discussion on the clinical applications of fMRI and DTI, including the role of the neuropsychologist and neuroimaging in the presurgical work-up of epilepsy and tumor patients, would have been welcomed. Additionally, discussion of cognitive enhancement through repetitive stimulation (e.g., TDCS, TMS) might also be of interest to the reader. The book succeeds on many levels but falls short of being a true neuropsychologists’ call to arms to embrace and utilize technology in clinical practice, which is much needed in our field. Neuropsychology is primed for a major paradigm shift capitalizing on technological advances but the book does not lay out specific recommendations or an actionable agenda to further this movement and promote change. The book would benefit from an inspiring chapter at the end that would energize the reader and excite them about the future of technology and neuropsychology with a more clear vision of where we as a field need to go and what we can do to help us get there. The book will appeal to a select group of neuropsychologists, students of neuropsychology, and individuals with an interest in technology and interfacing technology with cognitive assessment. Individuals with interest in test development using the various technological interfaces discussed in the book, such as tablet based testing and virtual reality environments, will find the book particularly relevant and informative. In summary, neuropsychology is an evolving field that historically has focused on localizing brain dysfunction but with the advent of neuroimaging has shifted more to assessing the impact of injury on cognitive function. With this shift, establishing the ecological validity of our tests is critical for the survival of our field. Using technology, such as virtual environments that can allow the patient to move around real world scenarios and test cognitive functions like memory in everyday activities like shopping while never leaving the exam room are now possible. Using tablets to assess cognitive functions in situations that normally limit our ability to test, such as in the operating room during awake brain surgery, or using cloud computing to gather voluminous real-time data to norm testing measures or to gather norms on populations that are underrepresented is now possible. Neuropsychology needs to embrace technology and The Role of Technology in Clinical Neuropsychology helps set the stage for this paradigm shift by offering the reader a summary of progress to date and important issues to consider as we hopefully continue to evolve and progress in this area. Reference Rabin , L. A. , Barr , W. B. , & Burton , L. A. ( 2005 ). Assessment practices of clinical neuropsychologists in the United States and Canada: A survey of INS, NAN, and APA Division 40 members . Archives of Clinical Neuropsychology , 20 , 33 – 65 . Google Scholar CrossRef Search ADS PubMed © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Journal

Archives of Clinical NeuropsychologyOxford University Press

Published: Aug 1, 2018

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