Clinicians most often use the GOAT to assess severe and moderately impaired patients. In essence, this test is a short mental status examination. It can be repeated as with the GCS. The vast majority of the questions on this test involve whether the patient is oriented as to time, place, and person. Two questions deal with anterograde and retrograde amnesia.

The GOAT is used to predict ultimate recovery in a patient and is also used as an indicator of level of responsivity. The measurements obtained using the GOAT questions dealing with anterograde and retrograde amnesia establishes the relationship between severity of injury (GCS), and a patient’s long-term outcome (GOS).

This test was designed for measuring the duration of post traumatic amnesia and tests memory, demographics, and orientation. Each day, the patient is tested as to his/her memory and ability to recall and recollect. When the patient is able to score a perfect score 3 days in a row, the test is concluded.

Different scales have evolved out of the Oxford Test. Different scales can be used to determine recovery and duration, thereby charting improvement on different components of orientation and memory.

Neuropsychological testing is the sine qua non for modern diagnostics of brain injury. It is proven reliable, accurate, and unlike other testing and evaluative mechanisms, which compare patients with the so-called “normal person”, neuropsychological testing evaluates whether a particular patient has himself/herself changed.

How Neurological Testing Works

As an individual grows and matures, s/he develops and utilizes the most efficient pathways in the brain. When traumatic brain injury occurs, many times those pathways are severed or unable to properly transmit or receive information. Methods of learning and behaving are altered. While this individual may still be within the normal population range, s/he would surely be outside their individual “pre-injury” range.

Neuropsychological testing allows competent professionals to reach the conclusion, to a reasonable degree of scientific probability, that organic brain injury has occurred. It further allows the professionals to pinpoint areas of deficit, be they visual/spatial, memory, recall or other. Simply put, neuropsychological testing is the most important testing most “mild” to “moderate” traumatic brain injury patients will undergo.

Approaches to Neurological Testing

Neuropsychological assessment is a method of validation, which measures the ability of the nervous system to perform cognitive functions we minimally need to exist. It measures compromise of functions against pre-morbid capabilities. Neuropsychologists are psychologists with specialized training. Neuropsychological assessment is an interface between science and practice.

A current debate in the field of Neuropsychology focuses primarily on approach. Many neuropsychologists advocate the quantitative approach utilizing the so-called “non-flex” Halstead-Reitan battery of testing. Still others advocate the “flexible battery” approach. Statistical accuracy is the issue. In a 2000 survey, it was found that only 15% of the neuropsychologists surveyed used a fixed battery (the Halstead Reitan or Lurie-Nebraska batteries).

Clearly, there are advantages and disadvantages to use of either a fixed battery or a flexible battery approach.

Utilization of a non-flex battery can reveal objective data in as much as it is gathered without subjective influence and all scores are subjected to the same variables. However a fixed battery does not allow the clinician the freedom to address specific diagnostic problems. The flexible battery does give the clinician the opportunity to individually test and assess for certain problems which may be present though missed under the non-flex approach.

Assessment Batteries

Irrespective of approach, neuropsychological assessment is essential to the proper diagnoses and treatment of most victims of traumatic brain injury. Neuropsychological assessment batteries are utilized in order to obtain an accurate diagnoses of the individual (though with the improvement of neuro- imaging, discussed below, utilization of assessment batteries for diagnostic purposes is not as important today as it was in the past).

Primarily then, neuropsychological assessment batteries are utilized in order to obtain and determined a functional assessment of the particular patient. Numerous formalized batteries have been developed for general use while others were “personalized” to assess a specific need. There are literally thousands of tests available to the neuropsychologist depending upon the issues faced. In essence, it is the incumbent upon the neuropsychologist to derive a battery that provides for an examination appropriate to the given patient.

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