This month Dr Gianna Cocchini talked about her work in Neuropsychology; it’s Clinical and Research Implications. Gianna was previously a Clinician in Italy and is now Course Director in Neuropsychology at Goldsmiths University of London. The following minutes are based on her handout.
Lesion method:
- Neuropsychology began to be studied in the early 20th Century.
- Interest stemmed from patients such as “HM”, a severe epileptic whose hippocampus was removed in the hope of improving his epilepsy. This led to him being unable to learn or retain and NEW information; despite remembering all old information.
- The lesion method is one way to study the brain and its cognitive processes.
- Damage to a particular part of the brain can indicate its function by the impairment it produces.
- Working with a clinical population of brain damaged patients gives an insight into brain function
Cognitive Neuropsychology vs. Neuropsychology
- These are the two main disciplines in neuropsychology.
- Cognitive neuropsychology in not interested in the anatomy of the brain so much and tend to be interested in single case studies since they don’t wish to be able to generalize to the wider population
- Neuropsychology, on the other hand, is interested in which part of the brain is linked to which functions. Tend to study groups of patients in order to be able to avoid the influence of individual anatomical differences and enable them to generalize to the wider population.
Linking clinical observations to research
- The amount of clinical attention paid to rehabilitation is minimal considering the money involved and the potential benefit for the patient
- Research allows clinicians to improve assessment and guides rehabilitation; it gives clinicians information they can use for their practice
- Ideally, these should work together, however, since improvement in a lab type environment does not necessarily mean patients will improve outside that environment as well.
- Clinicians and researcher working together leads to the best outcome for patients
Cocchini et al-2 year research study
- This study looks at Anagnosia where patients lack an awareness of their illness. E.g. a paraplegic may claim they can climb stairs, run around etc. Often give reasonable but delusional reasoning
- This obviously has a negative impact on their recovery since they refuse to believe they need any rehabilitation. Often give reasonable but delusional reasoning
- Risk that the patient will cause themselves serious harm by trying to do things they cannot
- Originally, this disorder was thought to be due to right brain damage. However, Cocchini et al questioned whether this might be more to do with the assessment methods. Since left brain damage causes difficulties in understanding language, it may have been that patients just couldn’t show they had this problem
- This patient group was originally studied for research but it led to the development of a new assessment tool that minimised the amount of language competency necessary.
- When administered to all patients, the prevalence of this disorder became equal in both right and left brain damaged patients.
- A good example of research being able to influence clinical practice
Limitations:
- Clinicians can’t often find time to carry out such research. They have a lot of day to day concerns with their patients whereas researchers tend to focus more on the long term future.
- Therefore, clinicians may find it hard to do research AND immediate day to day work with patients.
Questions:
- Is there a conflict between clinical and research and clinical work? For example, the impact on the therapeutic relationship.
- As long as you’re honest with the patients, they are generally keen to take part-even though it’s unlikely to help them as such.
- Very few say no to taking part since they generally only have 1 or 2 hours physio and are then left alone for the rest of the day.
- They often quite enjoy taking part
- Because you want patients to get better, could you overlook evidence to the contrary?
- Absolutely! And this is a methodological problem with research that you should always bear in mind
- It is possible to overcome it though e.g. by taking baseline measures on a no. of cognitive functions, then giving the treatment, then retesting those functions.
- To check it was the treatment that changed the patients functioning, administer a placebo treatment and, if they still improve, it’s probably not your treatment but something to do with your attention and interaction with them.
- Obviously, this is still great news if you’re a clinician but does make research potentially unreliable
- Could you tell us a little more about the Masters at Goldsmiths?
- It’s a taught masters with clinical flavour
- Linked to the rehabilitation centre at Blackheath
- Look at: the biological aspects of brain function, Clinical cognitive neuropsychology, Methodology, Developmental neurocognitive impairment e.g. in Down’s Syndrome and a research project
The group thanked Dr Gianna Cocchini for her time and the interessting presentation.