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Interpretation and use of the Luria-Nebraska battery
BRAIN
AND
COGNITION
3, 343-348 (1984)
interpretation and Use of the Luria-Nebraska Battery JOHN KNIPPA, CHARLES University
of Nebraska
J. GOLDEN, AND MICHAEL FRANZEN
Medical
Center, Nebraska
Psychiatric
Institute
In a recent article, T. V. Akhutina and L. S. Tsvetkova (1983, Brain and 2, 129-134) presented an analysis of the Luria-Nebraska Neuropsychologjcal Battery. Along with their generally positive review, they raised questions regarding the importance of the qualitative aspects of patients’ performance in the interpretation of the battery. We agree with the authors that any interpretation of the battery which does not consider qualitative performance can limit the power and applicability of the battery. The procedures of item analysis and qualitative analysis are discussed as essential to a comprehensive interpretation of the battery. Also discussed are comments on additional scaling for the battery and the development of a standardized qualitative scoring system. Cognition
In a recent article, Akhutina and Tsvetkova (1983) present a wellwritten and thoughtful analysis of the Luria-Nebraska Neuropsychological Battery and the role of quantified batteries attempting to replicate Luria’s work. Many of the comments they make are quite positive and well appreciated by the authors of the test. However, the authors also bring up issues regarding the role of the qualitative aspects of patients’ behavior in their analysis of the battery. Some of their statements reflect ideas about the battery which arise from the emphasis of our earlier papers on the more unique contribution of the Luria-Nebraska Battery, i.e., its quantitative characteristics. However, more recent work has directly addressed the questions brought up by the authors. In their article, Akhutina and Tsvetkova discussed their concern that the Luria-Nebraska Neuropsychological Battery (Form I) is subject to misuse by having ignored that which Luria himself most emphasized, the qualitative aspects of a patient’s performance. They draw attention to the quantification of patient’s performance on individual tests according to a dichotomous fashion and the summing of those “scaled scores.” They suggest that these methods do not allow for a systematic qualitative Send requests for reprints to Charles J. Golden, Ph.D., Professor of Medical Psychology, University of Nebraska Medical Center, Nebraska Psychiatric Institute, 42nd and Dewey, Omaha, NE 68131. 343 0278-2626184$3.OO Copyright 0 1984 by Academic Press, Inc. All rights of reproduction in any form resewed.
344
KNIPPA,
GOLDEN,
AND FRANZEN
analysis of neuropsychological performance and, therefore, may limit the conclusions which could be drawn from an otherwise adequate sampling of Luria’s tests. An objective of the Luria-Nebraska method has been to standardize aspects of Luria’s neuropsychological tests in ways that will improve the quantitative utility of the measures employed while preserving their qualitative nuances. This approach required establishing pass/fail criteria for individual items and combining items into scales so as to permit an objective psychometric evaluation of a patient’s performance. The scoring system and objective interpretation were not meant to replace qualitative evaluation. The quantitative scoring system is intended to be combined with a careful analysis of the qualitative characteristics of performance observed across items. To use only the psychometric data or the qualitative approach alone would be an incomplete use of the battery. Conclusions generated from such incomplete analyses are unnecessarily limited. The quantitative characteristics of the battery, and other issues which have appeared in the literature, are discussed in a recent review by Golden (in press). As Akhutina and Tsvetkova (1983) correctly point out, errors on specific test items can result from a variety of brain deficits which in many cases will not be immediately apparent from a profile analysis alone. However, consideration of the elevations of the Luria-Nebraska Battery Clinical Scales and the patterns of item failures are but two steps in the process of test interpretation. For this reason, Golden, Ariel, McKay, Wilkening, Wolf, and MacInnes (1982) indicated five steps involved in interpreting the Luria-Nebraska Battery. They suggested evaluation of (1) the 14 clinical scales, (2) the 8 localization scales, (3) the 30 factor analytic scales, (4) the item patterns across the scales, and (5) the qualitative aspects of performance. These steps are not ordered by importance, but are sequenced for efficiency. It is specifically Steps 4 and 5 which address Akhutina and Tsvetkova’s concerns. ITEM ANALYSIS
The idea of examining patterns of performance between items is related to Luria’s technique of comparing several tasks which have one or more common bases as a means of isolating and deducing the patient’s specific functional loss(es). For example, if a patient fails the items where he is asked to show his teeth, stick out his tongue, and then place his tongue between his lower teeth and lower lip, a motor or kinesthetic deficit might be initially hypothesized. If a patient is unable to accurately reproduce an aurally presented rhythmic series, a rhythm reception or production deficit might be suspected. Similarly, failure to repeat or write aurally presented groups of phonemes or words might suggest a receptive speech deficit. However, if items from all three areas are missing we would
LURIA-NEBRASKA
BATTERY
345
instead consider the possibility of memory deficits (among others) and examine those items specifically assessing immediate memory with interference. It should be recognized that Luria’s original tasks and those included in the Luria-Nebraska Battery were designed and selected to elicit behaviors which permit a logical analysis, consistent with Luria’s theories, leading to identification of the defective links within the functional system(s) of the brain. The task of performing this analysis is done by thoroughly examining the groups of test errors while keeping in mind exactly which intact functions are necessary for the successful completion of the behavioral task. Test items on the Luria-Nebraska were sequenced in a manner intended to facilitate such an analysis. For example, items l-4 primarily require intact simple motor speed. Items 5-8 are kinesthetically based motor tasks. Items 9-18 involve spatially organized, visually presented motor skills, etc. However, as Akhutina and Tsvetkova imply, it is important for the skilled test evaluator to be thoroughly familiar with the “primary factors” upon which deficient performance may be conditioned. It is this understanding of brain functioning, as exemplified by Luria’s theories, together with an adequate sample of test performances, which permits syndrome analysis. The effect (on behavior) of presenting these tasks within a standard format versus a more flexible approach has not been explored. However, general advantages and disadvantages of standard batteries versus flexible assessmentapproaches have been briefly discussed by Golden (1982). In a recent book, Golden and his colleagues (Golden, Hammeke, Purisch, Berg, Moses, Newlin, Wilkening, & Puente, 1982)have also discussed strategies of item analysis for the Luria-Nebraska and described certain patterns of test errors and their associated organic deficits. While evaluating item patterns can be viewed as one type of “qualitative” evaluation, it does not constitute a full qualitative analysis of a patient’s performance. More correctly, this clinical, deductive procedure is viewed as part of a “syndrome analysis” (Golden et al., 1982a). As Akhutina and Tsvetkova appear to suggest, the development of additional, separate scales which regroup items according to special functional similarities (e.g., combining items which require spatially based or kinesthetically organized movements, object naming, etc.), might be valuable toward further objectifying the item analysis. However, preliminary studies discussed by Moses, Golden, Ariel, and Gustavson (1983) indicate that there are relatively few cross-scale factors. For the original Clinical Scales, item intercorrelation studies by Golden et al. (1982b) support the impression that test items are grouped with those items to which they are most related. We have investigated and are continuing to examine the empirical bases for proposing new scales which supplement the 14 original scales
346
KNIPPA,
GOLDEN,
AND
FRANZEN
of the Luria-Nebraska Battery. For example, eight Localization Scales were developed by (a) identifying those items which were most missed by small groups of patients having localized brain lesions and (b) excluding items from the scales that were missed across groups (McKay & Golden, 1979). A cross-validation study later showed that single Localization Scale elevations accurately identified the damaged lobe in 74% of cases and the hemisphere in 92% of the patients (Golden, Moses, Fishburne, Engum, Lewis, Wisniewski, Conley, Berg, & Graber, 1981). Thirty Factor Scales were developed in a series of factor analytic studies described by Moses et al. (1983). In general, these studies involved examining the factor structure of the individual Clinical Scales and identifying those groups of items which both loaded together and discriminated between normal and brain injured groups (McKay & Golden, 1981). Recently, Sawicki and Golden (1984) also identified two new acrosstest scales, the Impairment Scale and Elevation Scale, by determining those groups of items most correlated to the number of scales above the age- and education-corrected critical level and to the mean T-score (i.e., of the basic Clinical Scales), respectively. The above described scales address some of the concerns discussed by Akhutina and Tsvetkova. Development of additional scales should similarly focus on the investigation and identification of psychometric characteristics of item groups and empirical relationships of item patterns to external, diagnostic criteria or measurement methods. Each new scale must significantly add to, or have substantial replacement value for, the 54 scales which are currently available. QUALITATIVE ANALYSIS The fifth interpretive step listed above is exactly that qualitative method which Akhutina and Tsvetkova describe as essential to the interpretation of Luria’s tests, namely consideration of the characteristics of performance as a means of isolating specific neuropsychological deficits so as to more accurately describe and predict behavior. Here one relies on the observation skills of the examiner and the integrative skills of the interpreter. It is important to know whether the subject missed the “draw a circle” item because of the poor quality of the drawing or if the subject drew a good circle but (a) took too long to initiate or complete the task, (b) continued on to draw more circles, or perhaps (c) ignored one side of the page when drawing. It is important to recognize that qualitative analysis of the characteristics of performance is done with reference to Luria’s theories of brain functioning; as such, this interpretive process is independent of the sequence of test tasks (i.e., standard format versus flexible approach). As noted by Moses et al. (1983), “the many levels on which the test can be interpreted depend on the needs as well as the skill and knowledge
LURIA-NEBRASKA
BATTERY
347
of the examiner.” Currently, a thorough qualitative analysis which includes both item analysis (Step 4 above) as well as attention to the special characteristics of performance (Step 5) can only be conducted by those who have had sufficient training and experience in the field to recognize qualitative errors or elements of performance. At the Neuropsychology Laboratory of the University of Nebraska Medical Center, we have begun to describe and examine across-test qualitative performance errors so as to provide a standard qualitative scoring system for which the empirical correlates of those qualitative aspects of performance can be established. For example, perseveration, attentional dysfunction, paraphasia, impersistence, naming difficulty, sequence errors, aprosody, etc., might be observed on a wide variety of items between scales. We fully agree with Akhutina and Tsvetkova that any use of Luria’s methods and the LuriaNebraska Battery which does not consider such observable, qualitative elements of behavior would ignore a primary element of Luria’s contributions to neuropsychology . This aspect of neuropsychological assessment has been discussed by Golden, Purisch, and Hammeke (1984) and briefly by Moses et al. (1983). CONCLUSION
We agree with Akhutina and Tsvetkova that any interpretation of the Luria-Nebraska Battery which omits consideration of qualitative performance can limit the predictive power and applicability of the test. We view the objective analysis of the Luria-Nebraska profile patterns as a significant addition to, not a replacement for, Luria’s original methods. As Akhutina and Tsvetkova note, the summary scores alone have been shown to be sufficient to discriminate the site of injury at a rate comparable to or better than other standardized tests. However, such an analysis (i.e., an empirical-actuarial approach) constitutes only the initial steps in interpretation. A naive or simplistic evaluation of the scale elevations alone is, at best, useful only in establishing baseline data or in making gross discriminations or hypotheses regarding diagnosis (e.g., normal versus impaired, lateralization of impairment, etc.). Yet, for the experienced and expert interpreter, this process provides hypotheses on which to base the more extensive evaluation of the patient’s performance. Furthermore, comparing the quantitative information with the qualitative findings provides the expert evaluator with the opportunity to check the data for consistency and convergent lines of deduction. Using this more comprehensive mode of analysis, the applicability of the Luria-Nebraska Battery can be extended to allow finer discriminations in diagnosis and localization, prognosis, and the design of rehabilitation programs. It is expected that general use of the additional scales of the battery (i.e., the localization, factor, and qualitative, as well as new scales generated
KNIPPA, GOLDEN, AND FRANZEN
348
in the future) will further improve the empirical grounds for making such finer discriminations. REFERENCES Akhutina, T. V., & Tsvetkova, L. S. 1983. Comments on a standardized version of Luria’s tests. Brain and Cognition, 2, 129-134. Golden, C. J. (1982). Diagnosis and rehabilitation in clinical neuropsychology. Springfield, Ill.: Charles C Thomas. 2nd ed. Golden, C. J. The Luria-Nebraska Neuropsychological Battery: The literature. Los Angeles: Western Psychological Services, in press. Golden, C. J., Ariel, R. N., McKay, S. E., Wilkening, G. N., Wolfe, B. A., & MacInnes, W. D. 1982. The Luria-Nebraska Neuropsychological Battery: Theoretical orientation and comment. Journal of Consulting and Clinical Psychology, 50, 291-300. (a) Golden, C. J., Hammeke, T. A., Purisch, A. D., Berg; R. A., Moses, J. A., Jr., Newlin, D., Wilkening, G. N., & Puente, A. E. 1982.Item interpretation of the Luria-Nebraska Neuropsychological Battery. Lincoln: Univ. of Nebraska Press. (b) Golden, C. J., Moses, J. A., Jr., Fishbume, F. J., Engum, E., Lewis, G., Wisniewski, A., Conley, F. K., Berg, R. A., & Graber, B. 1979. Cross-validation of the LuriaNebraska Neuropsychological Battery for presence, lateralization, and localization of brain damage. Journal of Consulting and Clinical Psychology, 49, 491-507. Golden, C. J., Purisch, A. D., & Hammeke, T. A. 1984. The Luria-Nebraska Neuropsychological Battery: Manual. Los Angeles: Western Psychological Services. McKay, S. E., & Golden, C. J. 1979. Empirical derivation of experimental scales for localizing brain lesions using the Luria-Nebraska Neuropsychological Battery. Clinical Neuropsychology,
1, 19-23.
McKay, S. E., & Golden, C. J. 1981. The assessment of specific neuropsychological skills using scales derived from factor analysis of the Luria-Nebraska Neuropsychological Journal of Neuroscience, 14, 189-204. Battery. International Moses, Jr., J. A., Golden, C. J., Ariel, R., & Gustavson, J. L. 1983. Interpretation of the Luria-Nebraska Neuropsychological Battery. New York: Grune & Stratton. Vol. 1. Sawicki, R. F., & Golden, C. J. 1984. The development of the profile elevation scale and the impairment scale: Two new summary scales for the Luria-Nebraska Battery. International Journal of Neuroscience, 23, 81-90.
AND
COGNITION
3, 343-348 (1984)
interpretation and Use of the Luria-Nebraska Battery JOHN KNIPPA, CHARLES University
of Nebraska
J. GOLDEN, AND MICHAEL FRANZEN
Medical
Center, Nebraska
Psychiatric
Institute
In a recent article, T. V. Akhutina and L. S. Tsvetkova (1983, Brain and 2, 129-134) presented an analysis of the Luria-Nebraska Neuropsychologjcal Battery. Along with their generally positive review, they raised questions regarding the importance of the qualitative aspects of patients’ performance in the interpretation of the battery. We agree with the authors that any interpretation of the battery which does not consider qualitative performance can limit the power and applicability of the battery. The procedures of item analysis and qualitative analysis are discussed as essential to a comprehensive interpretation of the battery. Also discussed are comments on additional scaling for the battery and the development of a standardized qualitative scoring system. Cognition
In a recent article, Akhutina and Tsvetkova (1983) present a wellwritten and thoughtful analysis of the Luria-Nebraska Neuropsychological Battery and the role of quantified batteries attempting to replicate Luria’s work. Many of the comments they make are quite positive and well appreciated by the authors of the test. However, the authors also bring up issues regarding the role of the qualitative aspects of patients’ behavior in their analysis of the battery. Some of their statements reflect ideas about the battery which arise from the emphasis of our earlier papers on the more unique contribution of the Luria-Nebraska Battery, i.e., its quantitative characteristics. However, more recent work has directly addressed the questions brought up by the authors. In their article, Akhutina and Tsvetkova discussed their concern that the Luria-Nebraska Neuropsychological Battery (Form I) is subject to misuse by having ignored that which Luria himself most emphasized, the qualitative aspects of a patient’s performance. They draw attention to the quantification of patient’s performance on individual tests according to a dichotomous fashion and the summing of those “scaled scores.” They suggest that these methods do not allow for a systematic qualitative Send requests for reprints to Charles J. Golden, Ph.D., Professor of Medical Psychology, University of Nebraska Medical Center, Nebraska Psychiatric Institute, 42nd and Dewey, Omaha, NE 68131. 343 0278-2626184$3.OO Copyright 0 1984 by Academic Press, Inc. All rights of reproduction in any form resewed.
344
KNIPPA,
GOLDEN,
AND FRANZEN
analysis of neuropsychological performance and, therefore, may limit the conclusions which could be drawn from an otherwise adequate sampling of Luria’s tests. An objective of the Luria-Nebraska method has been to standardize aspects of Luria’s neuropsychological tests in ways that will improve the quantitative utility of the measures employed while preserving their qualitative nuances. This approach required establishing pass/fail criteria for individual items and combining items into scales so as to permit an objective psychometric evaluation of a patient’s performance. The scoring system and objective interpretation were not meant to replace qualitative evaluation. The quantitative scoring system is intended to be combined with a careful analysis of the qualitative characteristics of performance observed across items. To use only the psychometric data or the qualitative approach alone would be an incomplete use of the battery. Conclusions generated from such incomplete analyses are unnecessarily limited. The quantitative characteristics of the battery, and other issues which have appeared in the literature, are discussed in a recent review by Golden (in press). As Akhutina and Tsvetkova (1983) correctly point out, errors on specific test items can result from a variety of brain deficits which in many cases will not be immediately apparent from a profile analysis alone. However, consideration of the elevations of the Luria-Nebraska Battery Clinical Scales and the patterns of item failures are but two steps in the process of test interpretation. For this reason, Golden, Ariel, McKay, Wilkening, Wolf, and MacInnes (1982) indicated five steps involved in interpreting the Luria-Nebraska Battery. They suggested evaluation of (1) the 14 clinical scales, (2) the 8 localization scales, (3) the 30 factor analytic scales, (4) the item patterns across the scales, and (5) the qualitative aspects of performance. These steps are not ordered by importance, but are sequenced for efficiency. It is specifically Steps 4 and 5 which address Akhutina and Tsvetkova’s concerns. ITEM ANALYSIS
The idea of examining patterns of performance between items is related to Luria’s technique of comparing several tasks which have one or more common bases as a means of isolating and deducing the patient’s specific functional loss(es). For example, if a patient fails the items where he is asked to show his teeth, stick out his tongue, and then place his tongue between his lower teeth and lower lip, a motor or kinesthetic deficit might be initially hypothesized. If a patient is unable to accurately reproduce an aurally presented rhythmic series, a rhythm reception or production deficit might be suspected. Similarly, failure to repeat or write aurally presented groups of phonemes or words might suggest a receptive speech deficit. However, if items from all three areas are missing we would
LURIA-NEBRASKA
BATTERY
345
instead consider the possibility of memory deficits (among others) and examine those items specifically assessing immediate memory with interference. It should be recognized that Luria’s original tasks and those included in the Luria-Nebraska Battery were designed and selected to elicit behaviors which permit a logical analysis, consistent with Luria’s theories, leading to identification of the defective links within the functional system(s) of the brain. The task of performing this analysis is done by thoroughly examining the groups of test errors while keeping in mind exactly which intact functions are necessary for the successful completion of the behavioral task. Test items on the Luria-Nebraska were sequenced in a manner intended to facilitate such an analysis. For example, items l-4 primarily require intact simple motor speed. Items 5-8 are kinesthetically based motor tasks. Items 9-18 involve spatially organized, visually presented motor skills, etc. However, as Akhutina and Tsvetkova imply, it is important for the skilled test evaluator to be thoroughly familiar with the “primary factors” upon which deficient performance may be conditioned. It is this understanding of brain functioning, as exemplified by Luria’s theories, together with an adequate sample of test performances, which permits syndrome analysis. The effect (on behavior) of presenting these tasks within a standard format versus a more flexible approach has not been explored. However, general advantages and disadvantages of standard batteries versus flexible assessmentapproaches have been briefly discussed by Golden (1982). In a recent book, Golden and his colleagues (Golden, Hammeke, Purisch, Berg, Moses, Newlin, Wilkening, & Puente, 1982)have also discussed strategies of item analysis for the Luria-Nebraska and described certain patterns of test errors and their associated organic deficits. While evaluating item patterns can be viewed as one type of “qualitative” evaluation, it does not constitute a full qualitative analysis of a patient’s performance. More correctly, this clinical, deductive procedure is viewed as part of a “syndrome analysis” (Golden et al., 1982a). As Akhutina and Tsvetkova appear to suggest, the development of additional, separate scales which regroup items according to special functional similarities (e.g., combining items which require spatially based or kinesthetically organized movements, object naming, etc.), might be valuable toward further objectifying the item analysis. However, preliminary studies discussed by Moses, Golden, Ariel, and Gustavson (1983) indicate that there are relatively few cross-scale factors. For the original Clinical Scales, item intercorrelation studies by Golden et al. (1982b) support the impression that test items are grouped with those items to which they are most related. We have investigated and are continuing to examine the empirical bases for proposing new scales which supplement the 14 original scales
346
KNIPPA,
GOLDEN,
AND
FRANZEN
of the Luria-Nebraska Battery. For example, eight Localization Scales were developed by (a) identifying those items which were most missed by small groups of patients having localized brain lesions and (b) excluding items from the scales that were missed across groups (McKay & Golden, 1979). A cross-validation study later showed that single Localization Scale elevations accurately identified the damaged lobe in 74% of cases and the hemisphere in 92% of the patients (Golden, Moses, Fishburne, Engum, Lewis, Wisniewski, Conley, Berg, & Graber, 1981). Thirty Factor Scales were developed in a series of factor analytic studies described by Moses et al. (1983). In general, these studies involved examining the factor structure of the individual Clinical Scales and identifying those groups of items which both loaded together and discriminated between normal and brain injured groups (McKay & Golden, 1981). Recently, Sawicki and Golden (1984) also identified two new acrosstest scales, the Impairment Scale and Elevation Scale, by determining those groups of items most correlated to the number of scales above the age- and education-corrected critical level and to the mean T-score (i.e., of the basic Clinical Scales), respectively. The above described scales address some of the concerns discussed by Akhutina and Tsvetkova. Development of additional scales should similarly focus on the investigation and identification of psychometric characteristics of item groups and empirical relationships of item patterns to external, diagnostic criteria or measurement methods. Each new scale must significantly add to, or have substantial replacement value for, the 54 scales which are currently available. QUALITATIVE ANALYSIS The fifth interpretive step listed above is exactly that qualitative method which Akhutina and Tsvetkova describe as essential to the interpretation of Luria’s tests, namely consideration of the characteristics of performance as a means of isolating specific neuropsychological deficits so as to more accurately describe and predict behavior. Here one relies on the observation skills of the examiner and the integrative skills of the interpreter. It is important to know whether the subject missed the “draw a circle” item because of the poor quality of the drawing or if the subject drew a good circle but (a) took too long to initiate or complete the task, (b) continued on to draw more circles, or perhaps (c) ignored one side of the page when drawing. It is important to recognize that qualitative analysis of the characteristics of performance is done with reference to Luria’s theories of brain functioning; as such, this interpretive process is independent of the sequence of test tasks (i.e., standard format versus flexible approach). As noted by Moses et al. (1983), “the many levels on which the test can be interpreted depend on the needs as well as the skill and knowledge
LURIA-NEBRASKA
BATTERY
347
of the examiner.” Currently, a thorough qualitative analysis which includes both item analysis (Step 4 above) as well as attention to the special characteristics of performance (Step 5) can only be conducted by those who have had sufficient training and experience in the field to recognize qualitative errors or elements of performance. At the Neuropsychology Laboratory of the University of Nebraska Medical Center, we have begun to describe and examine across-test qualitative performance errors so as to provide a standard qualitative scoring system for which the empirical correlates of those qualitative aspects of performance can be established. For example, perseveration, attentional dysfunction, paraphasia, impersistence, naming difficulty, sequence errors, aprosody, etc., might be observed on a wide variety of items between scales. We fully agree with Akhutina and Tsvetkova that any use of Luria’s methods and the LuriaNebraska Battery which does not consider such observable, qualitative elements of behavior would ignore a primary element of Luria’s contributions to neuropsychology . This aspect of neuropsychological assessment has been discussed by Golden, Purisch, and Hammeke (1984) and briefly by Moses et al. (1983). CONCLUSION
We agree with Akhutina and Tsvetkova that any interpretation of the Luria-Nebraska Battery which omits consideration of qualitative performance can limit the predictive power and applicability of the test. We view the objective analysis of the Luria-Nebraska profile patterns as a significant addition to, not a replacement for, Luria’s original methods. As Akhutina and Tsvetkova note, the summary scores alone have been shown to be sufficient to discriminate the site of injury at a rate comparable to or better than other standardized tests. However, such an analysis (i.e., an empirical-actuarial approach) constitutes only the initial steps in interpretation. A naive or simplistic evaluation of the scale elevations alone is, at best, useful only in establishing baseline data or in making gross discriminations or hypotheses regarding diagnosis (e.g., normal versus impaired, lateralization of impairment, etc.). Yet, for the experienced and expert interpreter, this process provides hypotheses on which to base the more extensive evaluation of the patient’s performance. Furthermore, comparing the quantitative information with the qualitative findings provides the expert evaluator with the opportunity to check the data for consistency and convergent lines of deduction. Using this more comprehensive mode of analysis, the applicability of the Luria-Nebraska Battery can be extended to allow finer discriminations in diagnosis and localization, prognosis, and the design of rehabilitation programs. It is expected that general use of the additional scales of the battery (i.e., the localization, factor, and qualitative, as well as new scales generated
KNIPPA, GOLDEN, AND FRANZEN
348
in the future) will further improve the empirical grounds for making such finer discriminations. REFERENCES Akhutina, T. V., & Tsvetkova, L. S. 1983. Comments on a standardized version of Luria’s tests. Brain and Cognition, 2, 129-134. Golden, C. J. (1982). Diagnosis and rehabilitation in clinical neuropsychology. Springfield, Ill.: Charles C Thomas. 2nd ed. Golden, C. J. The Luria-Nebraska Neuropsychological Battery: The literature. Los Angeles: Western Psychological Services, in press. Golden, C. J., Ariel, R. N., McKay, S. E., Wilkening, G. N., Wolfe, B. A., & MacInnes, W. D. 1982. The Luria-Nebraska Neuropsychological Battery: Theoretical orientation and comment. Journal of Consulting and Clinical Psychology, 50, 291-300. (a) Golden, C. J., Hammeke, T. A., Purisch, A. D., Berg; R. A., Moses, J. A., Jr., Newlin, D., Wilkening, G. N., & Puente, A. E. 1982.Item interpretation of the Luria-Nebraska Neuropsychological Battery. Lincoln: Univ. of Nebraska Press. (b) Golden, C. J., Moses, J. A., Jr., Fishbume, F. J., Engum, E., Lewis, G., Wisniewski, A., Conley, F. K., Berg, R. A., & Graber, B. 1979. Cross-validation of the LuriaNebraska Neuropsychological Battery for presence, lateralization, and localization of brain damage. Journal of Consulting and Clinical Psychology, 49, 491-507. Golden, C. J., Purisch, A. D., & Hammeke, T. A. 1984. The Luria-Nebraska Neuropsychological Battery: Manual. Los Angeles: Western Psychological Services. McKay, S. E., & Golden, C. J. 1979. Empirical derivation of experimental scales for localizing brain lesions using the Luria-Nebraska Neuropsychological Battery. Clinical Neuropsychology,
1, 19-23.
McKay, S. E., & Golden, C. J. 1981. The assessment of specific neuropsychological skills using scales derived from factor analysis of the Luria-Nebraska Neuropsychological Journal of Neuroscience, 14, 189-204. Battery. International Moses, Jr., J. A., Golden, C. J., Ariel, R., & Gustavson, J. L. 1983. Interpretation of the Luria-Nebraska Neuropsychological Battery. New York: Grune & Stratton. Vol. 1. Sawicki, R. F., & Golden, C. J. 1984. The development of the profile elevation scale and the impairment scale: Two new summary scales for the Luria-Nebraska Battery. International Journal of Neuroscience, 23, 81-90.