Wednesday, 21 December 2011

the cerebellum and cognition

In the spirit of the season, I'd like to share an article on a condition I had never heard of before this morning - Schmahmann's Cerebellar Cognitive Affective Syndrome. This article is freely available online (gotta love the internet!):

If you're looking for a brief review of how the cerebellum affects cognition, this article from 2004 looks like a gentle introduction.

If you want a more intensive and recent text to study, then Koizol and Budding's Subcortical Structures and Cognition: Implications for Neuropsychological Assessment is worth considering. It has very good and thoughtful reviews on Amazon, though a couple of reviews from people with neuroscience backgrounds suggests that neuropsychologists may be a few decades out of date with our cortico-centric view of neuropsychological function. Another good reason for the neuropsychologist to brush up on contemporary neuroscience:)
Subcortical Structures and Cognition: Implications for Neuropsychological Assessment

You don't need to buy it from Amazon, of course. ( ) will give you a list of online retailers selling just about any book you fancy, and gives you a link to their site (in Oz at least - DK if there's an equivalent elsewhere)

Anyway, thanks to Alex Troster for mentioning Schmahmann's CCAS. The syndrome seems to describe a patient I've seen recently, and while it doesn't clarify the diagnosis, as many diseases can affect the cerebellum, it does help make sense of the odd neuropsychological profile. And inspires me to expand the horizons of my neuroknowledge rather than indulging in fiction in the holidays (lucky I finished the final book of the Inheritance cycle a few weeks ago).

Wishing everyone a peaceful and happy festive season, whether you're in Australia, north America, Singapore, Lithuania, Russia, New Zealand, or anywhere else on this beautiful and amazing planet of ours.


Sunday, 18 December 2011

supervision and supervisees

I'm looking forward to lots of reading in the next couple of weeks!

One book I'm particularly keen to read isn't specifically neuropsychological, but its theme is central to one of the reasons why I love being a neuropsychologist - the ability to contribute to the training and development of other neuropsychologists. The book is:

Carroll, M, & Gilbert, MC (2011). On being a supervisee: Creating learning partnerships (2nd ed.) Kew: PsychOz Publications

The reason this book appeals to me is because it is intended to help the supervisee get the most out of supervision. It should also help supervisors to do a better job by looking at things from the supervisee's point of view.

I must confess I haven't read it in depth yet, but skimming through the chapters, it looks like it's going to be one of those useful books that I'll refer to repeatedly, and share with others (starting now). It has lots of useful Appendices at the end (eg sample 2-way supervision contracts, evaluation forms, checklists, learning styles, and other forms that I want to start using straight away!). It also has a nice declaration of supervisee rights and responsibilities at the start, which you can see in the download available here:

Finally, they quote this wonderful poem which seems very apt at this time of year. You can find more about the poem and the author if you look it up in your search engine of choice.

The Student's Prayer (Umberto Maturana)

Don't impose on me what you know,
I want to explore the unknown
and be the source of my own discoveries.
Let the known be my liberation, not my slavery.

The world of your truth can be my limitation,
your wisdom my negation.
Don't instruct me: let's walk together.
Let my richness begin where yours ends.

Show me that I can stand
on your shoulders.
Reveal yourself so that I can be
something different.

You believe that every human being
can love and create.
I understand, then, your fear
when I ask you to live according to your wisdom.

You will not know who I am
by listening to yourself.
Don't instruct me; let me be.
Your failure is that I be identical to you.

PS the book is available in Australia through PsychOz publications

Thursday, 15 December 2011

functional MRI and reading

At last, a concise article that uses fMRI research and clear explanations to demonstrate that phonological awareness, sounding out words, and repetition are necessary to help children acquire reading (and presumably spelling) skills.

It all makes good developmental and neuropsychological sense. Whole word recognition can't activate strong neural pathways unless the pathways have already been developed. This article argues that trying to teach through word recognition stops development of good multimodal phoneme and word recognition skills

I'm looking forward to sharing this with my children's school. I hope I'll find some other evidence to show that learning multiplication tables by absorption is not an effective route either.

I understand that teaching things over and over again can be boring for teachers, and for students as well, but repetition is a good way of consolidating learning in many modalities. And it can be fun if combined with music and raps. My eldest son's first school used the THRASS (teaching handwriting, reading and spelling skills) program that was developed by a speech pathologist in Western Australia. We're going to start playing the THRASS board game again in the summer holidays. THRASS breaks down English into 40+ vowel and consonant sounds, provides a child-friendly chart that shows the spelling choices for the various sounds, and helps spellers to learn the different sounds produced by varying graph, di-graph, trigraph, and split di-graph combinations. Parents of struggling readers in older grades said the system finally helped their kids to know how to spell. I'm hoping it will help consolidate my 9-year-old's spelling, and get my 7yo on a more solid footing for grade 1 next year.

Thanks to Darren Stops for sharing this link, and for inspiring me to get THRASSing with my boys over the summer break.

Wednesday, 7 December 2011

Don't worry, be happy - keys to Buddha's brain

This is a good read before Christmas, to remind us of simple steps to happiness, and to inform on the evidence behind them. Many thanks to Elissa Morris in Queensland for sharing this link with me.

The article reminds me of Buddha's Brain. The practical neuroscience of happiness, love and wisdom , by Rick Hanson and Richard Mendius. It's a great book that combines neuroscience with contemplative practice, and give a scientific background to the current surge of interest in mindfulness in psychology. It's not a highly technical book, which is great, because everyone deserves to be able to understand the material within it. I like the way it presents neuroscientific information in a simple, straightforward manner, and gives practical hints on how to make our brains better at being happy. I'd recommend it as a pleasant read for neuropsychologists, as it also provides an update on areas of neuroscience that we don't always attend to in our quest to assess and diagnose dysfunction and to remediate cognitive and behavioural weaknesses. It's also an interesting volume for anyone interested in science-informed self-help.

I hope you'll forgive me for a moment of Proustian reminising - I remember first hearing "Don't worry, be happy" in Bali at the end of 1989, when I was just about to embark on postgrad studies in neuropsychology. The song was being played everywhere in Kuta, and wa a blast of happiness after several weeks of beaches, rainforests, and freedom in Bali and Lombok. We'd been away from radios and television for 6 weeks, and had been astonished to come back to a world where the Berlin wall had fallen and the Romanian leader had been overthrown. There were so many images of chaos and revolution on the satellite television screens, and everywhere in the background was "don't worry, be happy." We brought in the New Year wondering what the world would be like in 1999, and if global warming would have been halted by then. It's wonderful how the a song, a sound, or a smell can bring memories flooding back as if they'd only happened yesterday. And it's wonderful that we can change the way we feel through a few simple steps, practiced daily - explained simply in Hanson and Mendius's book.

Thanks for reading

CTE in ice hockey

A sadly riveting story about chronic traumatic encephalopathy (CTE) in an ice hockey player.

Teenage brains

Nicely written article on teenage brain development in National Geographic.

Sunday, 4 December 2011

Neuropsychological Assessment: A Valuable Tool in the Diagnosis and Management of Neurological, Neurodevelopmental, Medical, and Psychiatric Disorders

Michelle Braun and colleagues have also published an article which should be helpful around the world for those wanting to advocate the benefits of neuropsychological assessment. It's certainly going to be useful for our cause in Australia, where neuropsychological work is not covered by Medicare, even though it is covered under the Department of Veterans Affairs, Workcover, and a number of motor vehicle accident insurance boards. Thanks again, Michelle et al, you've done great work!

reference details
Neuropsychological Assessment: A Valuable Tool in the Diagnosis and Management of Neurological, Neurodevelopmental, Medical, and Psychiatric Disorders
Braun, Michelle; Tupper, David; Kaufmann, Paul; McCrea, Michael; Postal, Karen; Westerveld, Michael; Wills, Karen; Deer, Teresa

Cognitive & Behavioral Neurology. 24(3):107-114, September 2011.

For both children and adults with neurological, neurodevelopmental, medical, or psychiatric disorders, neuropsychological assessment can be a valuable tool in determining diagnosis, prognosis, and functional abilities as well as informing clinical management. This review summarizes the contributions of neuropsychological assessment to clinical care across diagnostic categories, with the goal of helping clinicians determine its utility for individual patients.

The following quote from their section on non-CNS medical conditions shows how neuropsychologists can improve patient care outside of the traditional realms of neurology, rehabilitation, and psychiatry:

"Because cognitive dysfunction from a variety of
medical conditions is increasingly an issue in the elderly,
but is still poorly recognized, especially in primary care,
neuropsychological evaluation is critical to management.
124–128 There is a strong scientific basis for the use
of neuropsychological assessment to detect cognitive
impairment and guide treatment planning in many
noncentral nervous system conditions, including acute
respiratory distress syndrome, cancer, chronic kidney
disease, chronic obstructive pulmonary disease, cardiac
disorders, hypertension, obesity (for bariatric surgical
candidates), obstructive sleep apnea, and type II diabetes.
129 ... Neuropsychological
assessment sensitively detects the presence,
nature, and severity of brain dysfunction in these
conditions, and helps guide clinical management (eg, the
introduction of new medications or procedures such as
chronic transfusion in patients with sickle cell disease).
Neuropsychological assessment results also guide recommendations
for and implementation of rehabilitation
strategies such as speech therapy or training in activities
of daily living when functional disabilities interfere with
independent living or work productivity.137,140" (p.110)

I'd strongly recommend obtaining a copy of this article for your core reading list.

My next post will be the first in a series of classic papers in neuropsychology. This will be an entirely subjective series, based on writings that have had an ongoing impact on the way I aspire to practice clinical neuropsychology.

I'm interested to hear about other people's favourite references - email me at if you'd like to contribute.