THE DISCIPLINE OF

NEUROPSYCHOLOGY
Chapter 1
What is neuropsychology?
■ Focuses on relationship between brain functioning and behaviour
■ The 'bridge' between neurology and psychology
■ Makes use of assessment and intervention strategies
■ Underpinned by knowledge of functional anatomy and how multiple factors affect emotional,
cognitive, and behavioural functions
■ Attempts to explain how brain activity is expressed in observable behaviour
■ Central theme is that understanding the human brain is how we will understand human behaviour
■ 3 main branches:
– Clinical neuropsychology
– Behavioural neurology
– Experimental neuropsychology
■ https://www.youtube.com/watch?v=lqoFBvmRMSw
Historical Background
■ Trephination
– Ancient practice where pieces of the skull are scraped, chiseled, or cut out
– Purpose has typically been recorded as religious, magical, or as a primitive
medical procedure
– Started around 400 BC; lasted +/- 7000 years
– Had some success in cases assumed to have increased ICP aro TBI
■ Modern day equivalent would be drilling Burr holes or performing a
craniotomy for epidural/subdural hematoma
■ Ancient Greece
– Earliest records where brain function was associated with behaviour
– Hippocrates (460-355 BC) was the first person to record trepanning
– Galen's "De Medicina" one of the earliest records of precise instruction on
methodology for trepanning
■ Middle Ages
– Persian physician Albucasis (936 – 1013 CE) was a pioneer of neurosurgery
■ Introduced concepts such as the cross shaped skin incision, keeping the
dura mater intact and removing fragments of broken bone
– Other notable physicians include Rhazes, Avicenna, and Avenzoar
– Discoveries by Persian physicians informed research in the Renaissance and
form the basis of modern approaches to neurosurgery, neurology, and
neuropsychology
■ Renaissance Period
– Signified an increasingly accurate and descriptive
description of the human brain and its functions
– By the mid-1800's the basis of modern-day neuropsychology
was formed based on the following factors:
■ Attributing the cortex as the source of intelligence
■ Accurate descriptions of the anatomy of sensory and
motor pathways
■ Psychological processes analyzed and grouped
according to a set of faculties
■ Observation that damage to certain brain areas led to
the loss of language (Broca and Wernicke)
■ Phrenology
– Gall & Spurzheim (1796 – 1840)
– Practice where psychological attributes were determined by
the observation and/or feeling of the skull.
– Although ultimately dismissed, this practice refined the idea
that psychological processes could be broken down into
observable components which could be linked to specific
brain areas.
■ Localizationist theory (1860)
– Attempts to map the brain-behaviour relationship by studying corticol lesions associated
with psychological deficits
– Paul Broca (1861) very NB to this theory
■ Discovered the link between lesions on the inferior posterior frontal cortex of left hemisphere and
speech production
– Carl Wernicke (1874)
■ Demonstrated the link between lesions on the superior middle and posterior regions of temporal lobe
and understanding of speech
■ Equipotential theory (1824)
– Argues that precise brain mapping cannot occur because lesions to different areas can still
produce the same deficit
■ Jean Pierre Flournes (1820's) argued sensory input is localised, but perception involves the whole
brain – therefore, effects of brain lesions depend more on their severity than their precise location
– Karl Lashley (1950's)
■ Argued that neuroplasticity means when any section of the brain is removed, another portion will adopt
that function – granted it may require some time and training
■ Also introduced the principle of mass action – where the cerebral cortex acts as a whole in multiple
types of learning
■ These ideas have since been disproven
■ Interactionist theory (1934)
– Derived from the work of Hughlings Jackson
– Posits that higher-level behaviour may not be localised, but the more basic component skills are
■ Supported by the knowledge that no form of learning is completely dependent on one area of the
cortex, and that different parts of the brain play different roles in different functions to different extents
– Typically linked with regional equipotentiality
■ Argues equipotentiality but within relatively well-defined regions
■ This is the theory that is most widely accepted by modern neuropsychologists
Branches of Neuropsychology
■ Clinical neuropsychology
– Clinical setting
– Primarily focused on diagnostics
– Mainly focused on patients with lesions
■ NB: In this module lesions = any brain damage – effects of cancer/tumors; physical damage
or trauma; stroke; biochemical changes aro substance use
– Measures deficits in intelligence, sensory-motor function, and personality
■ Relates these to affected brain areas
– These measures are employed both to understand the brain-behaviour relationship
(scientific), and to aid diagnosis and rehabilitation of brain-injured patients (practical)
– Three distinct historically influential traditions
1. North American
■ Most systematic approach
■ Tests used are likely selected because they measure some element of psychological abilities
■ Test batteries only emerged in America
– Halstead-Reitan Neuropsychological test battery
■ Successful; but time consuming
 1. Russian
■ Individual, single case study approach
■ Focused on cerebral organization theories expressed in functional systems that can be referred to
particular brain regions
■ Informal, unstandardized testing
■ Relies heavily on the clinical skill and insight of the investigator
2. British
■ Falls in the middle of Russian and American approaches
■ Tends towards standardized testing but selection of tests is more pragmatic
■ Research procedures have evolved into relatively standardized test batteries
■ The selection of tests is based on the individual case rather than an all-encompassing battery being
used
■ Experimental neuropsychology
– Research/academic setting
– Primarily focused on research
– Mainly focused on patients with intact brains
– Measures speed and accuracy of patients undertaking performance tasks
■ Tested using stimulus presentation
– Also focused on the invention of lab techniques to study higher brain function
– Logic of stimulus presentation
■ Divided visual presentations
■ Dichotic listening
■ Lateralized tactile presentation
– Split-brain patient studies
■ Contralateral mapping for vision, hearing, and touch (sensory input)
■ Contralateral mapping for motor control
– Following the lateralized stimulus introduction, the different asymmetries established indicated cerebral
hemisphere specialisation
– Although there are methodological issues and a lack of clarity around the cognitive and
neuropsychological models used, there is enough consistency in the data for conclusions about cerebral
organization to be drawn.
 – Other performance asymmetries
■ Lateral eye movements
– During problem-solving, averted gaze direction has been linked to the mental process, and in turn the operation of the lateralised
brain system
– More extensive research has been done on handedness
■ Left and right handers have different brain organization
■ Left handers are less inclined to lateralization; Some have a laterally reversed pattern of organisation
– Specialised techniques
■ Wada test
■ Regional Cerebral Blood Flow
■ EEG

■ Cognitive neuropsychology
– Academic/research setting
– Focused on research between lesions/disorders and behaviour (ie brain-behaviour relationship)
– Distinct sub-branch
– Productive interchange of information between neuropsychology and cognitive neuropsychology
■ One of the most highly developed models is for single word reading
■ Cognitive neuropsychological models developed to assess reading disorders in terms of specific component processes, or their
connections
– Two forms
■ Hard form
– Model stands independently of anatomy
– Analysis purely psychological
– Descriptions put in terms of psychological terms
 ■ Soft form
– Acknowledges references to anatomical structure and neural organization are broadly correct
– Anatomy serves as a useful guide to the structure of the cognitive neuropsychological model
– These models have made significant contributions to research and theoretical development but have very
little impact on clinical practice
■ Behavioural neurology
– Clinical setting
– Primarily focused on the conceptual rather than operational deficits of behaviour
– Typically involves less formal testing than clinical neuropsychology
Comparative Neuropsychology
■ Studies cognition and behaviour between humans and animals
■ Relative importance has dramatically decreased in recent years
■ An advantage of animal studies is that precise lesions can be introduced, and behavioural change be
correlated with them
– NB for cortical function studies
■ Disadvantages occur when studying high-level functioning
– Perceptual functioning uncovered in the animal may not translate into humans
■ An NB issue facing this field is the integration of cortical and sub-cortical function studies
■ This field is providing valubale information in the sub-cortical processes involved in high-level
behaviour (eg intelligence)
■ Sexual behaviour can also be studied in animals and then compared to human behaviour in context.
Conceptual Issues
■ Descriptions of brain organization are, at best, relatively distant inferences from behaviour that is
observed
– Exceptions are electrophysiological studies, and cerebral blood flow and metabolism studies
■ The "mind-body problem" oversimplifies the complexity of the relationship neuropsychologists attempt
to study
– Are the mind and body fundamentally different things?
■ Emergent psychoneural monism suggests all mental states are states of the brain
– Brain is a biosystem

The Fringe
■ Hemisphere lateralization has been the starting point for many concepts and theories
in education, culture and society
■ These often go beyond what the current scientific evidence suggests
– Should they be implemented without the necessary evidence, they can be extremely
detrimental in both the short and long term.
Suggested Reading
Ghannaee Arani, M., Fakharian, E., & Sarbandi, F. (2012). Ancient legacy of cranial surgery. Archives of trauma research, 1(2), 72–
74. DOI: https://doi.org/10.5812/atr.6556

Kleiner, J.S. (2011). Equipotentiality. In: Kreutzer, J.S., DeLuca, J., Caplan, B. (eds) Encyclopedia of Clinical Neuropsychology.
Springer, New York, NY. DOI: https://doi.org/10.1007/978-0-387-79948-3_729

Finger S. (2010). Chapter 10: The birth of localization theory. Handbook of Clinical Neurology. 95, 117-128. DOI: 10.1016/S0072-
9752(08)02110-6
Badre, D., Frank, M. J., Moore, C. J. (2015). Interactionist neuroscience. Neuron. 88(5), 855-860.
DOI: https://doi.org/10.1016/j.neuron.2015.10.021
Hokkanen, L., Barbosa, F., Ponchel, A., Constantinou, M., Kosmidis, M. H., Varako, N., Kasten, E., Mondini, S., Lettner, S., Baker, G.,
Persson, B. A., & Hessen, E. (2020). Clinical Neuropsychology as a Specialist Profession in European Health Care: Developing a Benchmark
for Training Standards and Competencies Using the Europsy Model? Frontiers in Psychology, 11.
DOI: https://doi.org/10.3389/fpsyg.2020.559134
Oscar-Berman M. (1989). Links between clinical and experimental neuropsychology. Journal of clinical and experimental
neuropsychology, 11(4), 571–588. DOI: https://doi.org/10.1080/01688638908400915