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I hope, as is already becoming clear, the Neurologist sits at the head of a group of Neuro-scientists who provide vital information. Neuro-radiologists are more skilled at reporting complex neuro-radiology compared to General Radiologists and in medico-legal matters, a General Radiologist should not be giving opinion. I do not actually think that General Radiologists should be giving opinion about neuro-radiology matters in clinical practice.
Another Consultant individual on whom we as Neurologists depend greatly is the Consultant Neuro-psychologist. Consultant Neuro-psychologists are not medically qualified. They all start life as Clinical Psychologists and then take up the speciality of neuro-psychology.
Neuro-psychologists by virtue of some rather clever testing are able to determine the pre-morbid state of an individual by virtue of assessing their reading ability which does not tend to get damaged very easily in brain injury. They can then compare that pre-morbid estimate to patterns of under-functioning across a whole range of domains of cognitive testing. They are also able to determine whether an individual is under-performing on the basis of their psychological and emotional state rather than brain injury.
Neuro-psychologists from a clinical perspective have a major role in helping people come to terms with their cognitive deficits and getting them to lead more full lives.
In simple terms, there is general cognition, there is memory and there is executive functioning. There is also the ability to be aware of objects in space, that is spatial awareness, and also language function. I am sure a Neuro-psychologist would want to give a much greater explanation of their role. I think however it must be stated that although Neuro-psychologists come out with a string of numbers that seem remarkably precise, it must be emphasised that there is nothing quite as precise as is suggested in their testing and there can be a whole range of difficulties that emerge with testing particularly within the legal process. Different Neuro-psychologists have found different styles of testing and this can lead to misunderstanding. Frontal executive functioning is also difficult to measure on formal testing and this can once again lead to considerable difficulty with simple explanation of ongoing symptoms.
I personally believe that all neuro-psychology testing within the legal process should have so-called validation of symptoms and validation of performance testing carried out. Such tests as the TOMM (test of memory malingering) should always be undertaken. If the individual fails this test, it is definitely not saying they must be malingering, that is only one so-called differential diagnosis. They may just be having a bad day, not co-operating or psychologically challenged and again a competent Neuro-psychologist should raise all of these issues.
It is also known that tests of frontal executive functioning are rather fragile. How an individual performs in real life as opposed to under test circumstances also varies greatly. My advice to Solicitors acting for Claimants is to get as much clarity from the assessing Neurologist and Neuro-psychologist about the way in which testing can under-estimate difficulty in real life. With regard to Solicitors acting for Defendants, it is always worth asking fundamental questions about the reliability of the testing particularly if validity of test performance has not been carried out. Personally I would only instruct a Neuro-psychologist who confirmed that they would undertake validity of test performance.