Halstead-Reitan battery
From Psy3241
Definition
Fixed set of eight tests used to evaluate brain and nervous system functioning in individuals aged 15 years and older
Children's versions are the Halstead Neuropsychological Test Battery for Older Children (ages 9-14) and the Reitan Indiana Neuropsychological Test Battery (ages 5-8)
Purpose
Evaluates a wide range of nervous system and brain functions including visual input, auditory input, tactual input, verbal communication, spatial perception, sequential perception, the ability to analyze information, form mental concepts, make judgements, motor output, attention, concentration, and memory
Used to evaluate individuals with suspected brain damage
Provides useful information regarding the cause of damage, which part of the brain was damaged, whether the damage occurred during childhood development , and if the damage is getting worse, staying the same, or getting better
The information gathered about the severity of impairment and areas of personal strengths can be used to develop plans for patient rehabilitation and care
Precautions
Requires administration by a professional examiner and interpretation by a trained psychologist
Test results are affected by the examinee's age, education level, intellectual ability, gender, and ethnicity, all of which need to be taken into account when analyzing the results
Fixed battery of tests, which means that unnecessary information may be gathered and some important information may be missed
Requires 5-6 hours to complete, patience, stamina, and cost
Criticized because it does not include specific tests of memory; instead, memory is evaluated within the context of other tests
Description
The Halstead-Reitan battery was created by Ward Halstead and Ralph Reitan
The creation of the test was based on studies of patients with neurologic impairments at the University of Chicago
Halstead recognized the need for an evaluation of brain functioning that was more extensive than intelligence testing
Initially Halstead chose a set of 10 tests, all of which, except 3, are included in the current Halstead-Reitan battery
Ralph Reitan was one of Halstead's students who contributed to the battery by researching the tests' ability to identify neurological problems
Reitan diagnosed 8,000 patients using only their test results, without meeting the patients or knowing anything about their background, which provided support for the effectiveness of the battery
Reitan adapted the original battery by including additional tests
The Halstead-Reitan has been researched more than any other neuropsychological test battery
Research supports the ability of the battery to detect impairment accurately in a large range of neuropsychological functions
8 core tests
Category Test
Total of 208 pictures consisting of geometric figures are presented Individuals are asked to decide whether they are reminded of the number 1, 2, 3, or 4 for each picture and press a key corresponding to their choice
If the individual chooses correctly a chime sounds and if they choose incorrectly a buzzer sounds
The pictures are presented in 7 subtests
The key to the category test is that one principle or common characteristic underlies each subtest
The numbers 1-4 represent the possible principles
If the subject recognizes the correct principle in one picture they will respond correctly for the remaining pictures in that subtest
The next subtest may have the same or different underlying principle and the subject must once again try to determine the principle using the feedback of the chime and buzzer
The last subtest contains two underlying principles
Test takes 1 hour, but individuals with severe brain damage may take up to 2 hours
Considered to be the battery's most effect test for detecting brain damage
Does not help determine where the problem is occurring in the brain
Evaluates the ability to draw specific conclusions from general information
Also aids in detecting one's ability to solve complex and unique problems and one's ability to learn from experience
The children's versions consist of 80 items and 5 subtests for young children and 168 and 6 subtests for older children
Scoring involves recording the number of errors
Scores above 41 are considered indicative of brain impairment for ages 15-45
Scores above 46 indicate impairment for ages 46 and older Recommended cutoffs vary depending on age and education level
Tactual Performance Test
Board containing 10 cut-out shapes and ten wooden blocks matching those shapes are placed in front of a blindfolded individual
Instructed to use only their dominant hand to place the blocks in their appropriate space on the board
Same procedure repeated using the non-dominant hand only
Same procedure repeated using both hands
Board, blocks, and then blindfold are removed
The individual is then asked to draw the board and the shapes in their proper locations from memory only
Takes 15-50 minutes to complete
Time limit of 15 minutes per trial
Evaluates sensory ability, memory for shapes and spatial location, motor functions, and the brain's ability to transfer information between its two hemispheres
Detection of brain damage
Helps to determine which side of the brain damage may have occurred
For children under 15, only 6 shapes are used
Scoring involves the time to complete each of the 3 blindfolded trials and the total time for all trials combined, the number of shapes recalled, and the number of shapes drawn in their correct locations
Trial for the non-dominant hand should be 20 to 30 percent faster than the trial for the dominant hand because of practice effects
If the non-dominant hand is slower or more than 30 percent faster, brain damage is possible
Injuries of the arms, shoulders, or hands can also affect performance
Scores are adjusted depending on education level and age
Trail Making Test
Consists of 2 parts
Part A: 25 numbered circles randomly arranged and individuals are instructed to draw lines between the circles in increasing sequential order until they reach the circle labeled "end"
Part B: A page with circles containing the letters A through L and 13 numbered circles intermixed and randomly arranged and individuals are instructed to connect the circles by drawing lines alternating between numbers and letters in sequential order, until they reach the circle labeled "end"
If mistakes are made, they are quickly brought to the individuals attention and they continue from the last correct circle
Test takes 5-10 minutes to complete
Evaluates information processing speed, visual scanning ability, integration of visual and motor functions, letter and number recognition and sequencing, and the ability to maintain two different trains of though
A Color Trails Test is used for children and individuals of different cultures in which colors are used instead of numbers and letters
Scoring is the time to complete each part
Errors increase the total time
For adults, scores above 40 seconds for Part A and 91 seconds for Part B indicate brain impairment
However it is important to consider other variables such as age when scoring
Finger Tapping Test
Subjects place their dominant hand palm down, fingers extended, with the index finger resting on a lever that is attached to a counting device
They are then instructed to tap their index finger as quickly as possible for 10 seconds while keeping the hand and arm stationary
The trial is repeated 5-10 times until the examiner collects counts for 5 consecutive trials that are within 5 taps of each other
A practice session is given before the test
A brief rest is given between each trial and a 1-2 minute rest is given every third trial
The procedure is repeated with the non-dominant hand
Takes approximately 10 minutes to complete the test
The children’s version uses an electronic tapper instead of a manual one
The test measures motor speed and helps to determine particular areas of the brain that may be damaged
To score the examiner calculates an average number of taps per trial for each of the 5 accepted trials
The dominant hand should be 10% better than the non-dominant hand, which doesn’t always occur in left-handed individuals
Males and younger individuals perform better than females and older people
Education level, intelligence, fatigue, depression, and injuries to the shoulders, arms, or hands should also be considered when scoring
Must be interpreted in combination with other tests in the battery
Rhythm Test
30 pairs of tape-recorded, non-verbal sounds are presented
For each pair, a subject must decide if the 2 sounds are the same or different
The pairs of sounds are grouped into 3 subtests
Evaluates auditory attention and concentration
Also evaluates the ability to discriminate between non-verbal sounds
Helps detect brain damage, but not the location of the damage
A subject must have adequate hearing abilities to complete this test
Scoring is based on the number of correct item
The higher the score the less brain damage a subject has
Scores must be interpreted with the scores from other tests
The children’s version of this battery does not include this test
Speech Sounds Perception Test
60 tape-recorded nonsense syllables containing the sound “ee” are presented
After each syllable the subjects must underline the spelling that represents the syllable they heard from a list of 4 written syllables
The test evaluates auditory attention and concentration
The test also tests the subject’s ability to discriminate between verbal sounds
The results of the test provides information about the specific areas of brain damage a subject may have
The test can also indicate attention deficits or hearing loss
Scoring and interpretation are similar to the Rhythm Test
The Children’s version contains fewer syllable choices
Reitan-Indiana Aphasia Screening Test
Subjects are present with a variety of questions and tasks that are considered easy for someone without aphasia (the loss of ability to understand or use written or spoken language due to brain damage or deterioration)
The test includes verbally naming pictures, writing the name of a picture without saying the name aloud, reading printed material of increasing length, repeating words stated by the examiner, simple arithmetic problems, drawing shapes without lifting the pencil, and placing one hand to an area on the opposite side of the body
The test evaluates language-related difficulties, right/left confusion, and non-verbal tasks
This is a screening test aimed to detect possible signs of aphasia that may require further evaluation
As a result, a standardized scoring is not used
Reitan-Klove Sensory-Perceptual Examination
Detects if an individual is unable to perceive stimulation on one side of the body when both sides are stimulated simultaneously
Includes tactile, auditory, and visual components
Involves the subjects ability to specify whether touch, sound, or visible movement is occurring on the right, left, or both sides of the body
Also investigates a subjects ability to recall numbers assigned to particular fingers
Examines the subjects capacity to identify numbers written on their fingertips while their eyes are closed
Furthermore, the test looks at the subject’s ability to identify the shape of a wooden block placed in one hand by pointing to its shape on a board with the opposite hand
Ancillary Test
Tests that may be chosen to be included by an examiner based on the difficulties an individual is experiencing
Common tests include the Grip Strength Test, the Reitan-Klove Lateral Dominance Examination, the California Verbal Learning Test, the Grooved Pegboard Test, the Wechsler Memory Scale, the Bushke Selective Reminding Test, the Rey Complex Figure Test, the Wide Range Achievement Test, The Wechsler Adult Intelligence Scaleor Wechsler Intelligence Scales for Children, the Rey Auditory Verbal Memory Test, the Test of Memory and Learning, and the Minnesota Multiphasic Personality Inventory
Results
When interpreting the results of the battery, an examiner must look at the overall performance on the battery, performance on individual tests, and indications of lateralization and localization
After analyzing the results, a psychologist can diagnose the type of condition present, predict whether the patient will stay the same, get better, or get worse, and make recommendations regarding treatment, care, or rehabilitation
Validity
The battery has been shown to discriminate normal controls from patients with brain damage with considerable accuracy (84-98%)
The battery has been shown to differentiate between organic neurological from normal populations, organic neurological from functional psychiatric populations, focal from diffuse neurological disease, regional focal cerebral dysfunction by major zones, and the etiological conditions associated with individual differences in outcome pattern
