Masquerades of Brain Injury. Part II: Response Bias in Medicolegal Examinees and Examiners.

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Martelli, M.F., Zasler, N.D., Hart, R.P., Nicholson, K., and Heilbronner, R.L. (2001).

The Journal of Controversial Medical Claims, 8, 3, 13-23.

Neuropsychological and neuromedical assessments frequently provide the primary evidence of neurologic impairment following mild and moderate brain injury. The validity of these assessments, however, depends on the cooperation and motivation of the client. Unfortunately, litigation and adversarial insurance situations introduce a situation in which financial and other incentives often influence performance, and not just the behavior of examinees. This paper reviews neuropsychological and neuromedical procedures for assessing response bias during acquired brain injury (ABI) evaluations. In order to minimize limitations of these instruments and their use, a multiaxial model for conceptualizing and assessing motivation and response bias which incorporates a wide array of findings involving integration of interview, history, behavioral observation, and commonly employed instruments and procedures that are derived from neuropsychology, physiatric medicine, psychology, psychiatry, and neurology, is suggested. Recommendations for enhancing motivation, assessing response bias, and increasing efficiency, utility, and ecological validity of ABI assessments are offered.

http://www.angelfire.com/va/MFMartelliPhD/Masq_RB2.pdf

Heilbronner, R.L., Martelli, M.F., Nicholson, K. & Zasler, N.D. (2002)

. Masquerades of Brain Injury. Part IV:

Functional Disorders.

The Journal of Controversial Medical Claims, 9, 3, 1-7.

Patients presenting with significant functional disabilities after seemingly mild injuries represent complex assessment challenges for physiatrists, neuropsychologists, and other rehabilitation professionals. At a minimum, clinicians must have an understanding of the pathophysiology and neurobehavioral sequelae associated with MTBI. They must also have a familiarity with other more 'traditional' psychiatric disorders to assist in differential diagnosis, as well as admixtures. Data from neuropsychological testing, in combination with other objective and subjective psychological data (e.g., a thorough history, clinical interview, review of school records, reports of collaterals, etc.) and information from other medical disciplines, promises the greatest method for differentiating between premorbid factors and post morbid residua secondary to an accident/injury. Many cases of mild head trauma are not simple or clear-cut, but consideration of some of the other functional disorders mentioned in this paper may lead to a greater understanding of some of the complexities involved in differential diagnosis and provide a better foundation for rendering opinions about the causes, needed treatment, and eventual prognosis of symptoms following an accident that purportedly involves MTBI.