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Name: W. M.
Digit Span
Bells Test
Verbal Fluency
Dysexecutive Questionnaire
Mr.Willie Moss was referred for neurological assessment by his sister based on concerns
she had about abnormal behavior in his daily performance. She was told by him that he was
experiencing tremors and difficulty with writing reports for his clients as a therapist.
Dr. Willie Moss is a 47 year old man. He holds a bachelor's degree in psychology at The
as well as a doctorate degree in counseling. He has been a therapist now for about fifteen years
and has about five to eight clients in rotation at this practice presently. As a middle class citizen,
he also has a wife with two children of high school age, one boy and one girl.
Earlier in life, Dr. Moss had complications with seizure activity. He had to have
assessments at a local hospital and was given medication for them. After a couple years, they
became less frequent and he believed that they were taken care of. Other than having the seizures
and asthma, there were no other conditions or major surgeries he made me aware of.
Dr.Moss also described some of his own concerns about being referred for neurological
testing. In relation to daily activity, in the past month, he found that writing and making notes
about his clients had become more strenuous and difficult to manage. He also had issues with da
day-to-day tasks like brushing his teeth, brushing his hair, and simply getting out of bed in the
morning. Moss believes that these symptoms of him getting older rather than any other
explanation because all his other functions seem to be normal. Some of the other stressors in life
include thinking about his children’s futures financially and student loans.
During the interview he gave information about his family history regarding his
immediate family. He indicated that he, himself has asthma in addition to his mother and brother.
He does not have many issues with this condition in comparison to how it was as a child
attempting to play many sports but having to stop after complications with the seizures. His
mother did not want him to risk any other injuries and was very protective of him. He also told
me that his grandmother, when she passed, had Alzheimer's. Even though she did, he hasn’t
Behavioral Observations
Aside from the testing, I made some additional notes of behavior during the interview
and assessments. I noted the following observations: frequent eye blinking, tapping of the legs
and arms, and slower/delayed movements to the next task. When he came in he didn’t have any
obvious signs of impairment that I recognized except for some slight stuttering that I attributed to
being nervous at first. Throughout the assessments this action continued, but did not cause a
excessive impairment the client. I noticed that when he talked, there was some more than normal
frequent eye blinking. I was not sure if he was aware of how often he was having this happened
and after asking him, he expressed that it felt normal. Additionally, throughout the tasks, I made
note of when he started tapping or twitching his legs and arms. It appeared to be unintentionally
but noticeable by the client and myself. Lastly, was the over slower tentative pace that he
displayed coming in and going from task to task. The assessments, in general, did not appear to
be challenging but I could see that the mobility tasks were more difficult that the others in the
cognitive and focus categories. Because he felt like his age was attributed to his slower pace, I
abstraction, delayed recall and orientation. Dr. Moss had a score of 26 on this assessment. A
score below 26 would have indicated cognitive impairment. Within the subcategories, he lost
points in the visuospatial category where he had to draw an exact replica of a cube and also draw
a clock. He had difficulty with getting the lines straight for both drawings and specifically
missed two lines in cube drawing. He also lost points in the language section because he wasn’t
able to fully get out all the words he wanted in order to name as many words as he could in a
minute that started with the letter F. On the other tasks, he did well and received the full amount
of points.
This assessment is used as a measure of balance, mobility, and speed of movement. In the
assessment, he was asked to begin by standing up from the chair I set up, walk to a 3 meter mark,
turn, and walk back to the chair to sit down. In completing the task, I observed that Dr.Moss
walked at a slower pace than normal and had little or no arm swing. In the assessment, I
observed his postural stability, gait, stride length, and sway while timing the performance as
well. In this assessment, a time greater than or equal to 12 is an indication for risk of falling. Dr.
Moss did the task in 13.84 seconds. This indicates the he is at slight risk of falling because of the
slower pace resulting in a longer time. His actions made me aware of his unstable stature and
gave more insight to why had the slower pace coming into the interview.
Waterloo Handedness Questionnaire
Waterloo Handedness Questionnaire. In this assessment, Dr. Moss was asked to indicate, for
each statement, his hand preference for certain activities. The options for answers were “Ra or
La” for always using the right or left hand, “Ru or Lu” for usually using the right or left hand,
and “Eq” for indicating that he uses both hands equally. Throughout the assessment, he indicated
that he mainly uses his right hand with a scored of +21. At the end of questionnaire, it also asks
questions referring to if he ever had any injury that changes he hand preference or if he has
received training for encouragement to use a particular hand for a certain task. He answered “no”
The Western Aphasia Battery is used as a measure of language production and language
comprehension. This assessment does not have an indication of normal or impaired functioning
because we only used a sample version, but I was able to assess Dr. Moss’s language production
and comprehension. The sample we were given had three parts: spontaneous speech, auditory
verbal comprehension, and sequential commands. In the spontaneous speech, I asked him basic
questions such as “How are you today?” and “What is your name?”. Dr. Moss efficiently and
accurately answered these questions to my knowledge. He also was asked to describe a photo
that he was given with two children playing with blocks. For the picture he stated, when
describing the photo, “I see two kids playing with blocks. The two kids are a girl and a boy. Both
kids are smiling. They are sitting down too.” Lastly were sequential demands in which he had to
follow an order of tasks. For this task, I set up a bag of chips, phone, and pencil. He had to
complete tasks that stated, for example, “Point to the phone with pencil.” and “Put the pencil on
on top of the book then give it to me.” He was able to fully complete these tasks, but he went as
slower pace and had a slight shake in his hand while completing the tasks.
The Word Choice Test is a stand alone measure for suboptimal effort. In this assessment,
I had 50 cards with one word on each. Dr. Moss was instructed to state if the word presented to
him was man-made or natural. After going through all of the cards, I went through the word
choice card and said two words, in which he had a tell me which word was presented to him
before. For scoring, any score less than 47 is an indicator of possible malingering. Dr. Moss had
a score of 49 indicating that there no evidence provided for malingering. He consistently was
Digit Span
processing speed, working memory, and suboptimal effort. The assessment included two
different tasks, digit forward and digit backward. In this assessment, explained to him that I
would say a series of numbers. Then I instructed him, for digit forward, to say the numbers back
to me exactly as I said them. In the digit backward task, I said a series of numbers and instructed
him to say the numbers back to me in the opposite order. For scoring, Dr. Moss earned a score of
11 on digit forward and 6 on digit backward, when the normal function is greater than 12 on digit
forward and greater than 8 on digit backward. Because he scored 6 on digit backward, there is
Hopkins Verbal Learning Test measures verbal memory through 3 separate tasks/parts:
immediate recall, delayed recall, and recognition. In the immediate recall task, I instructed
Dr.Moss that I was going to read a list of words for him and he needed to tell me as many as he
could remember and I wrote them down. After reading the list of words to his and letting him
recall them once, I repeated this task another two times before allowing a five minute delay.
After the completion of part 1 and a five minute delay, the delayed recall task (part 2) was
initiated. I instructed him that I would read the list of words again to him I previously read. Then
I told him to repeat those words to me and I wrote them down. After completion of this task, I
began the recognition task (part 3). I instructed him to keep in the mind the list of words and
completed a checklist of words indicating “yes or no” for each word, identifying if they were on
the original list. For example, I asked “Was ruby on the list?” and just filled in the blank with
For part 1, a working memory impairment would be identified if there were issues with
immediate recall. Out of the 12 words, Dr.Moss gave 3 words the first time, 6 words the second
time and 6 the third time. For part 2, a long term verbal memory impairment would be identified
if there were issues in the delayed recall task and the client gives less than 6-8 words. Dr.Moss
gave 6 words, indicating that he is in normal range and not impaired. And lastly, out of the 24
checklist items, he was able to correctly identify 20 of them. Through his performance, I believe
that he is within the normal range and performance of a healthy individual. He also would mouth
the words and had an increase in the number of words remembered, indicating the use of his
working memory.
Rey-O Complex Figure measures visuoconstruction, long term spatial memory, and is
also an indicator of right hemisphere functioning. For the task, I place a picture of a figure
directly in front of Dr.Moss. I instructed him to copy the figure exactly as he saw it. I also gave
him a window of 10 seconds to study the figure before beginning to copy it and told him that he
would have to draw the figure again later from his memory. After a five minute delay, I then
asked him to draw the figure on a seperate sheet of paper without any assistance from from the
inconsistencies in the original copying of the drawing. Secondly, there would be an indication of
poor long term spatial memory impairment if there were errors in the second task of drawing the
figure after the 5 minute delay. In scoring this assessment, because the scoring is outside the
scope of our course, I mainly observed my client’s physical movements and actions throughout
Bells Test
The purpose of the Bells Test is to measure spatial attention and screen for hemispatial
neglect. I instructed Dr.Moss to watch me identity the bell on the demonstration sheet. For the
task, I gave him a sample of what the bell looked like and how to circle the location of it on the
sheet. In the scoring of the assessment, time to complete the task and how many bells are found
are taken into consideration and among the bells are also 264 distractors. It also asks us to take
into consideration the scanning strategy of client and the omissions. He didn’t have any
omissions, but I observed that towards the end the task, Dr. Moss began to scan the page from
left to right to find more bells and eventually finding all 35 of the bells. In addition to
This task measures spatial attention and is also screening for hemispatial neglect. For the
task, I placed the sheet in front of Dr.Moss. He was instructed to mark the center of each line
with a pencil that I provided him with. After he was done, I observed his marks. The task
explains that a normal or healthy individual will mark within a ¼ range of the true center of each
line. Overall, Dr.Moss had little to no deviation indicating that he most likely doesn’t have
rule-following. For the task, I explained to Dr.Moss that he would have tell me as many letters as
he could beginning with the letter F. He would not be able to say any word that was a proper
noun, number, or with the same root word or suffix. After completing this task, he would then
repeat the same process, but now saying as many words as he could beginning with the letter S.
During the task, I used my phone to time it and wrote down the words he said within 15 second
increments. For example, in the first task, during the 0-15 second window, he said “face, fear,
friend, and foe.” And during the 16-30 second window, he said “flower and freak.” Throughout
this task he did not break any rules, indicating that he pays attention to rules and had proper
executive function. The test indicates that a normal respondent would have at least 4 words
during the first 15 seconds and 14-18 words overall during the 60 seconds. Dr. Moss had 4 words
during the first 15 seconds in the first task but 3 in the second task. Overall, he provided 14
words in the first task and 16 in the second. The results of the study indicate that his functions
For the Trail Making Test, it is a measure of processing speed and task switching. The
assessment is given in two parts (Trail A & Trail B). In both parts, there are 25 circles. In part 1
(Trail A), the number 1-25 are in the circles and I instructed Dr.Moss to draw a line beginning at
1 to each number, in ascending order. In part 2 (Trail B), there are the number 1-13 and letters
A-L. I instructed in this task to draw a line to connect the dot from the number to the letter in
ascending order (i.e. 1-A-2-B-3-C). (Before each of the task, I also demonstrated how it should
be done.) For the task, I observed the number of errors and the time it took to complete.
Throughout the task, Dr.Moss frequently had to lift his pencil and stop because the tremors he
began to experience during the task. The assessment indicates that the average time for part 1 is
29 seconds, with greater than 78 seconds being a deficient. In part 2, the average time to
complete is 75 seconds and a deficient being more than 273 seconds. For part 1, it took Dr.Moss
1 minute and 34 seconds to complete and part 2 took him 2 minutes and 35 seconds to complete.
And in Trail B, I observed that he made 2 errors but corrected them right after.
Dysexecutive Questionnaire
impairments in daily life activities. The questionnaire does not have scoring where I can indicate
normal or actions declaring impairment. It, instead, give me more information about his original
concerns. The assessment has 20 items on a five point scale (never-very often). In the
Dysexeutive Questionnaire, he marked “fairly often” next to the statements such as “I tend to be
restless,and ‘can’t sit still’ for any length of time.”, and “I find it difficult to stop myself from
doing something even when I know that I shouldn’t.” He explained further to me that he made
these choices because his tremors cause him to feel restless in a sense and also, he isn’t able to
control motor functions making him do things he isn’t supposed to do. He didn’t find that none
explained that he would be given a group of numbers and letters, and I instructed Dr.Moss to tell
me the numbers first, in order, starting with the lowest number. Then I wanted him to give the
alphabetical order of the letters. In this assessment, Dr.Moss became frustrated and did not get
very far into the scoring. He earned a score of 10, with a score of 14 or better being within
Summary of Performance
Overall, Dr. Willie Moss had normal performance on cognitive assessments such as the
Verbal Fluency Task, Western Aphasia Battery, Letter-Number Sequencing, Hopkins Verbal
Learning Test, and Montreal Cognitive Assessment. Although he had mainly normal
performance on theses assessments, I did note the behavioral observations that make have
affected him from maybe receiving higher than normal scores on some assessments. During the
tasks, he had small, inconsistent language/speech errors such as hesitation and stuttering. For
example, in the Verbal Fluency Task, where it assesses cognitive flexibility, it indicates that
fewer than 4 words in the first 15 seconds is an indication of issues of initiation. In the first 15
seconds of his performance, he had exactly four words but had a stutter during that time that
delayed him from saying other words before the next 15 seconds. The only other concern I had
was in the Western Aphasia Battery because of his motor functions in the “sequential
commands” section. There was mobile difficulty rather than language comprehension.
The assessments, Word Choice Test, Digit Span Test, and Dysexecutive Questionnaire,
measured either attention or general executive function. Dr. Moss displayed mainly normal
performance in these assessments, scoring 47 in the Word Choice Test when normal function in
47 or higher. And on the digit span test, he scored 11 on digit forward and 6 on digit backward,
when the normal function is greater than 12 on digit forward and greater than 8 on digit
backward. Because he scored 6 on digit backward there is possible concern but not excessive. In
the Dysexeutive Questionnaire, I noted that he marked “fairly often” next to the statements such
as “I tend to be restless,and ‘can’t sit still’ for any length of time.”, and also another one referring
marked “fairly often” on these statements because when he had tremors, he wasn’t able to stop
Dr.Willie Miss had the primarily difficulty in these assessments. The assessments in this
section include the following: Time Up & Go, Rey-O Complex Figure, Waterloo Handedness
Questionnaire, Bells Test, Line Bisection Task, and Trail Making Test. The Rey-O Complex
Figure assessment indicated that he had motor difficulty copying down the figure which caused
him to provide less of the figure after the 5 minute delay. He was so focused on copying the
figure without shaking, that I believe he couldn’t remember all the figure when it came to
producing it second time. There was similar performance in the Bells Test, Line Bisection, and
Trail Making Test. There was normal performance on these task, but he took more time trying to
complete them because of tremors and stiffness in his hands at the time of the assessment. In the
Waterloo Questionnaire, scoring positive 21, he indicated that most of his activity was with his
right hand and almost never uses the left hand beside from a few tasks. Lastly, the Time Up &
Dr.Moss had impairments in these areas. During the assessment he had a little difficulty rising up
from the chair and took 13.84 second to complete the task, with more than 12 seconds being an
In the referral, my client had concerns about his tremors and difficulty writing while he
was in sessions with his clients. He also had concerns about difficulty being able to get out the
bed in the morning, in addition to other daily tasks. After testing and observation, I have
observations from the following assessments: Time Up & Go, Western Aphasia Battery, Rey-O
Considering that Dr. Moss was in mainly in normal range for cognitive and focus aspects
of the neuropsychological testing, I can connect his issues to spatial, balance, and stability but
more testing should be done over time in the cognitive area of memory and language as well. In
some assessments such as the Letter Number Sequencing and Verbal Fluency Task, he had just
the minimum requirements to be considered normal and I believe with his education as a
therapist and doctor for 15 years these numbers would be higher. It could possible that these
For the future, I recommend that he continue to monitor his actions day to day. From
observations that were made in the Time Up & Go (TUGs) assessment and Western Aphasia
Battery related to his mobility, it appears to be some progression is his loss of balance and
stability. Because of these observations, his family should also take some precautions with daily
movements and tasks. Their support is going to be crucial to his life if, after more, testing, he is
diagnosed with Parkinson’s disease. In the referral, Dr.Moss made statements that described him
having trouble doing daily tasks like getting up out the bed in the morning and cooking. I believe
that it is important to start now some more movements into his life. His job does not require a lot
of mobility, which can be increasing the problem. It may be helpful in the morning to do some
daily stretching, and overall making some additional healthy lifestyle choices like exercising
more during the week and a healthy diet. Until more testing is done, these actions should be
performed and if it’s determined that he has Parkinson’s he will need additional treatments such
Figure 1.
Figure 2.