Neuropsychological Formulation by Jamie A.B. Macniven

Author:Jamie A.B. Macniven
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

For this gentleman, it seems he understood both his native language and English well, but preferred his native language with other speakers. His opportunity to use or learn an extensive English vocabulary was probably limited. The majority of his family and community spoke their native language. Thus it would have been ideal to examine him in his native language. It should be expected that he would have a limited English vocabulary and limited English verbal reasoning skills prior to his SAH.

The second issue to consider is the level of his formal education. Learning a second language coupled with trying to complete a standard education in English was most likely difficult for this man. Thus, his reading level prior to his SAH was most likely functional and fluent enough to accomplish general activities, such as reading the paper, doing his banking, and filling out applications. It would be expected that his formal English reading skills would be no higher than the typical 8th grade level prior to his SAH.

The third issue is closely tied to the first two. Given the remoteness of his reservation, the access to many services including adequate healthcare was most likely limited. Grocery stores and clinics are often spread far apart, usually resulting in 1–3-h drives. In addition, the land is often rural, with a heavy emphasis on a ranching, off-the-grid lifestyle. Independence and self-reliance are key characteristics to living in this kind of area and are key aspects to this man’s sense of self-worth and purpose in life. If his family has livestock, it would be important for him to contribute to the care of the animals as well as general upkeep of the ranch or home. Riding horses would be an essential skill to contribute to a ranch. On horseback, a rider can get to places a vehicle cannot. In addition, he may have learned to ride at an early age; in some areas this was the only mode of transportation. Understanding these cultural influences is important to the examination and interview with this gentleman. They also have to be considered when giving him feedback regarding his neuropsychological functioning and the implications for his returning back to his old lifestyle.

Clinical Presentations at Different Time Periods Following the SAH

This patient was examined, from a neuropsychological perspective, on five different occasions over a 2-year period of time. The first examination was relatively brief, given the acuteness of his clinical condition. That examination occurred approximately 1 month after his SAH and surgical repair of his aneurysm. While cooperative, he was easily confused and demonstrated severe memory impairments. He was also easily fatigued and in a hypo-aroused state.

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