The aim of medico-legal neuropsychology assessment is manyfold.  Usually cases involve a history of head injury, and the first question is whether a head injury actually occurred.  This may seem obvious, but in many cases it is questionable.  Alternately the severity of the head injury is unclear.  As such the neuropsychologist makes all attempts to read the original medical file/s, ambulance reports, and brain scan reports, rather than relying on the client’s report or second hand information in other reports. 

Then the neuropsychologist needs to establish whether there have been any changes in the client’s behaviour, personality, or cognitive state as a result of the injury.  Also, has there been a psychological change since the injury, and how does that affect the client?  Cognitive deficits can often arise as an effect of depression or post traumatic stress disorder.  Are there any medication or drug use issues?  How does pain from their other injuries affect them?  The neuropsychologist needs to explore the client’s history to see if there is any other explanation for any changes reported.  Our role is to also critically review other assessments by any previous professionals, including previous neuropsychology reports but also other medical reports, and to evaluate how they inform the current presentation of our client. 

As our reports are used in a legal setting, the neuropsychologist must be very thorough and clear in marrying the information in other reports and the hospital medical file with the presentation and test results of their client, and the arguments and reasoning behind this must be clearly stated.  This information is then collated into an opinion about the effect of any injury, whether or not they have stabilised, and what their prognosis may be, along with any other specific questions asked by the referrer, any recommendations regarding work capacity, leisure activities, study, parenting, etc, and any recommendations for further assessment and/or treatment.

The ultimate aim of a neuropsychology report is to be able to clearly and logically explain the findings, rather than asserting an opinion without evidence.  When reading a neuropsychology report you should be led to the same conclusion as the neuropsychologist as you read through the report.  When making enduring and important opinions about a client it must be clear how that opinion was derived.  This aim also reduces the likelihood that the client will have to undergo further assessment (and associated cost) because there is disagreement or dismissal of the opinion based on lack of evidence or faulty/absent logic.    

Neuropsychologists in Victoria are not permitted to make impairment assessments in accordance with the American Medical Association’s (AMA) Guide for Evaluation of Permanent Impairment (4th Edition), but we are familiar with the relevant guidelines and can describe a client’s impairment in a way that can be assimilated into the reports of those medical specialists who can, such a neurologists and psychiatrists, etc.