Luria-Nebraska Battery - Interpretation

I. General Comments

- Battery created by Charles Golden based on Lurian theory and, somewhat, methodology, all measures are pathognomic signs indicators;

- Upper limit items and all items normal subjects couldn’t do were dropped, so the battery is not very good for premorbidly high-functioning people with mild injuries;

- Items chosen on the basis of discriminating normal controls from people with severebrain damage;

- Three indices were created to take into account age and education:

(a) Critical Level (CL)(p. 5 of the scoring booklet) = 68.8 + Age Value - Educ. Value

(b) Predicted Baseline (PB)= Critical Level - 10 (one standard deviation)

(c) Actual Baseline (AB)= average of the T-scores on clinical scales (C1-C11)

the T-scores of the scales are compared to the Critical Level (i.e. expected premorbid performance);

- During administration one can repeat instructions and problems for all scales but C2, C5, and C10;

- C7-C9 are very dependent on education, so they should not be included while inferring the presence of brain damage unless there is a suspicion of learning disability;

- If localization data contradicts clinical scales - disregard it.

II. Presence of Brain Damage

1) If you are using CL calculated from demographic data:

- Clinical Scales Comparisons:

(a) if C1, C2, C3, C4, C5, C6, C10, or C11 > CL there’s >90% probability of brain damage or psychosis

(b) if any 3 Clinical Scales (C1-C11) > CL there’s >95% probability of brain damage, esp. If there is a learning disability;

- Single Indicators of Brain Damage:

(a) if any of C1-S1 > 80T - very high probability of brain damage

(b) if any of C1-S1 > 70T - strong suspicion of brain damage

(c) C11 and S1 are especially sensitive to brain damage

- Range or Scatter of Clinical Scales (C1-C11) Indicators:

(a) if Range >30 - high probability of brain damage

(b) if Range >20 - strong suspicion of brain damage

2) If there is a premorbid IQ score, calculate CL from it and use that for comparisons, CL (for WAIS) = 164.8 - 1.09 x FSIQ + .2 x Age, CL (for WAIS-R) = 164.8 - 1.09 x (FSIQ + 8) + .2 x Age

(a) if premorbid IQ >120 use CL-10 for Clinical Scales comparisons and 70T for single indicators comparisons

(b) if premorbid IQ 81-119 use CL for Clinical Scales comparisons and 80T for single indicators comparisons

(c) if premorbid IQ <80 use CL+10 for Clinical Scales comparisons and 90T for single indicators comparisons

- One can also compare WAIS IQ with Luria-Nebraska IQ, where

LN VIQ = 158.9 - .47(C11) - .38(C8) - .20(C9),

LN PIQ = 156.9 - .35(C11) - .48(C4) - .26 (C10),

and LN FSIQ = 150.2 - .92(C11):

(a) WAIS IQ or WAIS-R IQ + 8 = LN IQ - low probability of brain damage

(b) WAIS IQ or WAIS-R IQ + 8 > LN IQ - high probability of brain damage

(c) WAIS IQ or WAIS-R IQ + 8 < LN IQ - low probability of brain damage, cultural or educational issues lowered WAIS IQ

3) If there is no demographic data, one can calculate the AB and compare Clinical Scale scores to it. As before, the results are more certain if only C1, C2, C3, C4, C5, C6, C10, and C11 are used:

- 1 Clinical Scale >10T > AB - equivocal results, there might be a subtle injury, a disease like Multiple Sclerosis, or nothing;

- 2 Clinical Scales >10T > AB - 70% probability of brain damage;

- 3 Clinical Scales >10T > AB - 90% probability of brain damage.

III. Lateralization of the Lesion

1) Clinical Scales:

- C2 & C4 are right hemisphere indicators, C5 & C6 - left hemisphere indicators, if there is more than 10T difference between them - lateralized lesion is likely.

2) Lateralization Scales. S2 contains sensory and motor items from the right side (left hemisphere) and S3 - from the left side (right hemisphere), since left hemisphere is dominant for motor functions, S3 is also elevated by left hemisphere damage. Consequently, use the following rules:

- S2>CL - left hemisphere definitely involved;

- S3>CL, S2<CL & <60T - likely to be right hemisphere only;

- S2&S3>CL:

(a) if S2 is 10T>S3 - probably only left hemisphere

(b) if S2 is 9-1T>S3 - probably both hemispheres

(c) if S2=S3 - probably diffuse bilateral damage

3) Localization Scales - if two highest scales are from the same hemisphere (first 4 vs. last 4), lateralization hypothesis is appropriate.

IV. Localization of the Lesion

1) Clinical Scales (relative to each other):

- C1 - anterior (frontal);

- C2 - posterior (temporal, mostly right);

- C3 - posterior (parietal, tactile);

- C4 - posterior (visual, mostly right);

- C5 - posterior (receptive speech, mostly left);

- C6 - anterior (expressive speech, mostly left);

- if >4 scales are >CL than thirtiary areas are more likely to be affected by brain damage.

2) Localization Scales:

- if one scale is 10T> all others it’s a hit, unless all scales are elevated;

- if two or more highest scores are in the ajacent areas - it’s also a hit.

V. Course of the Lesion & Prognosis

1) S1 is most sensitive to the process, if S1>CL or >10T above AB the injury is likely to be acute, progressive, or severe (if its 20T>CL - very acute, severe, or rapidly progressing):

- at 6 months past injury, if S1>CL - poor prognosis, if S1<CL - good prognosis;

- if S1 if near AB - they are compensating, good prognosis;

- if S1>CL, but the lowest score - they have recovered as much as they could, don’t expect drastic improvements;

- if S1<CL - stabilized, will not recover further;

- if S1<CL, but is the highest score - posiible subtle brain injury or a slowly progressing condition, like MS.

2) S4&S5:

- if S4>CL & S5<CL - good prognosis;

- if S4>S5>CL - good prognosis;

- if S4<CL & S5>Cl - bad prognosis.

VI. Emotional Issues Differentiation

1) S4 - Profile Elevation - is sensitive to brain impairment in uncompensated state (depressed, anxious, psychotic, no cog. rehab.)

2) S5 - Impairment Scale - is supposed to be a pure indicator of brain damage, without emotional overlay.

VII. Schizophrenia vs. “Organic” Brain Damage

1) Schizophrenics with no other brain damage are reliably elevated on C2, C5, C10, &C11; so, one can subtract 7 points from these scales in order to evaluate brain damage additional to schizophrenia.

2) A strategy for diagnosing presence of additional brain damage in schizophrenics (normative sample <45 years, 9-15 years of education):

- >4 Clinical Scales >70T => brain damage;

- give 1 point for each elevation > 70T on C2, C5, C10, &C11; give 2 points for each elevation >60 for remaining clinical scales; if the sum is >4 => brain damage;

- S1>65 => brain damage.

VIII. Individual Scales & Items