clinical neuropsychology

Understanding the factors that impact the severity of an Acquired Brain Injury

Neurodynamics provides neuropsychological testing and rehabilitation services that take into account all factors that impact upon the severity of an acquired brain injury.

Psychological Assessment / Neuropsychological assessment

The brain is the control centre for the body. In order to understand the impact of brain injury a number of factors must be considered during the psychological assessment (neuropsychological assessment). They are:

1. The amount of brain tissue that is damaged (Size),
2. The location of the injury within the brain (Site),
3. The stage of development when the injury occurs (Developmental stage), and
4. Other factors such as pre-existing factors and the environment.

1. Size: Extent of injury to the brain tissue

The extent or type of injury can be classified as focal versus global and closed versus open.

  • • A focal injury affects only a small area of the brain and may have very specific effects. This can occur in some strokes or when a person is injured by a blow to the head.
  • • Hypoxia (lack of oxygen) or damage resulting from pressure changes within the brain, or generalised damage from movement or ‘shaking’ of the brain may affect large areas of neural tissue. Such global damage can have numerous complicated effects.
  • • Similarly, injuries can be described as open (eg when the skull is penetrated the brain is damaged from the outside) or closed (when the brain is injured through sudden jolting inside the skull).

2. Site: Location of injury in the brain

To understand the importance of the location of the injury in the brain, it is essential to know some very basic anatomy. For example, the brain is divided into two halves, called hemispheres. The left half of the brain controls the right side of the body and the right half the left side of the body. Therefore if a stroke occurs on the right side of the brain, physical problems may occur in the left arm or leg, and vice versa.

3. Developmental Stage

Interruption of the developmental process
It is often incorrectly assumed that children recover more readily from brain injury than adults. This is based on the fact that children’s brains are considered to have more plasticity (e.g., one part of the brain may assume responsibility for the functions of the damaged area). This can have the effects of the brain averaging out the loss of function rather than resulting in specific deficits. However, each situation is very unique and it is important not to overgeneralise these comments. Importantly, the brain is not thought to be mature until a person reaches their mid-twenties, and some areas, such as the frontal lobe, reach maturity later than others.

Later age Injuries
Injuries sustained later in life can also have devastating effects. Indeed, while a person has had the opportunities to develop skills and form relationships, there are often significant psychological issues associated with loss and grief by the person. This is not to say that children don’t grieve for their losses, but rather to acknowledge the different process where one grieves what they may never attain versus grieving for the loss of a function. In addition to this, the adult brain is considered to be less plastic, and thus adults demonstrate more specific areas of difficulties. In many cases, a lot of functioning is otherwise functionally intact, being only minimally affected.

4. Other factors

There are individual differences in the skill level of the person prior to the brain injury that affect recovery. For example, someone with limited neuronal reserve prior to an injury (e.g., a person with an intellectual disability) is less able to sustain a further loss of function without very significant effects. The personality of the person can also influence recovery. Other environmental factors also have a major impact on outcome, including the involvement of family and friends as well as the quality of medical care and rehabilitation services.

If you are having a neuropsychological assessment, it is important to understand what the testing involves. Further, referrers should consider where a neuropsychological assessment is useful or indicated. Please contact us if you require further information or wish to discuss a matter.


Dr Nathaniel Popp
Clinical Neuropsychologist
BA., MA., DPsych., MAPS., CCN Member
TAC Provider number: 160 603 50
WorkCover Provider number: PS5676B

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Psychological Assessment