It is axiomatic that neuropsychologists are called on regularly to evaluate individuals who have been injured at work. Independent of whether a particular practice pattern does or does not usually involve compensation claim cases, work-related injuries are often serious, complex, and disruptive to a person's life in multifaceted ways. This means that neuropsychological exams are often needed even when injuries do not specifically entail questions of brain dysfunction. A myriad of reactive problems, such as sleep disturbance, chronic pain, situational stress, medication effects, job insecurity, financial strain, and preoccupation with matters of liability and blame, commonly follow work accidents. Of course, many individuals injured on the job are also “caught” in various kinds of compensation claim proceedings, which can easily distort and influence clinical presentations. All of this means that a neuropsychologist conducting an evaluation in the context of a work accident is virtually “never” being asked to merely quantify and describe the behavioral, cognitive, and emotional impact of a physical, neurological, and/or psychiatric injury. The task is, in practice, considerably more daunting and inevitably involves layers of complexity that go well beyond the definition of direct injury effects.
The book Neuropsychological Assessment of Work-Related Injuries, edited by Shane S. Bush and Grant L. Iverson, is an excellent guide that can help novices and experienced practitioners alike “light out” the often confusing and confounding territory of work-related conditions. With nearly uniform success, the chapters of this volume deliver on the promise to provide an evidence-based framework for the neuropsychological assessment of work-related injuries. Some chapters provide such detailed and comprehensive reviews of matters of universal clinical interest that the book actually transcends its work-related focus.
Parts I and II take up specific injury subtypes, which are frequently encountered among injured workers. Iverson and Lange's chapter on traumatic brain injury is one of the very best multidimensional overviews of this topic I have run across in the recent literature. Chapters on electrical injuries (Fink, Rog, Bush, & Pliskin), neurotoxic exposure (McCaffrey & Miele), depression (Ferguson, Iverson, Langenecker, & Young), and chronic pain (McCracken & Thompson) are thoroughly referenced, broad in scope, and contain a great deal of useful information. Rosen and Grunert's succinct and extremely clear review of posttraumatic stress disorder in the workplace, which compellingly dispels a number of common myths concerning the effects of trauma, is particularly outstanding. The chapter on mild traumatic brain injury in athletes by Lovell, while informative, is less comprehensive and detailed than the other reviews in this section; this is a little disappointing because this is such a hot topic in neuropsychology, medicine, and the popular press.
Part III addresses professional practice issues. Practitioners who are relatively new to the world of work injury assessment will benefit most from this section. With the exception of the chapter on evidence-based assessment, experienced practitioners will probably not find much new in these chapters. Lamberty gives wise counsel in his overview of the neuropsychological assessment process, particularly when distinguishing between clinical and forensic referrals. Chapters on independent neuropsychological exams and forensic practice by Bush and Heilbronner and Heilbronner and Henry, respectively, contain practical information that can help novice practitioners navigate the challenging logistics of “extra-clinical” referrals. Heilbronner and Henry wrongly claim, however, that the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Fake Bad Scale (FBS; Lees-Haley, English, & Glenn, 1991) was renamed the Symptom Validity Scale (SVS) in the MMPI-2-Restructured Form. Actually, the FBS was renamed the SVS in 2007 when the scale was added to the MMPI-2 standard validity scales by the test publisher, nearly 2 years before the RF was released (Ben-Porath, Greve, Bianchini, & Kaufmann, 2009).
The chapter on evidence-based assessment methods by Iverson, Brooks, and Holdnack is superbly instructive, emphasizing the importance of considering the base rates of low cognitive test scores. These authors explain the implications of their own important research, as well as research conducted by several others, particularly as it relates to the critically important topic of normal variation. In addition to providing a number of highly informative tables that can and should be put to immediate use for improving diagnostic accuracy, the authors of this chapter, here and elsewhere, teach an interpretive approach that truly advances evidence-based practice.
Lovejoy and Oakes do a fine job of delineating the role of the behavioral health provider in the disability determination process. They sharpen a number of definitional issues that are often baffling to practitioners who lack experience conducting these types of exams. The chapter on making neuropsychology relevant to the vocational rehabilitation process (Fraser, Strand, Johnson, & Johnson) is mainly aspirational in nature. The thrust is to outline means by which neuropsychological evaluations can be optimized for purposes of vocational consideration. The ideas put forth in this chapter mainly amount to advice to exercise common sense.
Overall, it is easy to recommend Neuropsychological Assessment of Work-Related Injuries. While doing a good job of clarifying many of the unique and difficult demands inherent in the evaluation of work-related conditions, the book includes several excellent and up-to-date reviews on topics of wide clinical interest. This fact alone makes it one of those volumes that are a delight to pull off the shelf when struggling with the best way to conceptualize a challenging case, especially those that require a neuropsychologist to be more than a skillful and well-informed diagnostician.