Put simply, a neuropsychologist is an expert on brain-behavior relationships. If a person experiences injury to brain tissue, there can be an impact on cognitive, behavioral, and personality functioning, depending on the severity of the brain injury, the part(s) of the brain impacted, and a host of other factors. The neuropsychologist is an expert on detecting these changes, if present. This can occur within the context of a personal injury cases, where an evaluation is conducted that is known as an independent medical evaluation (IME).
The neuropsychological evaluation of the individual being examined in a personal injury case includes both direct examination of the person involved (i.e., diagnostic interview, testing, and observation), as well as indirect examination through records review. The neuropsychologist integrates this information to formulate an opinion. The neuropsychologist can potentially comment on feigned and medically unexplained symptoms, if present, using the above methodology. The neuropsychologist is also alert to additional diagnostic considerations that may influence the case. The neuropsychologist conducts testing to try to obtain a measure of cognitive abilities, and is widely considered by other medical specialties to be the expert on test selection, administration, scoring, and interpretation of these tests. Tests should not be interpreted in a vacuum and thus the other sources of information listed above are relied upon. Neuropsychologists will comment on diagnosis, prognosis, and treatment needs. They are experts in predicting how independent an individual can be in terms of completion of activities of daily living, over the near term and long term.
Ultimately, the neuropsychologist will attempt to, based on his or her evaluation results:
1) Conclude, with reasonable neuropsychological certainty, that the event(s) alleged to have resulted in brain injury is/are a proximal cause of any impairment (on testing, or functionally)
2) Conclude that the alleged event is not, to a reasonable degree of neuropsychological certainty, the proximal cause of any impairment (on testing, or functional impairment) noted
3) That the event may have contributed to neuropsychological impairments but that it is not possible to determine this with reasonable certainty.
The role of neuropsychologist in the courtroom as an expert witness is a relatively recent development, with increasing popularity of this expert given the scientific base on which neuropsychologists rely. Particularly in cases that are not straightforward, as can be the case with concussion or mild traumatic brain injury, employment of a neuropsychologist would be critical. Neuropsychologists can integrate the “biopsychosocial” model into their assessment so that a more complete understanding of the factors at play is achieved.