Psychological Assessment
1992, Vol.4, No. 3, 272-277
Neuropsychological Test Feedback to Patients With Brain Dysfunction
Carlton S. Gass
Veterans Affairs Medical Center
Miami, Florida
The provision of neuropsychological test feedback is of central importance in helping patients and
their families cope with the consequences of brain injury. A general framework for presenting
feedback is described, with an emphasis on techniques designed to maximize patient benefit.
Special issues involving test-related limitations, patient characteristics, and family involvement in
the feedback process are discussed.
In recent years the emphasis in neuropsychological assess-
ment has extended beyond the traditional goals of assisting in
diagnosis and describing cognitive functioning. Neuropsycho-
logical test findings are now commonly used for formulating
prescriptive statements that help guide the brain-injured indi-
vidual through a course of treatment and rehabilitation. The
role of the neuropsychologist has been widely redefined to en-
compass more active involvement with both the patient and
treatment team of health professionals. In most settings, test-
ing is only one aspect of the neuropsychologist's work; test re-
sults must be translated into patient care, which means that
they must be communicated to the patient, family members,
and those individuals involved in helping the patient. This arti-
cle focuses on neuropsychological test feedback—its impor-
tance and role in various clinical settings. A methodology for
presenting feedback is proposed, and special issues involved in
presenting assessment data to patients with brain dysfunction
are addressed.
A review of the literature suggests limited consideration of
the present topic. The most thorough discussions of neuroreha-
bilitation examine the relationship between assessment and
treatment, but they rarely address the middle and pivotal point
in this process: feedback to the patient regarding test findings
and their relation to treatment planning and further recommen-
dations. It is also noteworthy that patients who have been tested
commonly remark that they were never informed of their re-
sults. This is a curious phenomenon, as the provision of feed-
back can be an important intervention in its own right. Feed-
back may be considered optional on the grounds that it serves
solely as a guide for individuals who work with the patient. Such
a narrow view of feedback neglects a number of considerations,
not the least of which involves the uncertainty and distress
experienced by many patients and their families as they strug-
gle to cope with the sudden onset of challenges and limitations
that accompany brain injury (Lezak, 1978).
We thank Teresa Rosario for her constructive comments on an ear-
lier draft of this article.
Correspondence concerning this article should be addressed to
Carlton S. Gass, Psychology Service (116B), \feterans Affairs Medical
Center, 1201 NW 16th Street, Miami, Florida 33125.
272
In the public domain
M. C. Brown
Department of Neurology
University of Miami School of Medicine
The Importance of Feedback
Feedback of test results is important from an ethical stand-
point because the neuropsychologist is obligated to recognize
professional responsibility to the patient. Clinically, feedback
serves as a vehicle for providing patients with objective guid-
ance in decision making. It can also assist in rehabilitation and
treatment planning and provide informational support for fami-
lies who struggle with issues of management and adaptation.
Responsibility to the Patient
As a consumer who has purchased a service, the patient has a
right to be informed in plain language of test findings and their
practical implications. At a minimum, patients may expect that
their investment of several hours of effort warrants some tangi-
ble and useful information in return. Regardless of whether the
findings are welcome from the patient's vantage point, there is
a professional responsibility to communicate them to the pa-
tient or, if necessary, to those responsible for the patient's wel-
fare.
Guidance for Decision Making
A host of issues commonly confronts the brain-injured indi-
vidual and his or her family. Many of these issues are directly
addressed in the neuropsychological evaluation. However, un-
less the results of the evaluation are communicated to the pa-
tient, their value is questionable. Often decisions must be made
that relate to matters of competency and independence, such as
handling finances, resuming a job, driving a car, managing a
medication regime, living alone, or pursuing a new living situa-
tion. Decisions concerning rehabilitation and post-hospitaliza-
tion care also require a reliable description of a patient's resid-
ual abilities and functional status.
For two reasons, face-to-face feedback plays an integral role
in guiding a patient in the process of decision making. First, it
allows the clinician to listen and respond to specific concerns
the patient may have about test findings and recommenda-
tions. Without this interactive dimension, such issues are un-
likely to emerge and may be overlooked in a clinical report.
Second, when properly managed, the feedback process adds
 NEUROPSYCHOLOGICAL TEST FEEDBACK
authoritative weight to recommendations derived from the as-
sessment. Even though the rationale for testing is clearly pre-
sented before the examination, once testing is completed, many
patients raise questions about the procedures and the signifi-
cance of the test findings for everyday functioning. Feedback
offers an opportunity to address such concerns.
Assistance in Rehabilitation and Treatment Planning
Feedback in a neurorehabilitation setting provides the pa-
tient and treatment team with an objective baseline of neurobe-
havioral functioning, a logical basis for designing specific thera-
peutic interventions, and one means of assessing the efficacy of
these interventions. Feedback also has a number of therapeutic
ingredients: It provides a rationale for treatment, a means of
monitoring rehabilitative progress, and a tangible incentive for
self-help behavior and compliance with therapy assignments.
Patients generally appreciate test feedback and usually view
areas of deficit as a challenge to improve their performances
through therapeutic effort.
In a typical rehabilitative setting, assessment and treatment
are part of an ongoing complementary process throughout a
patient's recovery. Feedback associated with periodic evalua-
tion not only serves to inform the patient of his or her current
functional status, it also provides information regarding the
progress achieved through rehabilitative effort. As it is shared
with the patient, the measurement of progress provides an ave-
nue for encouragement and can be a powerful reinforcer of
continued effort. Other areas of progress, such as positive cop-
ing with permanent deficits or learning a particular skill, can
occur in the absence of any improvement in neuropsychologi-
cal test scores and may also be included in feedback.
Provision of Family Support
The family of an individual who has sustained brain injury is
commonly thrown into a state of crisis and radical readjust-
ment. Substantial distress may stem from uncertainty regard-
ing the patient's functional status, prognosis, and bewilderment
over the emergence of undesirable or inappropriate behavior
(Rosenthal & Geckler, 1986). Moreover, as newly designated
caretakers, family members may be overwhelmed with a sense
of helplessness because they lack the requisite knowledge for
addressing the special needs of the patient. In this context,
feedback serves a supportive function, educating the patient
and family about the specific cognitive and behavioral effects of
brain injury. Such information has several advantages. First, it
can counteract the tendency of families to minimize or exagger-
ate the extent of a patient's impairment. Despite their good
intentions, families in denial commonly set up the patient for
failure as they struggle to maintain an illusion of the status quo
and overestimate competencies. Families must understand the
patient's limitations if they are to assist the patient in making
the necessary adaptations to prevent the onset of new prob-
lems. In other cases, overprotective families may benefit from
objective data that caution them against underestimating the
patient's abilities and fostering unnecessary, unhealthy, and
counterproductive dependency.
Feedback offers the second advantage of explaining problem-
273
atic behavior that is often a source of confusion, embarrass-
ment, and distress to families or caretakers. For example, the
lack of initiative and inability to sustain goal-oriented behavior
that often occur as a result of frontal brain injury are sometimes
mistaken for depression, laziness, or stubborn noncompliance.
Similarly, sudden disinhibited outbursts of crying, which often
occur in the complete absence of subjective sadness or dys-
phoria, are a major source of family distress and are misinter-
preted as symptoms of severe depression. In both examples,
feedback regarding neurobehavioral changes provides support
to families by fostering a proper understanding of these symp-
toms and more effective ways of responding.
Feedback and the Type of Setting
The manner in which test results and recommendations are
provided can depend on the setting in which the neuropsycho-
logical evaluation occurs.
Self-Referral
The patient who is self-referred for neuropsychological test-
ing is generally the least problematic from the standpoint of
feedback. Such individuals are seeking information and are
usually quite responsive to feedback. Furthermore, there are
fewer concerns regarding disclosure of information than exist
in other settings (see below). If the individual is self-referred for
evaluation, it is incumbent on the neuropsychologist to second-
arily refer these individuals to other specialists when certain
conditions apply, such as in the event of an unclear diagnosis or
when there may be a need for medical treatment.
Mental Health and Medical Consultation
In all consultation settings, there should be communication
with the referral source before the evaluation to determine the
optimal manner for presenting feedback. Those who refer their
patients for neuropsychological testing rarely express interest
in giving the test feedback themselves, though its content, tim-
ing, and manner of presentation are often crucial. However
informative a neuropsychological assessment may be, the phy-
sician who refers a patient can coordinate the feedback from a
comprehensive medical perspective and is therefore best
equipped to discuss difficult diagnostic issues.
Rehabilitation/Interdisciplinary
Feedback in the rehabilitative context is unique in several
respects. First, it connects test findings directly to specific
treatment modalities that are available in the rehabilitation fa-
cility. Feedback clarifies for the patient the cognitive areas for
which specific remedial or compensatory techniques are avail-
able. Second, the neuropsychological test feedback is partially
shaped by and provided in conjunction with the contributions
of other therapeutic specialties. That is, the test results and
feedback are integrated with data supplied by other members of
the interdisciplinary treatment team. In this context, the infor-
mation is as important for the treatment team as it is for the
patient, as the efficacy of other disciplines depends on an ade-
quate understanding of the patient's cognitive status, strengths,
274 CARLTON S. GASS AND M. C. BROWN
and limitations. Third, the process of feedback, like testing, is
ongoing and closely tied to the evaluation of progress and to the
discovery of new ways to enhance the patient's functional au-
tonomy.
A General Approach to Providing Feedback
The methodology of feedback can only be presented in gen-
eral terms because in practice it must vary to suit the special
needs of the patient and, to some extent, the clinician. Regard-
less of the procedures used, the effectiveness of feedback must
ultimately be judged in terms of patient benefit. No single ap-
proach to feedback can or should be used with all individuals.
Nevertheless, the following steps and guidelines seem to be
helpful with many brain-injured patients.
Step 1. Reviewing the Purpose of Testing
Many patients, particularly those with memory problems,
require a restatement of the purpose of the examination. This
often is an appropriate time to review the presenting com-
plaints of the patient (e.g., concentrational problems, headache)
that precipitated the assessment. Patients often begin the ses-
sion by asking, "Well Doc, do the results show that I'm nuts?" In
fact, it is common for patients to anxiously misperceive the
purpose of testing as addressing the issue of "sanity" versus
"insanity," and this can be an opportunity to respond to such
concerns. As a general rule, patients appreciate a straightfor-
ward approach that briefly restates the basic purpose of testing
as one of assessing the quality of brain-related skills and abili-
ties. Here, as elsewhere, the recipients of feedback prefer that
the information be presented in plain and understandable lan-
guage. Ideally, the clinician should avoid using professional jar-
gon and exercise special sensitivity when using terminology
that might be perceived as stigmatizing or demeaning (e.g., re-
tarded, demented}.
Step 2. Defining the Tests
Examinees commonly wonder how neuropsychological test
performance relates to competency in daily living. Defensive
patients who are frustrated by their own deficiencies some-
times criticize the tests as child's games that are irrelevant to the
demands of real life. Credibility is not invariably assumed; at
times it needs to be emphasized by the clinician. If the tests are
part of a widely used, well-established battery, this might be
mentioned as a means of building reassurance and confidence.
In any case, the tests can be described as behavior samples that
represent important domains of daily functioning. For exam-
ple, patients who skeptically question the importance of piec-
ing together puzzles (Object Assembly) or completing maizes
can usually be helped to understand their respective relevance
to familiar concepts such as hand-eye coordination, "mechani-
cal ability," and visual planning. Furthermore, a short explana-
tion is generally sufficient to help patients grasp the notion that
these behavioral skills are related to the functional integrity of
the brain.
Step 3. Explaining Test Results and Behavior
Depending on the size of the test battery, a neuropsychologi-
cal examination may generate far more information than is
necessary or even desirable to convey to patients. A test-by-test
review of scores is time-consuming and rarely holds the atten-
tion of the brain-injured individual, particularly when addi-
tional time is required to explain each test. Although test scores
are of major importance to the clinician and the treatment
team, it is well to keep in mind that the chief concerns and
priorities of the patient almost invariably center on practical
and existential issues pertaining to recovery of function and
return to normal daily routine. In most cases, these issues are
more effectively addressed by presenting information regard-
ing general performance level for each of the cognitive domains
of neurobehavioral functioning covered in the examination
(e.g., executive functions, attention and memory, speech and
language, visuospatial, perceptual, and motor). A flexible use
of this approach permits greater specificity as needed without
taxing the patient's cognitive resources. For example, under the
general heading of memory, a patient may be informed that the
test results suggest mild impairment of memory for visually
processed information, with intact memory for language-based
material.
The classification of performance level using impairment (as
opposed to deficiency) terminology—intact, borderline, im-
paired—is based primarily on a consideration of normative
comparisons and a careful estimate of the individual's premor-
bid capacity. However, the derivation of scaled scores for use
with a neuropsychological test battery is beyond the scope of
this discussion (see Russell, 1987). Suffice it to say that patients
should be informed that their test performance is assessed by
comparing it with that of a normative sample of individuals,
ideally of similar age and educational background. Level of
performance within a given neurobehavioral domain can also
be based on a summary score that represents the average for
that group of tests. If the test scores within a domain show
significant variation, greater feedback specificity may be ap-
propriate.
It is usually helpful to allow the patient to respond briefly
after feedback is given for each functional domain. A reciprocal
approach has several distinct advantages. First, it circumvents
the problems created by using a nonstop approach to reviewing
test findings—namely, boredom and inattention. Even when
findings are summarized across domains, it is simply too much
information for most patients to process. Second, the inter-
change of information has the advantage of soliciting further
clinical data from (and about) the patient. In many cases, the
patient's response provides pertinent data regarding degree of
insight regarding newly acquired limitations. Higher function-
ing patients, in particular, commonly wish to discuss the ways
in which the test findings relate to aspects of their daily func-
tioning. As findings are discussed with the patient in relation to
the particular demands of the Irving environment, they become
more relevant and useful.
Although feedback, like testing in general, achieves credibil-
ity by relying on psychometrically established tests, there are
several types of unmeasured behavior that should be consid-
ered in the process of giving feedback. These include qualitative
 NEUROPSYCHOLOGICAL TEST FEEDBACK
aspects of patient behavior during the evaluation. General be-
havior such as effort, cooperation, endurance, stamina, and
response to frustration or ineffective performance must also be
considered. These are critical behavior samples in their own
right that bear directly on the question of behavioral compe-
tency and adaptive potential.
Step 4, Describing Strengths and Weaknesses
After the presentation of test findings in terms of perfor-
mance level, the results should be summarized with an empha-
sis on areas of relative strength and weakness. Feedback regard-
ing residual strengths often provides the patient with the clear-
est rationale for treatment recommendations. In rehabilitation
settings it should be explained to the patient that a major focus
will be on the development and use of skills and areas of relative
strength. Furthermore, although the evidence is only anecdotal,
many patients with debilitating or degenerative conditions (e.g.,
AIDS) seem to derive emotional benefit from the encourage-
ment associated with feedback concerning cognitive strengths.
This therapeutic phenomenon has also been observed in rela-
tion to psychiatric patients, who commonly underestimate and
depreciate their own cognitive skills in the absence of objective
evidence.
Weaknesses in cognitive functioning are also important to
review to the extent that they necessitate a change in daily rou-
tine (e.g., driving, work, or school) or warrant specific remedial
or compensatory intervention. With some patients, specific
weaknesses must be emphasized as a means of discouraging
potentially destructive behavior, such as continued drug abuse
or noncompliance with medication. In most cases, areas of
deficit can be presented in a positive light as challenges to over-
come, rather than as losses that are irrecoverable.
Overall, the presentation of strengths and weaknesses can be
facilitated by family involvement. The family's participation in
this aspect of feedback sometimes produces additional details
about the patient's home environment that may be significant
for rehabilitation and aftercare. For example, environmental
supports may be identified during the feedback process that
can be used in conjunction with the patient's strengths or, in
many cases, for the purpose of compensating for an acquired
handicap.
A proper understanding of the dynamic functioning of the
brain is an essential prerequisite for the clinician at this stage of
feedback. Without this understanding it would be natural to
mistakenly delineate a patient's cognitive strengths solely on the
basis of test scores within a specific domain, without consider-
ing the status of executive functions that initiate and guide their
activity. This problem can be illustrated using a common sce-
nario. Patients who experience a decelerating head injury fre-
quently sustain fronto-orbital lesions, yet are able to produce
scores on the Wechsler Adult Intelligence Scale that are within
the normal range (Stuss & Benson, 1986; Teuber, 1964). Al-
though strengths may exist in the areas of verbal and percep-
tual-motor skills, the presence of executive deficits often pre-
cludes their effective use outside the highly structured testing
context. Skills that are manifested in the testing situation have
little value if the patient lacks the initiative or is too distracted
to apply them, regulate their application appropriately, or
275
correct for errors (Lezak, 1987). The same consideration ap-
plies in regard to cortical arousal, which is also a sine qua non of
cognitive effectiveness (Luria, 1973). In summary, with a proper
understanding of brain functioning, the clinician can present
the patient's strengths and weaknesses in a manner that ideally
elicits assistance from family members and ultimately contrib-
utes to the process of rehabilitation and adjustment.
Step 5. Addressing Diagnostic and Prognostic Issues
In cases in which testing is performed to assist in diagnosing
a suspected organic condition, the clinician should be cautious
and conservative in making diagnostic statements to the pa-
tient or to the patient's family. The patient's physician, who has
the benefit of more detailed information from various diagnos-
tic resources, is in a better position to make such statements. A
conservative approach is especially warranted when the diag-
nostic judgment is likely to have an impact on important deci-
sions for the patient. The problem is exemplified in the com-
mon case in which the test results are consistent with a demen-
tia. Such performance could result from innumerable medical
problems—some reversible—that, if misconstrued and pre-
sented, for example, as "probable Alzheimer's disease," could
create considerable needless anguish and lead to major life-al-
tering decisions that might never be corrected. On the other
hand, the clinician is obligated to assist the patient and family
in obtaining as much diagnostic clarity as possible. Therefore,
as a rule, the prudent response to delicate diagnostic questions
is to defer to a neurological specialist who can assess the neuro-
psychological report findings in conjunction with other neuro-
diagnostic data.
Whether the diagnosis is known or unknown, there is usually
a vital concern about whether current symptoms and deficits
are likely to improve, become worse, or remain unchanged with
the passage of time. Again, the clinician's responsibility is sub-
stantial because prognostic statements can generate hope or
despair and, in any case, provide an impetus for making spe-
cific plans and decisions of considerable import. Even when
recovery is expected, the rate varies considerably across individ-
uals, depending on a host of factors (Meier, Strauman, &
Thompson, 1987). For these reasons, great care should be exer-
cised in projecting the course of recovery or decline. Prognostic
statements, like diagnostic conclusions, are often best left to
the patient's physician. When they are made, the diagnostic
picture should be clear, the relevant medical information
known, and the statements presented as tentative estimates
based on current knowledge.
Step 6. Making Recommendations
The preceding steps of the feedback process can be viewed as
preparatory in nature, with the ultimate goal being one of mak-
ing recommendations. Ideally, the discussion of patient perfor-
mance provides a clear and logical basis for the recommenda-
tions that follow. Even as recommendations are made, however,
they may need to be justified to the patient on the basis of the
assessment findings. Recommendations should be stated
clearly, restated again in a concluding summary, and in many
276 CARLTON S. GASS AND M. C. BROWN
cases given in writing to the patient or patient's family to mini-
mize potential problems of forgetfulness or misunderstanding.
General recommendations concerning the need for supervi-
sion and treatment interventions can usually be derived directly
from the evaluation. In addition to information gathered in the
initial interview, in some cases new information comes forth
during the feedback session that can influence specific recom-
mendations. For example, family members who are present of-
ten provide detailed information about the patient's living envi-
ronment, demands of daily living, and patient or family plans
and intentions. Recommendations may address aspects of the
living environment that should either be avoided or used in a
manner that complements the specific strengths of the patient.
They may also help to shape previously undisclosed plans in-
volving travel, return to a specific job, or finances. Finally, the
clinician's role as a referral source often involves assisting pa-
tients and their families in making contact with community
agencies such as local family support groups, outpatient rehabil-
itation programs, sheltered workshops, supervised living facili-
ties, and agencies that provide group and individual therapy for
brain-injured individuals and their families (Lezak, 1978).
Special Issues
Test-Related Limitations
Neuropsychological test results appear to be moderately re-
lated to relevant measures of everyday performance (Dunn et
al., 1990; Heaton & Pendleton, 1981). Because of their limited
scope and generalizability, however, their relation to aspects of
daily living is not sufficiently strong to provide clear guidance
for the multiplicity of the issues facing patients with brain dys-
function. Many routine activities require a cognitive complexity
that may not be adequately sampled by current neuropsycholog-
ical tests (Lezak, 1982,1987). Neuropsychological tests gener-
ally provide only limited information pertaining to qualities
such as self-awareness, interpersonal sensitivity, or emotional
control (Prigitano, Altaian, & O'Brien, 1990). Finally, a strictly
test-centered approach to assessment neglects the fact that liv-
ing environments are as varied as the persons residing in them.
Tests measure skills and deficits, but the quality of adaptation
requires equal consideration of the patient's environment (Che-
lune & Moehle, 1986). For these reasons, recommendations
derived from the evaluation should be considered tentative and
remain open to revision as further information is acquired and
changes occur in the patient's neurobehavioral status and living
environment.
Feedback to the Patients Family
Feedback to family or other caretakers may be advisable for
several reasons. First, the patient may not have the cognitive
requisites for using feedback. For example, it is common for
head injury patients to lack an awareness of their own limita-
tions in the basic areas of managing money and driving a car
(Prigitano, Altaian, & O'Brien, 1990). The implementation of
specific recommendations often becomes the responsibility of
family members. Second, family members require proper un-
derstanding of the patient's behavior in order to know how best
to respond. The support initially obtained through feedback
can help to counteract the intense feelings of confusion, frustra-
tion, and aggravation commonly experienced by the family
members of brain-injured patients. Third, because of its speci-
ficity in identifying patient needs, neuropsychological test
feedback is probably an ideal starting point for a family's in-
volvement in educational or support groups that exist in the
community. Such involvement benefits the family as well as the
patient, inasmuch as the family's ability to adapt to the new
situation brought on by the patient's disability has a major ef-
fect on the patient's emotional adjustment (McKinlay &
Brooks, 1984). Finally, as previously indicated, family involve-
ment in the feedback process often produces information in
addition to that gathered in the initial interview regarding pa-
tient behavior and environmental resources that can be used for
adaptive and rehabilitative purposes.
Patient-Related Considerations
Feedback must be tailored to suit the patient's particular cog-
nitive and emotional needs. There are a number of cognitive
requirements. The brain-injured individual must be able to
comprehend the feedback, appreciate its importance, actively
attend to it, retain it, and apply it in a generalized rather than
concrete manner. To the extent that these abilities are compro-
mised, the involvement of a third party or family member may
be necessary. Other methods, such as a graphic presentation
and provision of recommendations in writing, may help. Feed-
back should be as specific and concrete as possible. In many
instances, patients can efficiently process only a small amount
of information at a time and therefore require several shorter
feedback sessions.
Emotional needs of the patient may shape both the timing
and the manner in which feedback is presented. For example,
some patients require a very supportive approach in which their
relative strengths are emphasized. Depressed individuals who
have a good prognosis and yet tend to focus more exclusively on
their deficits may be given encouraging words concerning the
prospect for progress. Patients involved in high-risk behavior,
such as substance abuse or noncompliance with a medical re-
gime, may need firm confrontation.
Measures of psychopathology and personality characteris-
tics, such as the MMPI-2, can assist the neuropsychologist in
planning feedback by providing clues regarding a patient's
openness, receptivity, insight, and other behavior (Butcher,
1990). For example, high MMPI-2 scores (T> 65) on the L
scale are often associated with naivete, limited self-insight, and
a tendency to deny or minimize deficits. Patients with high
scores on Scale 9 (Hypomania) commonly overestimate their
abilities and exercise poor judgment in decision making. A
significant percentage of brain-injured patients experience
problems of emotional adjustment that should be considered in
the context of planning both feedback and treatment. In every
case, the process and content of feedback should be tailored to
fit the individual needs of the patient.
Denial
Denial is a common initial response of patients and families
to the disabling effects of brain injury. Clinicians recognize that
 NEUROPSYCHOLOGICAL TEST FEEDBACK
some degree of denial is psychologically adaptive and should
not be vitiated in a premature manner. For this reason, the
timing of feedback and the force with which it is presented
should be weighed against the particular needs of the patient
and family. In many cases, follow-up counseling entails an ex-
tension of the feedback process and helps ensure that recom-
mendations are properly understood and implemented.
The occurrence of extreme or prolonged denial can pose ma-
jor problems, often precluding rehabilitative intervention and
exerting a destructive impact on both the patient and family
system (Romano, 1974). When this denial is psychological in
origin, test feedback can be an effective tool in the process of
softening defenses by virtue of its reliance on an objective
source of information about the patient's functional limita-
tions. A case in point involves a patient who presented with a
right parietal lesion and serious visuospatial deficits. Bolstered
by the patient's intact verbal-expressive skills, the denial of his
disability by both him and his family was tantamount to the
patient returning to driving, with a very high risk of accident. In
this situation, the provision of objective test data added credibil-
ity to the psychologist's recommendation that the patient re-
frain from driving pending further recovery and reevaluation.
Their final decision for him to refrain from driving may have
been life-saving. As this example illustrates, the potential bene-
fits of neuropsychological test feedback can sometimes extend
beyond those normally considered in relation to planning reha-
bilitation and aftercare.
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Received August 29,1991
Revision received November 4,1991
Accepted November 4,1991 •