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BROCAS SCAN: The Screening Cerebral Assessment of Neppe

This is a test of higher cerebral cortical functions used as a bedside screening instrument in the context of cerebral cortical and neuropsychiatric evaluation. A perfect score is zero with the normal intelligence individual without major psychopathology generally scoring < 15. The maximum score for the very grossly impaired is 100. Because the BROCAS SCAN test concentrates on physical signs, areas of the cerebral cortex such as temporal lobe and limbic system involving predominantly symptom profiles are not evaluated in detail - this is done with the INSET evaluation.
The validity score is based on clinical face value assessment of factors impairing the patient or the rater's ability to correctly score the patient. A score of 0 is the highest level of validity indicator reflecting a score which is likely to be meaningful at this time. By contrast, a score of four or more would be very dubious. Patient performance is based on a core score plus a fine score producing a a total score. There is also a validity score.
The profile has ten headings spelling out the ROCAS of the BROCAS namely:
                            
r       Spontaneous recall       ( usually 0-2)
r       Cued recognition         ( usually 0)
o       Orientation              ( usually 0-1)
o       Organization             ( usually 0-2)
c       Concentration            ( usually 0-2)
c       Calculation              ( usually 0-2)
a       Apraxia                  ( usually 0-4)
a       Agnosia                  ( usually 0-2)
s       Speech                   ( usually 0)
s       Sensory Motor Reflex.    ( usually 0)
Comment on score and subtest interpretative report

Memory as reflected by recall and retention includes perseveration, significant verbal or visual difficulties on spontaneous recall or cued recognition in the context of age and intelligence

Normal recall/recognition implies adequate eventual registration (measured, in part, more acutely by concentration) and retention of information.

Impaired recall with reasonable recognition may imply difficulty with organizing retained information.

Orientation includes for time, space and passage of time.

Passage of time is selectively impaired in certain psychoses; spatial impairment may imply organicity

Organization is reflected by abstraction of proverbs and ability to coherently put elements together taking cultural elements into account.

The measure in this instance unfortunately has more cultural elements than any other part of this test.

Communication skills are also assessed.

Concentration: The ability of the patient to concentrate reasonably.

Calculation Simple calculation skills are measured by subtraction.

Calculation difficulties may reflect specific impairments including pre-existing

learning difficulties and focal impairments of either parietal or frontal lobeor generalized concentration disturbance

Praxic skills pertain, inter alia, to copying, construction and sequential movements.

Many normal people have significant difficulties with tests of complex sequences.

Separation of the motor impairment from the perceptual gnosic difficulties is at times very difficult clinically.

Gnosic elements test both perceptual modality ( auditory, visual, tactile) and organization of information

The test involves relatively simple tasks so abnormality reflects significant pathology or limited attention to detail.

Speech involves several somewhat separate elements: Pronunciation as in dysarthric functions. Comprehension of complex English phrases in receptive aphasia. Naming of body parts , colors and objects as in anomia. Speech generation as reflected by spontaneous word generation using stipulated criteria as in expressive aphasia. These tests broadly cover the spectrum of receptive and expressive speech.

Sensory-motor-reflex elements: This evaluates evidence for impaired gait or posturing, obvious motor weakness in the upper limbs with arm sway and flexor-extensor weakness and also the lower limb strength. Motor tone, tremor on either side either at rest or on writing, obvious sensory loss and presence of primitive reflexes demonstrated by this test.

Because broad elements only are tested this is no substitute for a detailed neurologic examination.

 

 

 


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