Halstead-Reitan Neuropsychologycal Battery (adult >15) – Interpretation
I. General Interpretive Strategy
1. Look at demographic and obtained IQ scores- compare obtained scores with demographically based norms.
Barona Index: FSIQ = Age ()*.47 + Sex ()*1.76 + Race ()*4.71 + Educ ()*5.02 + Occup ()*1.89 + Region ()*.59 + 54.96 = X+12.14
Age: 1 = 16-17years Sex: 1 = M Race: 1 = Black
2 = 18-19 2 = F 2 = Other
3 = 20-24 3 = White
4 = 25-34
5 = 35-44
6 = 45-54
7 = 55-64
8 = 65-69
9 = 70-74
Educ.: 1 = 0-7 years Occup.: 1 = Unskilled Region: 1 = South
2 = 8 2 = Semiskilled 2 = N. Central
3 = 9-11 3 = Not Employed 3 = West
4 = 12 4 = Skilled 4 = Northeast
5 = 13-15 5 = Business & Government
6 = 16+ 6 = Professional & Technical
Estimated WAIS-R Deterioration IQ (DETIQ): (Dig.Sp.+Bl.Des.+Dig.Symb.+Sim.)*1.25 + 50 = DETIQ
Deterioration Quotient (DETQ): (FSIQ-DETIQ)/FSIQ = DETQ, if DETQ >.11 – indicative of impairment.
2. Review most sensitive indicators of presence/absence of brain damage: Neuropsychological Deficit Scale, Average Impairment Rating, Halstead Impairment Index, Categories (>51 errors, after 51 age becomes the cutoff score), Tactual Performance Test – Location (<4), Trails B (>91 sec., > 3 times slower than Trails A).
A. Neuropsychological Deficit Scale:
| Test Name | 0 | 1 | 2 | 3 |
| Verbal IQ | 90+ | 82-89 | 73-81 | < 72 |
| Performance IQ | 90+ | 82-89 | 73-81 | < 72 |
| Impairment Index | 0 – .2 | .3 – .4 | .5 – .7 | .8 – 1 |
| Category Test | 0 – 25 | 26 – 45 | 46 – 64 | 65 + |
| TPT Total Time | 0’ – 9’ | 9.1’ – 15.0’ | 15.1’ – 25.0’ | 25.1’ + |
| TPT Memory | 8 – 10 | 7 | 4 – 6 | 0 – 3 |
| TPT Localization | 7 – 10 | 6 | 3 – 5 | 0 – 2 |
| Seashore Rhythm Test – correct | 28 – 30 | 25 – 27 | 20 – 24 | 0 – 19 |
| Speech-Sounds Perception Test – errors | 0 – 6 | 7 – 10 | 11 – 15 | 16 + |
| Finger Tapping – Dominant Hand | 55 + | 50-54 | 41 – 49 | 0 – 40 |
| Finger Tapping – Non-dominant Hand | 49 + | 45 – 48 | 37 – 44 | 0 – 36 |
| Trail Making Test – Part A | 0” – 26” | 27” – 39” | 40” – 51” | 52” + |
| Trail Making Test – Part B | 0” – 65” | 66” – 85” | 86” – 120” | 121” + |
| Tactile Form Recognition – total time | 0” – 16” | 17” – 23” | 24” – 33” | 34” + |
| Bilateral Tactile Stimulation – errors | 0 | 1 | 2 -3 | 4 + |
| Bilateral Auditory Stimulation – errors | 0 | 1 | 2 | 3 + |
| Bilateral Visual Stimulation – errors | 0 | 1 | 2 -3 | 4 + |
| Tactile Finger Recognition – errors | 0 – 2 | 3 – 4 | 5 – 8 | 9 + |
| Finger-tip Number Writing – errors | 0 – 3 | 4 – 6 | 7 – 11 | 12 + |
| Dysnomia | yes | |||
| Auditory Verbal Dysgnosia | yes | |||
| Visual Number Dysgnosia | yes | |||
| Visual Letter Dysgnosia | yes | |||
| Body Dysgnosia | yes | |||
| Dyscalculia | yes | |||
| Dysgraphia | yes | |||
| Dyslexia | yes | |||
| Constructional Dyspraxia | yes | |||
| Central Dysarthria | yes | |||
| Spelling Dyspraxia | yes | |||
| Right-Left confusion | yes | |||
| VIQ/PIQ Difference | 0 – 5 | 6 – 10 | 11 – 19 | 20 + |
| HII and FSIQ | II = 0 – .4 or II = .5 – 1 & FSIQ = < 90 | II = .5 – 1 & FSIQ = 90 – 95 | II = .5 – 1 & FSIQ = 96 – 100 | II = .5 – 1 & FSIQ = 101+ |
| Finger Tapping (1 – non-dom./dom.) | .08 – .12 | .13 – .16.07 – .05 | .17 – .21.04 – (-.03) | .22 +(-.04) – |
| TPT (1 – non-dom./dom.) | .38 – .26 | .25 – .15.39 – .42 | .14 – .05.43 – .50 | .04 -.51 + |
| Grip Strength (1 – non-dom./dom.) | .08 – .12 | .13 – .17.07 – .06 | .18 – .20.05 – .00 | .21 +(-.01) – |
| Tactile Form Recognition (dom. – nond.) | 0 – 1” | 2” – 3” | 4” – 5” | 6” + |
| Bilateral Tactile Stimulation (r. err. – l. err.) | 0 | 1 | 2 | 3 + |
| Bilateral Auditory Stimulation (r. err.-l. err.) | 0 | 1 | 2 | 3 + |
| Bilateral Visual Stimulation (r. err. – l. err.) | 0 | 1 | 2 | 3 + |
| Tactile Finger Recognition (error % for the hand with largest # of errors in table ->,use row with total # of errors below)21 or more18 – 2015 – 1712 – 149 – 116 – 83 – 50 – 2 | 50-5450-5450-5450-5550-5650-5650-5950 | 55-5755-5755-5856-5857-5957-6360-671 error | 58-6058-6259-6359-6360-6364-7068-79100 | 61 +63 +64 +64 +64 +71 +80 +- |
| Finger-tip Number Writing (use calculations & table above) |
Total of all ratings making up the Neuropsychological Deficit Scale, the rough cutoff point for the impaired range is 25or higher.
B. Halstead’s Impairment Index:
| Test Name | Test Score | Cutoff Score | Impaired range |
| Category Test (errors) | >51 | ||
| TPT Total Time (minutes) | >15.7 | ||
| TPT Memory (correct) | <5 | ||
| TPT Localization (correct) | <4 | ||
| Seashore Rhythm (correct) | <25 | ||
| Speech-Sound Perception (errors) | >8 | ||
| Finger Oscillation (Domin. Hand – # of taps in 10 seconds) | <50 |
HII = (# of scores in impaired range) / (total # of scores) = X
For people with higher of PIQ or VIQ =/> 100 HII of .4 or > falls into impaired range, for people with higher of PIQ or VIQ < 100 HII of .5 or > falls into impaired range.
C. Average Impairment Rating:
| Test Name | 0 | 1 | 2 | 3 | 4 | 5 |
| Category (errors) | < 25 | 26-52 | 53-75 | 76-105 | 106-131 | 132 + |
| TPT Total Time (minutes) | < 9 | 9.1-15.6 | 15.7-21 | 21.1-29.9 | >30 & 14-30 blocks | >30 & 13-0 blocks |
| TPT Memory (correct) | 10-9 | 8-6 | 5-4 | 3-2 | 1 | 0 |
| TPT Localization (correct) | 10-7 | 6-5 | 4-3 | 2-1 | 0 & TPT Mem.>0 | 0 & TPT Mem.=0 |
| Speech-Sounds (errors) | 0-3 | 4-7 | 8-14 | 15-25 | 26-30 | 31 + |
| Seashore Rhythm (errors) | 0-2 | 3-5 | 6-9 | 10-13 | 14-18 | 19 + |
| Finger Tapping (# – use the worst of two hands)Dom. MaleFemaleNondom. MaleFemanle | >55>51>49>45 | 54-5050-4648-4444-40 | 49-4345-3943-3739-33 | 42-3238-2836-2632-22 | 31-2027-1625-1421-10 | 19-015-013-09-0 |
| Trail Making B Time (min.) | <57 | 58-87 | 88-123 | 124-186 | 187-275 | 276 + |
| Aphasia Screen (errors) | 0 | 1-6 | 7-15 | 16-25 | 26-40 | 41 + |
| Spatial Relations (errors, if BD<PC or PA add 2 points) | 1 | 2-3 | 4-5 | 6-7 | 8-9 | 10-12 |
| Perceptual Exam: Bilateral Simultaneous Stimulation (errors) | 0-4 | 5-12 | 13-30 | 31-50 | 51-80 | 81 + |
| Digit Symbol Scaled Score & Perc. Average -1, where (Av-1) = (PA+PC+BD)/3-1 | DS>12 & >(Av-1) | DS>12 & <(Av-1)orDS=9-11DS=7-8 & >(Av-1) | DS=7-8 & <(Av-1)orDS=5-6 & >(Av-1) | DS=5-6 & <(Av-1)orDS=3-4 & >(Av-1) | DS=3-4 & <(Av-1)orDS=2-1 & >(Av-1) | DS=2-0 & < (Av-1) |
The Average Impairment rating is calculated by dividing the sum of ratings by the number of ratings (12) and evaluating on the following scale (from none to severe impairment):
0 1 2 3 4 5
———–+——————-+——————–+——————–+——————–+——————-+———
0-1 1.01-1.35 1.36-2 2.01-2.85 2.86-3.5 3.51-5
3. Evaluate for lateralization/localization:
Right vs. Left errors on sensory and motor tests, Dysphasia vs. Dyspraxia, PIQ (r) vs. VIQ (l), Speech (l) vs. Rhythm (r), Trails A vs. Trails B (B<A – left, A<B – right). Look at motor vs. sensory, WAIS patterns, pathognomic signs.
4. Evaluate the course of the lesion:
Trails B, Speech/Rhythm (acute-both impaired approximately equally, if one is significantly worse than other – more chronic and localized), pathognomic signs with (acute) / without (chronic) general impairment.
5. Look at etiology
6. Behavioral description of strengths and weaknesses
7. Prognosis
II. Tests
| Test | Cutoff for Impairment | Functions Tested | Localization Information | Notes |
| Category Test | >51 errors, after 51 years age becomes the cutoff score | Current learning skill, concept formation, concept utilization, degree of generalization, mental efficiency, vsuo-spatial component, judgement, memory, ability to use external feedback | Sensitive, but not specific to frontal lobe damage | 208 items; subtests 5&6 – figure-ground rel-ps; subtest 3 pulls for perseveration; can prorate by adding 15 to # of errors on subtests 1-4 if subjects gives up after subtest 4 |
| Tactual Performance Test | Total time > 15.7’;Memory < 5 correct;Localization < 4 correct | motor speed, use of haptic info to guide behavior (spatial but not visual), response to novel situation & type of problem, incidental haptic memory | look at left/right hand differences; primary motor and sensory areas (frontal & parietal) | 30% improvement is expected on the second trial; pattern for times (dom/ nond/both = 6:4:3); if takes more than 10 minutes per trial, can stop and prorate 1 min. per unplaced block |
| Speech-Sounds Perception Test | > 8 errors, >18 errors – suspect malingering | mostly taps sustained attention/concentration, auditory verbal perception, auditory-visual coordination of language processes (reading & sounding) | left mostly, usually 10-12 errors with brain damage, left temporal lesion can give more errors | 60 items, 16 min.; requires 4th grade reading level; place recorder equidistant from both ears 1 yard away; can do sample up to 3 times |
| Seashore Rhythm Test | < 25 correct | best in the battery for sustained attention/ concentration, nonverbal auditory perception | right temporal | 30 items, 7 min. |
| Finger Oscillation Test | < 50 on dominant hand | motor speed; body and arm recruitment – pathognomic for motor control problems | lateralization: 5-15% diff. between hands is expected; primary motor area (frontal lobes) | the average of 5 trials within 5 taps of each other or the average of 10 trials for each hand; start timing with the first tap |
| Trail Making Test | A > 41‘;B > 91’;B should take 2 1/2 – 3 times longer than A | set switching, visual scanning, sequencing, psychomotor speed, B is a whole brain test | if B<<A and errors are mostly switching – lesion is anterior; B<<A – left lesion, A<<B – right lesion | Show first 4 items on tests as well as samples; bring them back to the point before error as soon as they make one; schizophrenics usually do badly on B, have weired elaborations; look for errors confined to one side of the page |
| Lateral Dominance Exam | grip strength – expect 10% diff. between hands | r/l discrimination, r/l dominance, motor functions, periferal problems | lateralization, primary motor control | give first – easy, determines hand dominance; if one hand moves first and then the action is performed with the other one – suspect periferal impairment; for grip strength need average of two trials within 5 kg. of each other, alternate hands |
| Reitan-Klove Sensory Perception Exam | pathognomic signs; for tactile form recognition > 5’ discrepancy between hands | tactile, auditory, visual perception problems (subtle – imperceptions on bilat. simult. Stim.-lateralization), finger agnosia (tactile finger recognition), agraphesthesia (fingertip # writing), astereognosis (tactile form recognition) | tactile – parietal, visual – occipital, auditory – temporal | for tactile form recognition always start with right hand, self-correction < 1/2’ is acceptable |
| Reitan-Indiana Aphasia Screen | pathognomic signs | naming, spelling, reading, # & letter recognition, writing, arithmetic, enunciation, body part identification, apraxia, comprehension, following directions, r/l differentiation, constructional dyspraxia | depending on the sign | get two copies of greek cross for scoring, score a point for each distorted corner (examples in the folder) |
III. Results Form
Trail Making Test
Part A: seconds; errors
Part B: seconds; errors
Strength of Grip:
Dominant Hand: kilograms
Non-Dominant Hand: kilograms
Reitan-Klove Tactile Form Recognition Test
Dominant Hand: seconds; errors
Non-Dominant Hand: seconds; errors
Reitan-Klove Sensory Perceptual Exam
RH LH Both H: RH LH
RH LF Both H and F: RH LF
LH RF Both H and F: LH RF
RE LE Both E: RE LE
RV LV Both: RV LV
RV LV Both: RV LV
RV LV Both: RV LV
Tactile Finger Recognition
R 1: 2: 3: 4: 5:
L 1: 2: 3: 4: 5:
Finger-Tip # Writing
R 1: 2: 3: 4: 5:
L 1: 2: 3: 4: 5:
Aphasia Screening Test:
Category Test:
Number of Errors
Tactual Performance Test
Dominant Hand: ’” Total Time: ’”
Non-Dominant Hand: ’” Memory:
Both Hands: ’” Localization:
Seashore Rhythm Test
Number Correct
Speech-sounds Perception Test
Number of Errors
Finger Oscillation Test
Dominant Hand
Non-dominant hand
Reitan-Klove Lateral Dominance Exam
Show me how you:
throw a ball
hammer a nail
cut with a knife
turn a door knob
use scissors
use an eraser
write your name
Record time used for spontaneous name-writing:
Preferred Hand seconds
Non-preferred Hand seconds
Show me how you:
kick a football
Step on a bug
