People living with repetitive mild traumatic brain injuries (RmTBI) report difficulties in brain function which does not show up on standard structural scans. RmTBI causes microstructual damages, too small to be seen on modern brain scans. Consequently, people living with RmTBI must get neuropsych testing to measure changes in brain function. Access to comprehensive RmTBI assessment is not routinely available and difficult to access for people with a history of Electroconvulsive Therapy (ECT) or Shock Treatment. In community-based mental health settings, if an ECT recipient is tested, psychiatrists use assessments like the Mini-Mental State Examination (MMSE) which is not sensitive enough to measure Mild Cognitive Impairment (MCI) and cannot be used to qualify a person for academic or employment accommodations or comprehensive rehabilitation to improve life after ECT.
I am a nationally certified rehabilitation counselor who’s researched improving quality of life after ECT for more than a decade. People routinely contact me requesting information on comprehensive neuropsych and occupational testing to assess neurological changes (vision, motor, memory, balance, auditory, etc) in people with a history of Electroconvulsive therapy (ECT) or shock treatment.
One ECT recipient explained the need for appropriate testing this way:
Often ‘proof’ of injury or disability is required not only to try and access further healthcare and services/supports (if there are any) but also in order to support applications or renewals for disability social assistance – to access some income/ housing, albeit about 60% below the poverty line (in Canada, at least).
Example – some may have had psychiatric diagnos(es) on their original applications but, as it becomes apparent that their injury and disability isn’t psychiatric but organic … they may need to or wish to clarify that on their medical records. Or may need ‘proof’ in order try and access other types of assistance/ services.Sadly, ‘proof’ often also seems to help others comprehend the injury or disability, in this world of ours where a medical stamp is valued more than the clearly observable impairments. Having said that, it can often be really hard to access proper testing and thorough medical care, even if we know what to ask for.
For that reason, I’ve compiled a list of Neuropsych and occupational tests for people with a history of ECT. This list is based on available research, adverse events reported in one of the ECT device instruction manuals and deficits reported by people with a history of ECT in online forums:
- Clinical Test of Sensory Integration and Balance (CTSIB)
- Box and Block Test
- Purdue Pegboard Test
- Halstead Category Test
- Wisconsin Card Sorting Test
- Trail Making test
- Test of Visual Perceptual Skills (non-motor)-Upper Level (TVPS-UL),
- Developmental Eye Movement Test (DEM)
- Delis-Kaplan Executive Functioning System (D-KEFS),
- Autobiographical memory Interview (AMI).
- Janis Autobiographical assessment (only possible if administered before ECT and then retested after ECT)
- Verbal Learning subtest of the Williams battery.
- Bender-Gestalt and the Benton Visual Retention Test (with the The Pascal and Suttell method of scoring for deviations on the Bender- Gestalt designs).
- Hyperacusis/Tinnitus/Auditory processing assessments
Depending on how testing is completed, ECT memory loss can be difficult to capture accurately. One study acknowledged that “Even people with severe brain injury or lobotomy can perform well on simple tests of overlearned verbal material that require culturally common information, for example the Wechsler Memory Scale. Highly motivated and concerned ECT patients are even more likely to do well on these tests. However, clinicians who conclude from this that there is ‘no memory loss’ have not measured memory loss at all, and certainly not the type of memory and cognitive disability that people can experience after ECT” (Read more about sensitive testing for ECT recipients here).
I recommend connecting with a qualified psychologist (familiar with repetitive mild traumatic brain injury) and with a Neuro-Optometric Rehabilitation provider.
For additional testing related to delayed electrical injury, please see the “The aim of this petition” update on our International petition to “Standardize, Regulate & Audit Shock Treatments (Electroconvulsive therapy or ECT).”
I hope that helps. Please let me know how things unfold.