P. G. I. Battery of Brain Dysfunction

AIM :

To assess cognitive dysfunctions in the participant using the P. G. I. Battery of Brain Dysfunction.

INTRODUCTION :

The P.G.I Battery of Brain Dysfunction was developed by D. Pershad and S. K. Verma. It is a sophisticated collection of various tests that are used to quantify cognitive dysfunction, impairment, decline, or deficits in clinical settings. The P.G.I Battery of Brain Dysfunction measures well-known cognitive functions of the brain behaviour such as intelligence (both performance and verbal), memory, perceptual acuity, and transference from one hemisphere to another. While the test is supposed to be used as a whole, it can also be used in parts based on special circumstances. Each of the tests has separate norms, thus making it easy for them to be used autonomously.

It also helps assess the extent of decline or loss in the cognitive area because of illness, accident, injury, or natural calamities, etc. This assessment can be helpful in planning rehabilitation strategies accordingly and may also help the judiciary in taking decisions about the extent of decline for grant of compensation.

PGI Battery of Brain Dysfunction, 1990, Second edition 2007, By Dwarka Pershad and S.K.Verma.

This battery includes five tests :

  • Bhatia’s Short Scale,
  • Verbal Adult Intelligence Scale,
  • PGI Memory Scale,
  • Bender Visual Motor Gestalt Test and,
  • Nahor Benson Test of Perceptual Acuity.

All these tests are fully validated and widely acclaimed throughout the world. Norms are developed for the 20 to 50 years age group; following a factorial sampling design of 2 X 3 X 5 [two levels of sex, three levels of education, and five levels of age]. It gives a global rating of cognitive dysfunction based on 19 test variables and estimates well accepted/validated psychological concepts of (a) intelligence, (b) memory, and (c) gestalt formation of perceptual acuity. It provides a profile of the current cognitive functioning of the subject.

The objective of the Use –

PGI-BBD is used to quantify cognitive dysfunction/impairment/decline/deficit

  • For clinical purpose
  • To evaluate extent of decline or loss in cognitive area as a result of illness/ accident/injury/natural calamities.
  • To plan rehabilitation strategy
  • Helping judiciary in taking decision about extent of decline for grant of compensation
  • To plan training/ treatment
  • For the evaluation of outcome of the treatment/ management.

Areas where PGI-BBD is used

  • Is used in all training institutes of clinical psychology
  • Used in research works leading to M.Phil or Ph.D degrees of the universities.

SUBSCALES OF PGI-BBD

A. PGI- Memory Scale

PGI memory scale was constructed and standardized in 1977. The PGI Memory Scale has become a popular memory scale throughout India and replaced the Boston Memory Scale and Wechsler Memory Scale at both the premier institutes of psychiatry i.e., National Institute of Mental Health and Neuro Sciences, Bangalore, and Central Institute of Psychiatry, Ranchi.

Memory is a highly complex phenomenon and a subject matter of many biological and behavioral sciences. Its importance lies in the fact that mere imagination or loss of memory may threaten the very existence of human beings. Here memory is considered from a psychological point of view as required for behavioral adequacy. Memory is generally believed to be a function temporal lobe of the cerebral cortex- Right Temporal lobe is responsible for non-verbal and the temporal lobe towards the left hemisphere is responsible for the verbal part of the memory. PGI- Memory Scale is included in the Battery of Brain Dysfunction. The PGI Memory Scale (PGIMS) provides a comprehensive and simple scale to measure verbal and nonverbal memories on the basis of neurological theory; very short term, short term, and long term memories on the basis of experimental evidence and remote, recent, and immediate memories on the basis of clinical practice of evaluation of memory. It contains 10 subtests –

  1. Remote memory
  2. Recent memory
  3. Mental balance
  4. Attention
  5. Delayed recall
  6. Immediate recall (sequential reproduction of sentences
  7. Retention for similar pairs
  8. Retention for dissimilar pairs
  9. Visual retention
  10. Recognition Psychometric Properties

B. Battery of Performance Tests of Intelligence- Revised Bhatia’s Short Battery of Performance Tests of Intelligence for adults included in PGI-Battery of Brain Dysfunction consists of (1.)Koh’s Block Design Test (2.)Pass-A-long Test  – consists of 2 subtests

  • Koh’s Block design test – The Kohs Block Design Test was developed in 1923 at Stanford University by Samuel Calmin Kohs (1890-1984), building on earlier and similar designs. . In a later revision by Hutt, scoring of the test incorporated the time taken to complete each trial. The Block Design Test was subsequently adapted by David Wechsler into the WAIS (Wechsler Adult Intelligence Scale). The Koh’s block design is a performance test to measure intelligence. The test consists of 16 colored cubes and 17 cards with colored designs, which the subject is supposed to duplicate by using the blocks. Because the instructions are easy to give and easy to understand, the test was designed so it could be given in mime , therefore making it especially valuable for testing those with language or hearing handicaps, or individuals speaking a different language than the administrator of the test.
  • Alexender Pass Along Test – Passalong Test, a performance test of intelligence for persons 7 to 20 years old, invented by W.P. Alexander c. 1937 and published by University of London Press in 1937. Intelligence was measured using the Pass along Test. It was a component of W. P. Alexander’s Performance scale. This allocated children aged 11 to different types of secondary school. The child moved the blocks around a tray to match a predetermined design. The test was devised in 1937. It was published by the University of London Press the same year. In this test, graded problems are presented. The coloured boxes are arranged in the reverse order and the individual is to rearrange it to give the shape given in the card. Time is one important factor here also.

C. Bendor Visual Motor Gestalt Test

The Bender Visual-Motor Gestalt Test is meant for assessing the participant’s perceptual and visual-motor functioning. The perceptual behavior with respect to the Bender Visual-Motor Test involves 3 broad stages— sensory reception of the figures, interpretation or organization of the lines at the central level of the nervous system, and motor performance of the figure. When there’s a brain injury, chemical imbalance, toxicity, or degenerative processes in the brain cells and nervous system, all these different levels of sensation, interpretation, organization, consolidation, and execution may be impacted. The Bender Visual-Motor Gestalt Test consists of 9 figures characterized by their gestalt. Each of the figures has to be replicated by the participant. Any question that the participant asks about drawing, he should be told that the drawing has to be as similar to the original one as it can be. For the scoring, Hain’s method is followed to yield more quantitative results. There are a total of 15 signs that are to be checked when assessing the drawings to assign them scores. These signs have to be scored in an all-or-none manner. The scores range from 0 to 34. Following are the 15 signs.

  1. Perseveration- there are 2 types of perseverations- Intra and inter. Intra perseveration is when the design is enlarged while inter perseveration is when the design from the earlier figure persists despite working on a different design. The maximum score for this sign is 4.
  2. Rotation- this is counted when the figure is rotated more than 45 degrees, which would account for a score of 4.
  3. Concretism- whenever there is a marked deviation in the reproduction of the subject, the participant may be enquired what they have drawn. If they name an object like bow, bird, or tree, a score of 4 may be given.
  4. Added angles- This is scored when an extra angle is added on cards A, 4, 7, and 8. A numerical score of 3 is given.
  5. Separatism of lines- When a line appears to be broken and the two lines formed separately do not touch each other, give a score of 3.
  6. Overlap- When a part of the design runs into the space or area of another, a score of 3 is to be given.
  7. Distortion- This is scored when there is a destruction of the gestalt of any one or more designs that leads to an extreme departure from the stimulus card. This is given 3 scores.
  8. Embellishments- Embellishments are scored 2 when an extra meaningless line is added to the design.
  9. Partial rotation- When the whole design is rotated 20 to 45 degrees from its axis or when any of the sub-part is titled for more than 20 degrees, this sign scored 2.
  10. Omission- This is given 1 score when either of the 2 subparts of a design is omitted.
  11. Abbreviation- This is scored 1 when the number of dots is reduced.
  12. Separation- When there is a separation between the subparts, it is given 1.
  13. Absence of erasure- When the participant does not use an eraser for a mistake, the sign is given a score of 1.
  14. Closure- When more than one angle of a design is not closed, this sign is scored 1.
  15. Point of contact- This is given 1 score when on design A, the square and circle do not touch each other adequately.

D. Verbal Adult Intelligence Scale (VAIS)

Verbal intelligence is crystallized by social interaction, experiences, schooling, etc. and hence it continues to develop beyond the age of physiological maturity. Aging and brain injury generally, do not reduce the verbal ability until the domineering hemisphere is involved. Verbal Adult Intelligence Scale (VAIS) consists of 4 subtests

  • Information– This subtest consists of 33 items. Read each question exactly as stated. If the response to a question is incomplete or not clear. We may say “Explain what you mean or tell me more about it.” Do not ask leading questions or spell the words. Record the subject’s response to each item in the appropriate space on the Record form.
  • Digit Span – Two parts of this test Digit Forward and Digit Backward have already been administered under subtest IV – Attention and Concentration of the PGI Memory Scale, therefore, the items and procedure are not reproduced here again. The scoring procedure, however, is different than for the memory scale.
  • Arithmetic – It consists of 15 items. Start with item 3 and give credit for items 1 and 2 if the subject passes either item 3or item 4. If both items 3 and 4 are failed, administer items 1 and 2 before proceeding further. A problem may be repeated once if the subject may not be permitted to use pencil and paper for any problem. However, the subject is not to be discouraged from using a finger to ‘write’ on the table. 1 point for each correct response was given.
  • Comprehension – It consists of 18 items. Start with item 1. Read each question slowly to the subject. Some subjects find it difficult to remember an entire question. You may repeat the question, but do not alter the wording or abbreviate it. It is good practice to repeat the question if no response is obtained but no further urging should be given. Item 3,7,10,15 require 2 correct response for full credit. If the subject gives one correct response but does not give another spontaneously, ask for a second response. Say, ‘Tell any other way to keep the health it.’

The scale is meant for adult subjects in the age range of 20 and above. It gives Test Quotients separately for 4 subtests and a V.Q (Verbal Quotient) that is the mean of T. Qs (Test Quotient), separately for males and females of different age and educational levels (Pershad and Verma,1988). It stresses power or capacity rather than speed or efficiency. The administration of this test is simple and takes about 20-30 minutes. The Digit Span test has already been administered earlier in Memory Scale, it is not repeated here. Only the scoring of this test is described.

E. NAHOR- BENSON TEST

The Nahor Benson Test is a drawing test that helps measure the functioning of the right hemisphere specifically related to the parieto-occipital lobe. The parietal lobe helps understand spatial relationships and the occipital lobe involves visual-perceptual acuity. The test consists of 8 cards, out of which the first 5 cards contain a design each and the rest of the 3 cards contain the instructions to be followed to draw an object. The 5 cards at the start are based on developmental patterns, and the 4th and 5th cards assess the copying ability with respect to depth perception. These cards help assess if there is an organic brain dysfunction and the extent of it. In people with organic brain dysfunctions, there is a diminishing of the thing learned earlier in life. The designs from 1 to 4 in the Nahor Benson Test are disturbed when the person has a lesion in the right parieto-occipital region. The other 3 cards require understanding, consolidating, and following the instructions which help assess any left hemisphere-related disturbances, especially that in transference from left to the right hemisphere.

METHODOLOGY:

MATERIAL REQUIRED :

Pencil, paper, PGI BBD, and stopwatch.

PROCEDURE TO FIND THE PARTICIPANT: The participant was chosen as random based on convenient family members as it was highly difficult to find a person suffering from or diagnosed with any neurological disorder or brain dysfunction.

INFORMED CONSENT: The participant was first given a brief description of the test. He was also informed that the test would be conducted entirely at his own discretion which implies that he could decline his participation in this experiment if it was not convenient. He was then given a consent form and all the relevant details related to the form were explained before soliciting the signature.

____________________________________________________________________________________________________________________________________________________

INFORMED CONSENT FORM

This form seeks to take your consent to participate in a study. The following will provide you with information about the study that will help you in deciding whether or not you wish to participate. If you agree to participate, please be aware that you are free to withdraw at any point throughout the duration of the experiment. All information you provide will remain confidential and will not be associated with your name. If for any reason during this study you do not feel comfortable, you may leave the laboratory and your information will be discarded.

When this study is complete you will be provided with the results of the experiment if you request them, and you will be free to ask any questions. Please indicate with your signature on the space below that you understand your rights and agree to participate in the experiment. Your participation is solicited, yet strictly voluntary. All information will be kept confidential and your name will not be associated with any research findings.

NY

SIGNATURE OF THE APPLICANT

____________________________________________________________________________________________________________________________________________________ __

RAPPORT FORMATION:

A rapport was established before giving the instructions by giving him a brief detail of the study. It was also ensured that the details were explained to the participant in the language which was most agreeable to him. All the arrangements regarding the experiment were arranged in an appropriate manner. The participant’s concerns if any were also managed for the smooth conduction of the experiment.

 DEMOGRAPHIC DETAILS-

  • NAME: ny
  • AGE: 22
  • GENDER: MALE
  • DATE OF ADMINISTRATION OF THE TEST: 29TH NOVEMBER 2020.

INSTRUCTIONS

Each of the subtests from the P. G. I. Battery of Brain Dysfunctions has its own set of instructions that are to be given before starting the test. Following are the general instructions given to the participant-

  • For P. G. I. Battery of Brain Dysfunction

I am going to conduct a test by the name of P. G. I BBD which consists of 5 subtests. Each subtest has a set of questions, and I will give you the necessary instructions and clear your queries before asking the questions or giving you the tasks from the subtests. We will start with the PGI Memory Scale.

  • For PGI Memory Scale

There are 10 subtests in the PGI Memory Scale, and each has its own set of instructions that I will provide you before starting each subtest. You can ask me any queries you have now or while I give you the task to be completed in case of confusion.

  • For Battery of Performance Tests of Intelligence

It has 2 parts that you must complete. For the first part that we are going to start, I will show you 10 cards of designs one by one. You have 16 cubes in front of you. You are required to replicate the design shown in the card with the help of the cubes. You will get 2 minutes for each design. I will demonstrate the first design to help you understand how it has to be done. You can examine the blocks to gain a better understanding of them.

For the second part of the test, I will show you 8 cards with designs. You have to replicate the design by moving around the blocks that you see in front of you within the rectangular boxes. However, remember that you are only allowed to move the blocks and you can’t lift them.

Subtest 1- The first part consists of 33 questions that are related to basic, general knowledge. You must answer as many questions as you can be based on whether or not you know the answer.

Subtest 2- The second part is divided into 2 sub-parts. For the first sub-part, I will read aloud a sequence of numbers, and you are supposed to repeat it after me. In the second sub-part, I will read aloud the number sequence, however, you are supposed to repeat it in backward order. I will demonstrate how to do it once.

Subtest 3- For the 3rd sub-test, there are 15 basic arithmetic questions. You have to answer the questions and you won’t be allowed a paper and a pencil to calculate the answers.

Subtest 4- The 4th sub-test has a total of 18 questions. You can give as many responses to each question as you can. In case you have any queries now or during the test, you can ask me.

  • For Nahor Benson Test

This test consists of 8 cards. 5 of the cards have certain designs. You are required to copy these designs as precisely as you can. For the last 3 cards, you will find the instructions on the cards. You are required to follow the instructions as precisely as you can and draw. You can clarify any queries you have.

  • For Bender Visual-Motor Gestalt Test

I will give you 9 cards one by one, and you are required to copy the designs in these cards as precisely as you can. You can ask me in case you have any queries.

RESULT TABLES

  1. PGI-memory scale
S. NoSub-testRaw ScoreConverted ScoreDysfunction rating
1Remote Memory   65+0
2Recent Memory  55+0
3Mental Balance  85+0
4Attention and Concentration135+0
5Delayed Recall  95+0
6Immediate Recall115+0
7Verbal Retention for Similar Pair  55+0
8Verbal Retention for Dissimilar Pair145+0
9Visual Retention125+0
10Recognition  95+0
  • Verbal Adult Intelligence Scale
S. noSubtestRaw ScoreT.QDysfunction Rating
1Information Subtest221030
2Digit Span Subtest241550
3Arithmetic Subtest121010
4Comprehension Subtest331270
  • Nahor Benson Test
DesignError ScoreDysfunctional Score
100
200
300
400
500
600
700
800
  • Bender Visual-Motor Gestalt Test
SignsError scoreFigure
EMBELLISHMENTS26
ABBREVIATION11
RAW SCORE TOTAL OF ALL SIGNSDYSFUNCTION RATING
30

INTERPRETATION AND DISCUSSION :

In P.G.I-Memory Scale (PGI-MS) the participant scored well for attention and concentration in forwarding digit span while scoring relatively lower for backward digit span could be due to any disturbance. Other tests were performed well and the dysfunction rating score obtained was 0, which indicates that the patient can pay attention and concentrate, meaning no impact on attention from damage to areas like the prefrontal cortex because of the lesion is there.

In Verbal Adult Intelligence Scale, the total dysfunction rating is 0, which indicates no deficits. The participant answered 22 out of the 33 questions in the Information subtest. This indicates that the participant’s general knowledge meets the standards as expected with respect to his age, educational qualifications, and socio-economic and cultural background. He scored 24 on the digit span test, 12 on the arithmetic test lastly he scored 33 on the comprehension test. Which indicates normally functioning attention, ability to encode the numbers, and auditory processing when the numbers were being recited indicates that his ability to understand basic language and the ability of abstract thinking are intact.

In Nahor-Benson Test, the participant was able to draw all the 5 design shapes of the card and was able to follow the rest 3 instruction in the card and draw them completely without an error. So, these give the participant 0 scores in error score and 0 scores in the dysfunctional score. These indicate that the participant has no brain dysfunction, as well as his right hemisphere specifically related to the parieto-occipital lobe that helps understand spatial relationships and occipital lobe involves visual-perceptual acuity are intact.

In Bender Visual-Motor Gestalt Test, the participant was able to draw most of the 9 figures characterized by their gestalt appropriately. In figure 1, the participant missed one dot and in figure 6, when drawing a line the participant draws a little extra wave meaningless line. And apart from this, all the figures were drawn appropriately, which gives him a total raw score of all figures 3 and which is converted into dysfunction rating as 0. This indicates that the participant has no sign of brain dysfunction. It also indicates that the participant’s perceptual and visual-motor functioning are intact. The participant has no neurological impairment and emotional disturbances.

CONCLUSION:

The participant score 0 in a dysfunction rating of the P.G.I-Memory Scale (P.G.I-MS). This indicates that there is no deficit in his semantic memory, verbal episodic memory, and visual episodic memory. And the participant score 0 in a dysfunction rating of the Verbal Adult Intelligence Scale which indicates overall normalcy in his intelligence, memory, concentration. The participant score 0 in a dysfunction rating of the Nahor-Benson Test which indicates normalcy in his visual perceptual acuity. The participant score 0 in a dysfunction rating of the Bender Visual-Motor Gestalt Test which indicates that the participant’s perceptual and visual-motor functioning are intact. Thus the overall results of the test indicate no deficits in those specific brain functioning from lesions or any neurological disorders or dysfunctions in the participant. Hence, it can be concluded that participants are functioning normally.

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