This paper outlines some of the issues that arise when neuropsychologists, usually white, are faced with carrying out neuropsychological assessments on indigenous people. Whilst the focus is on the New Zealand situation and the assessment of Maori, it is suggested that some of the issues and possibly some of the solutions will provide a useful starting point for other countries, including Australia, where indigenous people have been colonised and as a result are over-represented in many of the negative statistics. New Zealand is in a transition stage where the number of indigenous clinical psychologists and neuropsychologists is growing but is still very small. Even when there are enough Maori neuropsychologists to serve the needs of Maori clients, there will still be situations when Maori prefer to be seen by a white neuropsychologist, or when a white neuropsychologist is the only professional available with the appropriate expertise related to the assessment of a particular disorder. It is therefore our professional responsibility to develop knowledge and skills that will assist us to carry out culturally-fair assessments which can lead to a better outcome for the client, and at the very least can reduce the harm done by an insensitive and invalid assessment.

This study investigated cognitive flexibility as indexed by the Written and Oral Trail Making Test (TMT) in sixteen persons with dementia and 60 normal elderly. Written and Oral TMT performances were significantly correlated with each other and with other tests of cognitive flexibility providing an index of the convergent construct validity of these tests. Part B of the Written TMT was influenced by psychomotor ability although this was diminished by the use of a ratio score B/A rather than simply Part B performance. The Oral test was not related to visual or motor skills, providing evidence for its divergent validity. Both parts of the Written and Oral TMT were found to be sensitive to cognitive decline in dementia. Performance on both Oral and Written TMT was also influenced by age, gender, education and intellectual ability. Previous norms (e.g., MOANS) for the Written TMT which are based on relatively educated elderly, tended to provide deflated scores for the community group tested here. Some additional, preliminary normative data for both tests were compiled which take into account the influences of each of these variables.

We report on the development of a new assessment tool to monitor recovery after severe traumatic brain injury (TBI). Although a number of scales exist to identify such recovery, most are limited if one is interested in monitoring small changes or in setting goals for rehabilitation. This is due to the fact that items are too broad, they may cross more than one dimension (e.g. cognition and motor functioning) and there is a danger that recording of responses may be too subjective. The Wessex Head Injury Matrix (WHIM) was developed to avoid these problems. We observed 88 people with severe TBI. These were consecutive admissions to two hospitals. Mean coma duration was 14 days and mean duration of post traumatic amnesia (PTA) was 56 days. Of 145 behaviours observed, we selected 62 and each behaviour was compared to every other behaviour to determine a likely order of recovery. The resulting WHIM is an observational tool to assess and monitor cognitive recovery after severe head injury. It can be used with patients who are in coma, just out of coma or who are minimally conscious. Two case examples are provided.

Over the past two decades there has been an increasing number of patients surviving severe traumatic brain injury and entering rehabilitation facilities at an earlier phase in their recovery. These patients often present in a minimally conscious state and are difficult to objectively assess. As a result, a number of batteries have been developed targeting this population. The Western Neuro Sensory Stimulation Profile (WNSSP) was used in the present study to identify patterns in recovery of cognitive-sensory modalities. The WNSSP records of 25 patients in a minimally conscious state were examined and profiles of recovery over four test occasions of a subset of 12 patients were examined in detail. Results demonstrated that within this highly heterogeneous group, Object Manipulation was an early emerging skill, and trends to significance were also observed in Auditory Response, Visual Tracking and Olfactory Response. A case study is presented to illustrate how the WNSSP results can be utilised to direct individualised treatment planning.

On addressing our first meeting in 1976, I speculated on whether the study of the brain and behaviour which had flowered in the preceding decade would continue to develop and assist us in treating brain impaired individuals. Not only did this happen but our Society (Australian Society for the Study of Brain Impairment) founded two years later has gone from one good thing to another. My reservation in accepting the invitation to speak at this 23rd Annual Brain Impairment Conference was a concern about preaching to the converted. My life-time role has been that of missionary, both at home and abroad and, like teachers of all faiths, I have no reservations about repeating what are to me fundamental truths. I will try to keep to the theme of the emergence of ideas rather than an autobiography, but some chronology will help set the background.