The Luria-Nebraska

Neuropsychological Battery (LNNB)

Dr. Meenakshi Shukla

Assistant Professor
Department of Psychology
Magadh University
Bodh Gaya
 Luria-Nebraska Neuropsychological Battery
• It is based on the work of the Russian neuropsychologist A. R. Luria (1966). The standardized version of LNNB
contains 269 items. Each item is administered separately and represents a specific aspect of function.
• With a few exceptions, each item differs in some respect from all other items on the test. The items vary along such
dimensions as complexity, degree of difficulty, mode of stimulus input (auditory, verbal, tactile), mode of answering
(open-ended, motor, speech, multiple-choice), whether it is timed or untimed, and amount of information available.
• In this way, 11 major areas of neuropsychological performance are explored: motor skills; rhythmic and pitch abilities;
tactile abilities; expressive speech skills, receptive speech abilities; reading, writing, and arithmetic skills; memory
skills; visual-spatial skills; and intellectual ability.
• It is usually recommended that the administration of the LNNB be preceded by information about the client. This can
focus on problems the patient perceives he/she is having, as well as giving the clinician the opportunity to observe
difficulties the patient has in such areas as speech (both receptive and expressive), memory and intelligence. This can
aid in giving the clinician a focus for problems that may arise during the examination.
 Test materials
• The set of test materials contains all the stimulus cards needed for the test and a cassette tape used in administering
the C2 scale. It also uses the Patient Response Booklet for items that require written responses from the client, such
as drawings of figures or writing samples. A number of common household objects are also required for the
administration and must be supplied by the user.

Test setting
• The battery can be administered at bedside with the client in a reclining position; however, it is preferable for the
client to be seated upright with a hard surface available for presenting materials and for writing responses. The
examiner should be seated upright opposite the client and should present the visual materials in the midline of the
client's visual field.
• The battery may be given in a series of sessions. The examiner may vary the length of the sessions as necessary
depending on the ability of the client to concentrate and the build up of fatigue in the individual. By carefully
observing the ways in which the client is able to handle the testing situation, a great deal of important qualitative
information can be gained, some of which is scored within the qualitative scoring system of the LNNB.
 Repeating or Paraphrasing Items

• Item instructions may be repeated or paraphrased as necessary to allow the client to understand.
Instructions generally are not repeated more than twice unless the examiner judges that this will
improve client’s performance.
• When instructions are paraphrased, changes should reflect such factors as the client’s cultural
language background and any impairment in understanding that may have been caused by brain
damage.
• On most items, instructions can be written or communicated in a system other than oral speech.
Where appropriate the examiner may demonstrate what is requested of the client to ensure that the
client understands the task.
• The demonstration should not use items actually employed in the battery.
• For all scales except C2 (Rhythm), C5 (Receptive speech), and C10 (Memory), the item stimuli may
also be repeated as necessary unless prohibited by specific item directions.
• It is permissible to re-administer any item in the battery, with the exception of specific C5 (Receptive
Speech) and C10 (Memory) items. In these cases the entire item, not only subsections, is to be
administered.
 Encouraging, questioning and instructing the client

• Before initiating testing, the client should be informed that he/she will be asked to do a number of
things and answer a number of questions, some of which may be very simple and seem silly,
whereas others may be very difficult.
• Despite the fact that some items may seem silly and meaningless to the client, it is important that
the client try to do his/her best in responding to the task, as quickly as possible, but at the same
time making sure that accuracy and quality are maintained.
• It is important that the examiner be skilled in working with clients, who either have emotional
problems or are suffering from acute neurological disorders, as these groups tend to be the most
difficult to test in an adult population.
• When the client gives an answer to any item on the battery, that is inadequate but not wrong, the
examiner may further query the client (e.g., “Can you tell me more?”) until the examiner is clear that
the client’s intent was clearly right or wrong.
• Leading questions are not permissible for the objective scoring; however, for the qualitative
scoring, the examiner may add questions when necessary to clarify the nature of any errors or
unusual behaviour on the part of the client.
 Quantitative scoring
• Each item is scored in one of a number of ways, depending on the item content. The scoring
techniques include accuracy, speed, quality of response, time to make a response, trials to a
criterion level, and the number of responses.
• After a raw score is determined for each item, it is translated into a scaled score of 0, 1, or 2.
• A score of 0 indicates normal performance, a score of 1 indicates weak evidence of brain disorder,
and a score of 2 indicates strong evidence of brain disorder.
• The administration protocol of the test contains the normative data necessary to determine the
scaled score for any given raw score on each item.
• After the individual responses to each item have been converted into item scores (0, 1, or 2), the
item scores are summed within each scale to yield summary scale indices. For all scales, one
simply adds together the scores of the items that make up each scale.
• With the addition of the summary, localisation, and factor scales, items may each be on multiple
scales. Raw scores are converted into T scores with a mean of 50 and a standard deviation of 10,
using the appropriate tables in the manual.
• High scores reflect more pathology.
 Qualitative scoring

• A score of an error on the LNNB may arise from a wide range of difficulties: the client may fail
to understand the instructions, may perseverate, may ignore the left side of the stimuli, and so
forth.
• In addition, clients may get an answer correct and still show signs of brain dysfunction. For
instance, the client may give the correct answer to an intelligence item but show signs of
dysarthria in giving the answer.
• Similarly, a client may understand instructions for motor items only after several repetitions and
demonstrations.
• Therefore, in addition to the quantitative scoring system, the qualitative scoring system is now
available. The qualitative scoring categories catalogue the client’s “test behaviour”.
• Comparisons may then be made between the frequency of the client’s qualitative signs in each
category and the frequency of these qualitative signs for normals and various groups of brain
damaged clients.
• There are 66 basic qualitative categories that may be scored on the LNNB. These categories
have been divided into 11 conceptual groupings or areas: Motor Functions, Sustained
Performance, Self-monitoring, Self-cuing, Visual-Spatial Functions, Peripheral impairment,
Expressive Language, Dysarthria, Receptive Language, Speed, and Option Card.
 General scale descriptions
• After the scores for each item are determined, the following 11 primary summary scales are scored.
• These summary scale scores are the sum of the individual scaled scores on each item within a given area.

➢ C1- Motor Functions

✓ This scale includes both simple and complex motor skills. The items on the scale involve simple timed
motor tasks, simple motor tasks without visual feedback, simple motor tasks that are produced by
imitation, simple and complex motor movements directed by verbal commands, and bilateral motor
coordination.
✓ In addition, the scale evaluates mouth and tongue movements, including simple movements and series of
movements, and the ability of the subject to spontaneously draw and copy simple geometric shapes.
➢ C2- Rhythmic and Pitch Skills
✓ The first half of this section evaluates pitch skills: The ability to determine whether two
tones have the same pitch, to determine which of the two tones is higher, and to reproduce
increasingly complex tonal sequences.
✓ The second half of the section evaluates rhythmic skills identifying the number of tones in a
sequence, identifying whether the rhythmic patterns are the same, and producing rhythmic
patterns on verbal command.
➢ C3- Tactile Functions
• This section evaluates simple and complex tactile and kinaesthetic functions. All items in this section are
given to the subject while he or she is blindfolded. The subject must identify where he or she is touched, state
whether a touch is sharp or blunt, discriminate between a hard and soft touch, identify numbers and letters
written on the hands, reproduce a movement of one arm that is flagged by the examiner, and identify
common objects by touch alone.

➢ C4- Visual (Spatial) functions

• This section evaluates basic visual and spatial functions, except for construction skills, which are evaluated in
the motor section.

• The items require subjects to recognise simple objects presented to them, to identify photographs and line
drawings, to identify objects presented in a mixed-up jumble, to discern pictures in which only part of the
gestalt is visible, to solve problems similar to those found in Raven’s Matrices and to work with 3-D piles of
blocks and two dimensional rotations.
➢ C5- Receptive Speech

• This section evaluates the subject’s ability to correctly understand a wide variety of material presented
auditorily. The initial section evaluates the subject’s skills in understanding simple phonemes, phonemic
combinations, series of phonemes, and phonemes presented in different pitches.

• The second part of the section evaluates simple word comprehension, comprehension of simple sentences,
and comprehension of sentences involving contradictions, prepositions, possessive constructions, spatial
relationships, logical relationships, inverted grammatical structures, and complex or compound constructions.

➢ C6- Expressive Speech

• This section evaluates an individual’s skill at expressing material orally. This includes the repetition of
phonemes and the repetition of successively more difficult words.

• The section also evaluates the subject’s ability to repeat increasingly complex sentences, as well as to repeat
automatic and simple sequences (such as the days of the week).

• The section also measures a subject’s ability to spontaneously discuss a topic in response to pictures, a story
and a theme. Finally the subject must organise words into intelligible statements.
 Assessment - Expressive Language

[Abnormal] [Normal]
➢ C7-Writing

• This section evaluates basic writing skills, including simple spelling and the ability to copy letters and words
from cards, from memory, and from dictation. Spontaneous writing skills are also evaluated.

➢ C8-Reading

• This section parallels the writing section. The subject must reproduce sounds from letters, name individual
letters and their sounds, and read words of varying complexity, sentences, and short stories.

➢ C9-Arithmetic

• This section covers a wide range of skills related to mathematical abilities. This skills include number
recognition (both Arabic and Roman numerals), the combination of numbers, simple arithmetic skills
(addition, subtraction, multiplication, and division) & simple algebraic problems.
• Two items require the subject to subtract 7 and 13 from 100 continuously, which are similar to the tasks seen
on most mental status examinations.
➢ C10- Memory

• This section evaluates a wide range of

amnestic processes. Subjects are re-
examined on their ability to memorize a list
of items over several trials to memorize
pictures and other non-verbal stimuli, to
memorize short verbal lists with and without
interference, to memorize a story, and to
associate verbal labels with pictures.

➢ C11- Intellectual Processes

• This section which covers a wide range of

intellectual processes, includes a number of
items similar to those on the Wechsler Adult
Intelligence Scale Comprehension, Picture
Arrangement, Arithmetic, Similarities, and
Vocabulary subtests, subjects must explain
the theme of a picture, describe what is
funny about a picture, and make logical
comparisons.
• In addition to these basic 11 sections, three additional summary scores are calculated. The Left Hemisphere
score consists of all items in the Motor and Tactile sections that require the use of the right hand alone. The
Right Hemisphere score consists of all items in the Motor and Tactile sections that require the use of the left-
hand alone.
• The final scale, Pathognomonic (the word means ‘signs/symptoms of a particular disease), consists of 31 items
that are especially sensitive to brain damage. These items, rarely missed by non brain-injured patients, are
missed by brain-injured patients much more frequently than other groups of patients.
• After raw scores are determined for each summary index, they are plotted on the profile sheet. From the left-
hand column of the profile sheet, T scores (with the mean of 50 and a standard deviation of 10) can be read for
each score.
• These T scores can be averaged across all 14 indices to yield a total score which can act as a quick summary of
the individual’s level of performance.
Profile Sheet
Thank you…