Assignment

Neuropsychological testing
Definition

 Clinical neuropsychology is a field with historical origins in both psychology and

neurology. The primary activity of neuropsychologists is assessment of brain
functioning through structured and systematic behavioral observation.
 Neuropsychological tests are designed to examine a variety of cognitive
abilities, including speed of information processing, attention, memory,
language, and executive functions, which are necessary for goal-directed
behavior. By testing a range of cognitive abilities and examining patterns of
performance in different cognitive areas, neuropsychologists can make
inferences about underlying brain function.
 Neuropsychological testing is an important component of the assessment and
treatment of traumatic brain injury, dementia, neurological conditions, and
psychiatric disorders. Neuropsychological testing is also an important tool for
examining the effects of toxic substances and medical conditions on brain
functioning.
Causes of Neurocognitive problems

Neuropsychological testing provides diagnostic clarification and grading

of clinical severity for patients with obvious or supposed cognitive
deficits. Often these include patients with a history of any of the following
problems:

 Head injury
 Failure to achieve developmental milestones
 Learning or attention deficits
 Exposure to drugs, alcohol, or maternal illness in utero
 Exposure to chemicals, toxins, or heavy metals
 Neurodegenerative diseases
 Cerebral palsy
 Genetic disorders including, but not limited to, trisomy’s,
monosomies, and trinucleotide repeat disorders
 Parkinson disease
 Seizure disorders
 Substance abuse
 Strokes
 Dementia
 Psychiatric disorders
 Categories/Domains
 Tests can be organized into broad categories based on the cognitive
function which they predominantly assess.
 Intelligence
 Memory
 Language
 Executive function
 Visuospatial
 Dementia specific
 Batteries assessing multiple neuropsychological functions
 Intelligence
 National Adult Reading Test (NART)
 Wechsler Adult Intelligence Scale (WAIS)
 Wechsler Intelligence Scale for Children (WISC)
 Wechsler Preschool and Primary Scale of Intelligence (WPPSI)
 Wechsler Test of Adult Reading (WTAR)
Memory

 Benton Visual Retention Test

 California Verbal Learning Test
 Bender Visual Motor Gestalt Test
 Measures visual perception and visual memory
 Memory Assessment Scales (MAS)
 Rey Auditory Verbal Learning Test
 River mead Behavioral Memory Test
 Test of Memory and Learning (TOMAL)
 Wechsler Memory Scale (WMS)
 Test of Memory Malingering (TOMM)
 Cambridge Test of Prospective Memory (CAMPROMPT)
 Language
 Boston Diagnostic Aphasia Examination
 Boston Naming Test
 Comprehensive Aphasia Test (CAT)
 Multilingual Aphasia Examination
Executive Functioning

 Behavior Rating Inventory of Executive Function

 CNS Vital Signs (Brief Core Battery)
 D2 Test of Attention
 Digit Vigilance Test
 Figural Fluency Test
 Halstead Category Test
 Hayling and Brixton tests
 Kaplan Baycrest Neurocognitive Assessment (KBNA)
 Kaufman Short Neuropsychological Assessment
 Paced Auditory Serial Addition Test (PASAT)
 Rey-Osterrieth Complex Figure
 Ruff Figural Fluency Test
 Stroop task
 Test of Variables of Attention (T.O.V.A.)
 Tower of London Test
 Trail-Making Test (TMT) or Trails A & B
 Wisconsin Card Sorting Test (WCST)
 Symbol Digit Modalities Test
 Test of Everyday Attention (TEA)
Visuospatial

 Clock Test
 Hooper Visual Organization Task (VOT)
 Rey-Osterrieth Complex Figure
 Batteries assessing multiple neuropsychological functions
 There are some test batteries which combine a range of tests to provide an
overview of cognitive skills
 Barcelona Neuropsychological Test (BNT)
 Cambridge Neuropsychological Test Automated Battery (CANTAB)
 Cognisa (The Neurobehavioral Cognitive Status Examination)
 Cognitive Assessment Screening Instrument (CASI)
 Cognitive Function Scanner (CFS)
 General Practitioner Assessment Of Cognition (GPCOG)
 Luria-Nebraska Neuropsychological battery
 Micro Cog
 Mini mental state examination (MMSE)
 NEPSY
 Sensory-perceptual functions
 Halstead-Reitan Neuropsychological Battery (HRNB)
 Tactual Performance Test and Sensory Perceptual
Examination
 Index Finger Tapping
 Hand Grip Strength
Neurocognitive Tests
1. Memory
Benton Visual Retention Test
 Arthur Name: L. Benton, PhD
 Purpose: Measures the ability of brain-damaged patients to match
unfamiliar faces
 Format: Paper and pencil
 Age range: 16 years to 74 years
 Time: Varies
California Verbal Learning Test

 Purpose
 Assessment of verbal learning and memory
 Age Range: 16 to 89 years
 Administration: By hand (Assist Software) or web-based (Q-interactive)
 Completion Time: Standard and Alternate Forms: 30 minutes testing plus 30
minutes of delay. Short Form: 15 minutes testing plus 15 minutes of delay
 Forms: Short Form, Standard Form, Alternate Form
 Norms: Nationally normed on a representative sample
Bender Visual Motor Gestalt Test

 Definition
 is a psychological test used by mental health practitioners that assesses visual-
motor functioning, developmental disorders, and neurological impairments
 Population: Ages 4 and over.
 Time: (10) minutes.
 Author: Lauretta Bender.
 Purpose
 The Bender Gestalt Test is used to evaluate visual maturity, visual motor
integration skills, style of responding, and reaction to frustration, ability to correct
mistakes, planning and organizational skills, and motivation. Copying figures
requires fine motor skills, the ability to discriminate between visual stimuli, the
capacity to integrate visual skills with motor skills, and the ability to shift attention
from the original design to what is being draw.
 Scoring: Scoring is usually relatively easy and rapid, rarely requiring more
than three or four minutes, regardless of whether a formalized or intuitive
scoring system is employed.
 Work in Pakistan
 Automated Scoring of Bender Gestalt Test Using
 Image Analysis Techniques
 Bahria University, Islamabad, Pakistan
 Age range from 16 years to 66 years.
 Limitation
 Not work on children
Measures visual perception and visual
memory
 Age: 8year to Adult
 Time: 30 mint
 Author: Lester Benton
 Purpose
 The examinee is given a booklet containing 10 blank pages on which he or
she reproduces the designs. These designs are used to gauge the
examinee's visual perception and memory, and can be administered five
different ways. The test results are professionally scored by form, shape,
pattern, and arrangement on the paper.
Memory assessment scale

 Author J. Michael Williams

 Purpose This comprehensive battery assesses short-term, verbal and visual
memory functioning. This exceptionally well normed instrument reliably and
accurately differentiates normal from neurologically impaired individuals.
 Scoring The MAS can be scored in 10 to 15 minutes.
Rey Auditory Verbal Learning test

 Authors Rey (1964) Schmidt (1996), Spreen & Strauss (1998).

 Purpose The Rey Auditory Verbal Learning Test (RAVLT) evaluates a wide
diversity of functions: short-term auditory-verbal memory, rate of learning,
learning strategies, retroactive, and proactive interference, presence of
confabulation of confusion in memory processes, retention of information,
and differences between learning and retrieval.
 Administration Time 10 to 15 minutes
River mead Behavioral Memory Test

 Author(s) Barbara A. Wilson, Eve Greenfield, Linda Clare, Alan Baddeley,

Janet Cockburn, Peter Watson, Robyn Tate, Sara Sopena, Rory Nannery
 Age Range: 16:0-96:0 years
 Completion Time: 25-30 minutes
 Forms: Four parallel versions
 Purpose The RBMT-3 as it assesses multiple components of memory including
visual, verbal, recall, recognition, immediate and delayed everyday
memory.
Test of Memory and Learning

 Author(s): Cecil R Reynolds, Erin D Bigler

 Purpose TOMAL-2 provides the most comprehensive coverage of memory
assessment currently available in a standardized battery
 Publication Year: 2007
 Age Range: 5 years to 59 years 11 months
 Administration: Individual: Core Battery - 30 minutes; Core Battery plus
Supplementary - 60 minutes.
 TOMAL-2 is useful for evaluating children or adults referred for learning
disabilities, traumatic brain injury, neurological diseases, serious emotional
disturbances and ADHD.
Wechsler Memory Scale

 Author: David Wechsler.

 Purpose: Designed to assess learning, memory, and working memory.
 Population: Individuals in the age range of 16-89 years.
 Score: Eight primary indexes and four supplemental auditory process composites.
 Time: (30 - 35) minutes, 25-30 min. between tests, (15-20) min. for optional subtests.
 Publisher: The Psychological Corporation.
 Work in Pakistan
 This scale used in the study of comparison of Memory deficits among chronic
Schizophrenics, Drug addicts, and normal.
 Limitations
 Only work on hospitalized patients (including, schizophrenics, drug addicts, and normal).
 Small sample size with only 75
Test of Memory Malingering

 Author(s): Tom N Tombaugh

 Publication Year: 1996
 Age Range: 16 years to 84 years
 Administration: Individual - 15 to 20 minutes
 Purpose A test that distinguishes between malingered and true memory
impairments
Cambridge Test of Prospective Memory
(CAMPROMPT)
 Purpose Assess difficulties in prospective memory
 Ages / Grades: Adult
 Administration Format: Paper-and-pencil
 Scores / Interpretation: Hand-scoring
Boston Diagnostic Aphasia
Examination
 Author Harold Good glass, PhD, Edith Kaplan, PhD, ABPP/CN, and Barbara
Barresi, PhD
 Purpose: Assesses aphasia
 Format: Paper and pencil
 Age range: 18 years to 79 years
 Time: Standard Form: 90 minutes; Short Form: 30-45 minutes
Multilingual Aphasia Examination
(MAE-E)
 Publication Date: 1994
 Test Type: Developmental
 Language: English
 Target Population: Native Speaker of English
 Administration Time: Untimed/guidelines
 Standardized: Yes
 Purpose: Diagnosis
Boston Naming Test

 Author: Sandra Weintraub.

 Purpose: Designed to measure object naming from line drawings.
 Population: Not reported.
 Time: 30 min
 Publisher: The Psychological Corporation.
 Scoring: The BNT contains 60 items.
Comprehensive Aphasia Test

 Author Swinburn, Porter, & Howard, 2005 The Comprehensive Aphasia Test,
Hove, , UK: Psychology Press.
 Published 2005, the first new aphasia battery in English for 20 years.
 Purpose The test is designed to (1) screen for associated cognitive deficits,
(2) assess language impairment in people with aphasia, (3) investigate the
consequences of the aphasia on the individual's lifestyle and emotional
well‐being, and (4) monitor changes in the aphasia and its consequences
over time.
Behavior Rating Inventory of Executive
Function
 Purpose: Assesses impairment of executive function
 Format: Paper and pencil, online administration and scoring
 Age range: 5 years to 18 years
 Time: 10-15 minutes
 Work in Pakistan
 Gender Differences in Executive Functions among Secondary School Students, Karachi,
Pakistan.
 Limitations
 Age limit: 12 to 14 years
 Test applied on private school students rather than government school students
 This test is applied only on English medium school students
 Scale is not translated in Urdu
Digit Vigilance Test

 Author Ronald F. Lewis, PhD

 Purpose: Assesses attention during rapid visual tracking
 Format: Paper and pencil
 Age range: 20 years to 80 years
 Time: 10 minutes
WCST Wisconsin Card Sorting Test

 Purpose: Assesses perseveration and abstract reasoning

 Format: Paper and pencil
 Age range: 6 years, 5 months to 89 years
 Time: 20-30 minutes
The Stroop Effect: Naming the Color but
Not the Word
 Author Kendra Cherry
 Purpose The Stroop effect is a phenomenon that occurs when you must say the
color of a word but not the name of the word. For example, blue might be
printed in red and you must say the color rather than the word.
 Work in Pakistan
 Cognitive interference for Trauma Related Word cues in Maltreated Children:
Evidence from the Emotional Stroop Task in a Pakistan Cohirt Lahore Pakistan,
2011.
 Limitation
 Age limit 8 to 12 years
 School children
 Applied only on urban population
Symbol Digit Modalities Test

 Author Aaron Smith, PhD

 Purpose: Screen for organic cerebral dysfunction
 Age: 8 through to 78 yrs
 Admin: Individual or group
 Time: 5 minutes
Test of Attention

 Author R. Brickencamp & E. Zilmer

 Age Individuals aged 9 to 60 years
 Language English
 Purpose The d2 has become one of the most widely-used measures of
attention - particularly visual attention - throughout Europe. Used not only
within clinical and educational settings, it is also used within the
pharmaceutical and transport sectors, and finds further application in areas
such as sports psychology.
Figural Fluency Test

 Authors Ronald Ruff

 Purpose The Ruff Figural Fluency Test (RFFT) measures an individual’s ability
to produce novel figures utilizing five different dot configurations.( Fama, R.,
Sullivan, E., Shear, P., Cahn-Weiner, D., Marsh, L., Lim, K., et al. (2000).
 Age ranged from 35 to 82 years
The Halstead Category Test

 Author Halstead and Settlage

 Formation date 1943
 Purpose The Category Test, a major part of the Halstead-Reitan
Neuropsychological Battery, This paper reviews the development of the
test, the psychometric properties of the instrument, available administration
and scoring methods, discusses various interpretative strategies, and the
empirical support for the test's clinical validity. Recent developments are
then reviewed, as well as what the authors see as the future potential for
this instrument.
Kaplan Baycrest Neurocognitive
Assessment
 Author(s) Larry Leach Edith Kaplan Dmytro Rewilak Brian Richards Guy B.
Proulx
 Purpose Assess cognitive abilities of adults with a comprehensive screening
test and Screen for cognitive ability in adults
 Ages / Grades: 20 through 89 years
 Publication Year: 2000
 Administration: Individual - 60 minutes
Kaufman Short Neuropsychological
Assessment Procedure
 Author Alan S. Kaufman
 Purpose The Kaufman Short Neurological Procedure, often abbreviated as
K-SNAP, is a brief test of mental functioning appropriate for adolescents
and adults
 Ages 11 and 85 years.
 Administration time 20–30 minutes.
Hayling and Brixton Tests

 Purpose Clinical assessment of executive functioning. Suitable for people

with a wide range of problems (eg visual perception, movement) as it is
entirely spoken.
 Author(s): Paul W Burgess, Tim Shallice
 Publication Year: 1997
 Age Range: 18 years to 80 years
 Administration: 15 minutes
Paced Auditory Serial Addition Test
(PASAT)
 Author Gronwell
 Test formed 1977
 Administration Time 10-15 minutes
 Scoring The score for the PASAT is the total number correct out of 60
possible answers. This score can be used individually or used as part of the
MSFC composite score.
 Purpose The PASAT is a measure of cognitive function that assesses auditory
information processing speed and flexibility, as well as calculation ability
Rey Complex Figure Test and
Recognition Trial
 Author John E. Meyers, PsyD, and Kelly R. Meyers
 Purpose: Measures visuospatial ability and visuospatial memory
 Format: Paper and pencil
 Age range: 6 years to 89 years
 Time: Approximately 45 minutes, including a 30-minute delay interval
(timed)
Simple Rey-Osterrieth Complex Figure
Test
 Author Swiss psychologist André Rey in 1941,
 Purpose assess spatial perception and visual memory.
 Time administration approximately 2 minutes,.
Ruff Figural Fluency Test

 Author Ronald M. Ruff, PhD

 Purpose: Provides information about nonverbal capacity for initiation,
planning, and divergent reasoning
 Format: Paper and pencil
 Age range: 16 years to 70 years
 Time: 5 minutes (60 seconds for each of the 5 parts)
 Test of Variables of Attention

 Author Lawrence Greenberg

 Purpose: assessment of attention disorders, including ADHD
 Format: Software
 Age range: 4 years to 80 years
 Time: 15-30 minutes
Test of everyday attention

 Author Ian H. Robertson, Tony Ward, Valerie Ridgeway, Ian Nimmo-Smith.

 Test formulate 1994
 Purpose Measure selective attention, sustained attention, and attentional
switching
 Age Range: 18 years to 80 years
 Administration: Individual - 45 to 60 minutes
Tower of LondonDX

 Author(s) William C. Culbertson, Psy.D. , Eric A. Zillmer, Psy.D.

 Purpose Measure higher order problem-solving ability
 Ages 7 to 80
 The Tower of London (TOL) is one task used in the assessment of executive
function
Rey Complex Figure Test and
Recognition Trial
 Author John E. Meyers, PsyD, and Kelly R. Meyers
 Purpose: Measures visuospatial ability and visuospatial memory
 Format: Paper and pencil
 Age range: 6 years to 89 years
 Time: Approximately 45 minutes, including a 30-minute delay interval
(timed)
The Clock Drawing Test

 Author(s) Ivan Aprahamian, José Eduardo Martinelli, Anita Liberalesso Neri,

and Mônica Sanches Yassuda
 Purpose To investigate the importance of the CDT compared to other
commonly used tests, in the diagnosis of dementia in the elderly; (2) to
evaluate the reliability and correlation between available CDT scoring
scales from recent studies.
 The clock-drawing test is a simple tool that is used to screen people for signs
of neurological problems, such as Alzheimer’s and other dementias. It is
often used in combination with other, more thorough screening tests, but
even when used by itself, it can provide helpful insight into a person’s
cognitive ability.
Hooper Visual Organization Test

 Author H. Elston Hooper, PhD

 Purpose Assesses neurological impairment through a quick measure of
visual integration, relatively unaffected by situational factors
 AGES5 years and up
 ADMIN TIME Less than 15 minutes
 FORMAT Patient identifies 30 objects represented in line drawings as puzzle
pieces
 SCORES T-scores and cutoff points
Cambridge neuropsychological test
automated battery
 Author obbins & Sahakian
 Purpose The CANTAB has been used to assess neurocognitive performance in modeling
studies of CFS The CANTAB has modules for several neurocognitive functions and
processes including psychomotor and motor speed, reasoning and planning abilities,
memory and attention, and frontal, temporal and hippocampal dysfunctions. Thus, it
allows assessment of neuro-cognitive dysfunctions associated with neurologic disorders,
phannacologic manipulations, and neuro-cognitive syndromes.
 Time 40-45 minutes.
 Suitable for all areas of research, especially CNS, neurological & psychiatric research
 Validated by 30 years of global neuroscience research
 Published in over 2,000 peer-reviewed papers and cited over 100,000 times
 Used extensively in global pharmaceutical trials, academic research & healthcare
Cognistat

 Author Ralph J. Kiernan, PhD, Jonathan Mueller, MD, and J. William

Langston, MD
 Purpose: Assesses neurocognitive functioning
 Format: Paper and pencil
 Age range: 12 years and older
 Time: 10 minutes for cognitively intact clients; 20-30 minutes for cognitively
impaired clients
 The Cognistat is designed to rapidly assess neurocognitive functioning in
three general areas: level of consciousness, orientation, and attention
span; and five major ability areas: language, constructional ability,
memory, calculation skills, and reasoning/ judgment.
Cognitive Function Scanner

 Author Peter Laursen, DMedSc, DPsySc, and Thomas Sams, PhD,

 Test formulation 1982
 Purpose to establish a computer-aided, standardized, reliable and
economical method for assessment of general cognitive status.
 Today the Cognitive Function Scanner is a comprehensive state-of-the-art
assessment tool including nine tests of learning and memory, psychomotor
function, visuospatial function, attention, perception, and vigilance
producing a total of 45 psychometric parameters all normed on the basis of
large epidemiological studies of the general Danish population. In addition
to the psychometric parameters the system includes a detailed time-linked
recording of the response process in accordance with the
recommendations of modern cognitive psychology, supplying essential
information for interpretation of the test results.
Cognition Assessment Screening
Instrument
 Author(s): Freddi Segal-Gidan, PA-C, PhD
 Tools to screen cognition
 Standardized Modified Mental State Exam (SMMSE)
 Clock Drawing Tool
 Montreal Cognitive Assessment Tool
Tools to screen for delirium

 Confusion Assessment Method: The CAM is a standardized, validated and

reliable screening tool for delirium
 CAM plus PRISME: PRISME provides a quick pocketguide to review
protective and causative factors
 CAM Training Manual: Provides instructions and scoring details.
 Assessing and Managing Delirium in the Patient with Dementia: Provides an
important algorithm in recognizing that the client's baseline mental status
must be taken into account when using clinical screening tools like CAM. A
revised version from the Hartford "Try This" series
 Pocket cards for delirium
Tools to screen for depression

 Geriatric Depression Scale (short English version): A brief screening tool for
depression, for use in clients with no or very subtle cognitive losses. Tested
and reliable in all clinical settings.
 Cornell Assessment Scale for Depression in Dementia (for persons with
dementia)
 MicroCog: assessment of cognitive
functioning.
 Authors. Douglas Powell, Edith Kaplan, Dean Whitla, Sandra Weintraub, Randolph Catlin,
Harris Funkenstein
 Ages / Grades: 18 to 89 years
 Administration Format: Computer administration
 Scoring Options: Computer-scored
 Scores / Interpretation: Domain index scores speed and accuracy scores functioning and
proficiency scores and summary index scores
 Report Options: Test/re-test report index report subtest proficiency score report and
significant differences report
 Overview: Automated neuropsychological battery developed for clinical practice
 Completion Time: Standard form: 60 to 90 minutes; Short form: 30 to 45 minutes
 Forms: Two: Standard and Short
 Publication Date: 2004
Luria-Nebraska Neuropsychological
Battery: Children's Revision
 AUTHOR Golden, Charles J.
 PURPOSE "To diagnose general and specific cognitive deficits, including
lateralization and localization of focal brain impairments, and to aid in the
planning and evaluation of rehabilitation programs."
 PUBLICATION DATE 1987.
 Overview The LNNB was developed in an attempt to combine the
qualitative techniques of some neuropsychological tests with the
quantitative techniques of others. However, the scoring system that most
clinicians use is primarily quantitative. The battery measures specific
neuropsychological functioning in several areas including motor skills,
language abilities, intellectual abilities, nonverbal auditory skills, and visual-
spatial skills.
NEPSY SECOND EDITION 2007

 AUTHOR Marit Korkman, Ursula Kirk, Sally Kemp

 Purpose Tailor the tool to measure cognitive abilities specific to the referral question
 Administration Format: Digital (Q-interactive) Paper-and-pencil
 Administration Time: General Assessment: Preschool ages - 45 minutes School ages - 1 hour
Diagnostic & Selective Assessment: Varies Full Assessment: Preschool ages - 90 minutes
School ages - 2 to 3 hours
 Scores / Interpretation: Scaled scores (standard scores) diagnostic scores behavioral
observations (presented as cumulative percentages or base rates)
 Report Options: Clinician reports longitudinal reports parent/ teacher reports
 Publication Year: 2007
 Age Range: 3 years to 4 years; 5 years to 16 years
 Administration: Core Assessment 45 minutes for preschool ages, 1 hour for school ages;
Comprehensive Assessment - 90 minutes for preschool ages, 2-3 hours for school ages
The General Practitioner Assessment of
Cognition
 Authors Katrin M. SeeherHenry Brodaty 2002
 PURPOSE The General Practitioner Assessment of Cognition (GPCOG) is a
very brief cognitive test specifically designed for use in primary care. .(
Brodaty, H., et al 2002).
 Administration time is less than 5 min.
Mini-Mental State Examination (MMSE)

 Purpose Widely used tool for detecting cognitive impairment, assessing severity, and
monitoring cognitive changes over time
 Time Takes ~ 5–10 minutes to administer
 Assesses 5 areas: Orientation, Short-term memory (retention), Attention, Short-term
 Memory (recall) and language
 Most commonly used tool in screening for Alzheimer’s disease (AD)
 Highly educated people tend to score higher even when they have AD
 Language Available in many languages
 Work in Pakistan
 Validation study of the Mini Mental State Examination in Urdu Language for Pakistani
Population.
 Limitation
 Applied on Dementia patients
Finger Tapper (Adult/Adolescent)

 Author PAR Staff

 Purpose: Provides information regarding brain damage and the integrity of
brain functions
 Age range: 6 years to 69 years
 Time: Varies
 Overview To measure the maximum oscillation rate of the index finger, the
individual depresses a lever attached to a mechanical counter. A
stopwatch is required.
Tactual Performance Test

 Purpose: Assesses speed of movement, tactile perception, and problem-

solving ability
 Format: Paper and pencil
 Age range: 5 years to 90 years
 Time 15 to 50 minutes to complete. There is a time limit of 15 minutes for
each trial, or each performance segment.
Handgrip Strength Test

 Author Trosclair, D; Bellar, D; Judge, L, W; Smith, 1; Mazerat, 1; Brignac, A

 Purpose The purpose of this test is to measure the maximum isometric
strength of the hand and forearm muscles. Handgrip strength is important
for any sport in which the hands are used for catching, throwing or lifting.
 Age 18 above
 Work in Pakistan
 Evaluation of Pakistani Adult Handgrip Strength Reference Values Through
Dynamometer
 Limitations
 Age limit: 18 to 54 years