Reliability and Validity of Culturally Adapted Executive Function Performance Test for Koreans with Stroke

Processing Speed and Attentional Shift/Mental Flexibility in Patients with Stroke: A Comprehensive Review on the Trail Making Test in Stroke Studies

The Trail Making Test (TMT) is one of the most commonly administered tests in clinical and research neuropsychological settings. The two parts of the test (part A (TMT-A) and part B (TMT-B)) enable the evaluation of visuoperceptual tracking and processing speed (TMT-A), as well as divided attention, set-shifting and cognitive flexibility (TMT-B). The main cognitive processes that are assessed using TMT, i.e., processing speed, divided attention, and cognitive flexibility, are often affected in patients with stroke. Considering the wide use of TMT in research and clinical settings since its introduction in neuropsychological practice, the purpose of our review was to provide a comprehensive overview of the use of TMT in stroke patients. We present the most representative studies assessing processing speed and attentional shift/mental flexibility in stroke settings using TMT and applying scoring methods relying on conventional TMT scores (e.g., time-to-complete part A and part B), as well as derived measures (e.g., TMT-(B-A) difference score, TMT-(B/A) ratio score, errors in part A and part B). We summarize the cognitive processes commonly associated with TMT performance in stroke patients (e.g., executive functions), lesion characteristics and neuroanatomical underpinning of TMT performance post-stroke, the association between TMT performance and patients' instrumental activities of daily living, motor difficulties, speech difficulties, and mood statue, as well as their driving ability. We also highlight how TMT can serve as an objective marker of post-stroke cognitive recovery following the implementation of interventions. Our comprehensive review underscores that the TMT stands as an invaluable asset in the stroke assessment toolkit, contributing nuanced insights into diverse cognitive, functional, and emotional dimensions. As research progresses, continued exploration of the TMT potential across these domains is encouraged, fostering a deeper comprehension of post-stroke dynamics and enhancing patient-centered care across hospitals, rehabilitation centers, research institutions, and community health settings. Its integration into both research and clinical practice reaffirms TMT status as an indispensable instrument in stroke-related evaluations, enabling holistic insights that extend beyond traditional neurological assessments.

Measurement properties of performance-based instruments for assessing mental function during activity and participation in persons with stroke: A systematic review

BACKGROUND

Various performance-based instruments exist to assess mental function after stroke and users have to select one for research or clinical practice.

OBJECTIVES

To evaluate the measurement properties of performance-based instruments to assess (any aspect of) mental function during activity and participation in persons after stroke.

MATERIAL AND METHODS

We searched in five electronic databases. COSMIN methodology was used to conduct the review. The strength of evidence was assessed using a modified GRADE approach.

RESULTS

Fifty articles were included reporting on 20 instruments assessing (1) multiple mental functions including ≥ four subdomains (2) attention, memory and executive functions, or single subdomains (3) executive functions, (4) perception, and (5) mental function of language. Highest quality evidence for sufficient results was found for some measurement properties in seven instruments. These instruments included: FIM + FAM, MPAI-4 and EFPT, MET, CBS/KF-NAP, BIT and the Scenario Test.

CONCLUSIONS

Further studies of high methodological quality are needed that evaluate the measurement properties of instruments to allow clinicians and researchers to select the most suitable performance-based measures for purpose.

SIGNIFICANCE

Results may be used to select the most suitable performance-based instrument to measure mental function during activity and participation in persons with stroke.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42018086744.

Association of nursing hours with cognitive function, balance, and dependency level of stroke patients

AIMS

To examine the association of nursing hours given to patients with stroke with clinical characteristics to predict the nursing care needs.

DESIGN

Twenty-four-hour observational study METHODS: Nursing hours per patient day (NHPPD) of 171 stroke patients were measured by 146 nursing personnel who worked on the day of the observation. Cognitive function, balance ability and dependency level were assessed using the Korean version of the Mini-Mental State Examination (K-MMSE), the Korean version of the Berg Balance Scale (K-BBS) and the Korean version of the Modified Barthel Index (K-MBI), respectively.

RESULTS

The NHPPD were moderately correlated with K-MMSE (r = -.450), K-BBS (r = -.529) and K-MBI (r = -.549). The worse the cognitive function, balance ability and dependency level, the more were the nursing hours given to the patients. Therefore, these factors can be considered to be factors that predict nursing care needs for patients with stroke.

Effects of activities of daily living-based dual-task training on upper extremity function, cognitive function, and quality of life in stroke patients

Objectives

The aim of this study was to investigate the effect of daily living dual-task training focused on improving attention and executive function of the upper extremities, cognitive function, and quality of life in stroke patients.

Methods

We included 30 stroke patients who were hospitalized between July 2020 and October 2020. They were divided into experimental and control groups through randomization. The experimental group performed 20 minutes of dual-task training and received 10 minutes of conventional occupational therapy, while the control group performed 20 minutes of single-task training and received 10 minutes of conventional occupational therapy. Both groups underwent their respective rehabilitation for 30 minutes per session, 5 times per week for 5 weeks.

Results

Both groups showed significant improvements in upper extremity function, cognitive function, and quality of life; the experimental group showed higher results for all items. A significant between-group difference was observed in the magnitude of the changes.

Conclusion

In stroke patients, dual-task training that combined attention and executive function with daily living activities was found to be meaningful, as it encouraged active participation and motivation. This study is expected to be used as a foundation for future interventions for stroke patients.

Executive Function Performance Test: transcultural adaptation, evaluation of psychometric properties in Brazil

OBJECTIVES

Executive dysfunction occurs in 18.5% to 39% of patients who present with cognitive impairment. Occupational therapy aims to facilitate independence and autonomy, hence improving quality of life. The Executive Function Performance Test - Brazilian version (EFPT-BR) has been developed to assess the need for assistance in performing four basic daily tasks. The aims of this research were: (1) to offer cross-cultural adaptation in patients with stroke; (2) to assess the psychometric properties of the Brazilian version of the EFPT-BR in patients with stroke; (3) to assess the relationship between scores on the EFPT-BR in patients with stroke, and demographic variables, stroke location, symptoms of anxiety and depression.

METHODS

The transcultural adaptation and validation were performed based on standard procedures, and psychometric properties were assessed in 86 Brazilian patients who suffered a stroke.

RESULTS

The test has shown a good internal consistency (Cronbach's alpha: 0.819). The ICC for intra-rater reliability was 0.435 and for the inter-rater was 0.732. Significant correlations between scores in the EFPT-BR and executive measures (verbal fluency test, clock drawing test, digit span - forwards and backwards, zoo map test and Six Elements Test) were observed.

CONCLUSION

The EFPT-BR is a valid and reliable tool for occupational therapists to assess executive dysfunction in daily routine tasks in patients with stroke in Brazil.