Performance-based everyday functioning after stroke: relationship with IADL questionnaire and neurocognitive performance

Cognitive and everyday functioning after bacterial brain abscess: a prospective study of functional recovery from 8 weeks to 1 year post-treatment

OBJECTIVE

A bacterial brain abscess may damage surrounding brain tissue by mass effect, inflammatory processes, and bacterial toxins. The aim of this study was to examine cognitive and functional outcomes at 8 weeks and 1 year following acute treatment.

METHODS

Prospective study of 20 patients with bacterial brain abscess (aged 17-73 years; 45% females) with neuropsychological assessment at 8 weeks and 1 year post-treatment. Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) and Patient Competence Rating Scale (PCRS) were used to assess everyday functioning and administered to patients and informants.

RESULTS

Cognitive impairment was found in 30% of patients at 8 weeks and 22% at 1 year. Significant improvements were seen on tests of perceptual reasoning, attention, verbal fluency, and motor abilities (p < 0.05). At 1 year, 45% had returned to full-time employment. Nevertheless, patients and their informants obtained scores within the normal range on measures of everyday functioning (PCRS and BRIEF-A) at 8 weeks and 1 year. No significant improvements on these measures emerged over time.

CONCLUSION

Residual long-term cognitive impairment and diminished work ability affected 22% and 45% of patients one year after BA. Persistent cognitive impairment emphasizes the importance of prompt acute treatment and cognitive rehabilitation.

Do neurocognitive impairments explain the differences between brain tumour patients and their proxies when assessing the patient’s IADL?

Background

Neurocognitive impairments are common among brain tumour patients, and may impact patient’s awareness of performance in instrumental activities in daily life (IADL). We examined differences between patient- and proxy-reported assessments of the patient’s IADL, and whether the level of (dis)agreement is associated with neurocognitive impairments.

Methods

Brain tumour patients and their proxies completed the phase 3 version of the EORTC IADL-BN32 questionnaire measuring IADL, and patients completed six neurocognitive measures. Patient-proxy difference scores in IADL were compared between patients who were defined as neurocognitively impaired (≥2 neurocognitive measures ≥2.0 standard deviations below healthy controls) and non-neurocognitively impaired. With multinomial logistic regression analyses we examined if neurocognitive variables were independently associated with patient-proxy disagreement in IADL ratings.

Results

Patients (n=81) did not systematically (p&lt;0.01) rate IADL outcomes different than their proxies. Proxies did report more problems on 19/32 individual items and all five scales. This effect was more apparent in dyads with a neurocognitively impaired patient (n=37), compared to dyads with non-neurocognitively impaired patients (n=44). Multinomial logistic regression analyses showed that several neurocognitive variables (e.g., cognitive flexibility and verbal fluency) were independently associated with disagreement between patients and proxies on different scales.

Conclusion

Neurocognitive deficits seem to play a role in the discrepancies between brain tumour patients and their proxies assessment of patient’s level of IADL . Although replication of our results is needed, our findings suggests that caution is warranted in interpreting self-reported IADL by patients with neurocognitive impairment, and that such self-reports should be supplemented with proxy ratings.

Divergence Between Informant and Self-Ratings of Activities of Daily Living Impairments in Parkinson’s Disease

Objective

To examine the agreement between self- and informant-reported activities of daily living (ADL) deficits in Parkinson’s Disease (PD) patients, and to examine factors influencing ADL ratings.

Background

In PD, the loss of functional independence is an important outcome of disease progression. The valid assessment of ADL function in PD is essential, but it is unclear to what extent informants’ and patients’ perceptions of their daily functions concur, and how other factors may influence both ratings.

Methods

Data of 150 PD patients who underwent cognitive and motor testing, as well as their informants were analyzed. The 10-item Functional Activities Questionnaire (FAQ), completed separately by patients (FAQ-S) and their informants (FAQ-I), assessed ADL function. Weighted κ statistics summarized level of agreement, and a discrepancy score (FAQ-I – FAQ-S) quantified agreement. Correlation analyses between FAQ total scores, patient and informant characteristics, and cognitive scores were conducted, with post hoc regressions to determine the associations between both FAQ scores and cognition, independent of patient characteristics.

Results

The sample included 87 patients with normal cognition, 50 with mild cognitive impairment, and 13 with dementia. Overall, there was fair to moderate agreement between patients and informants on individual FAQ items (0.27 ≤ κ ≤ 0.61, p &lt; 0.004), with greater discrepancies with increasing cognitive impairment. Patients’ age, motor severity, non-motor burden, and depression also affected both ratings (0.27 ≤ r ≤ 0.50, p &lt; 0.001), with motor severity showing the greatest influence on both ratings. Both the FAQ-I and FAQ-S were correlated with almost all cognitive domains. Post hoc regression analyses controlling for patient characteristics showed that the attention domain was a significant predictor of both the FAQ-S and FAQ-I scores, and memory was also a significant predictor of the FAQ-I score. Only 29.3% of patients agreed perfectly with informants on the FAQ total score, with informants most commonly rating ADL impairments as more severe than patients.

Conclusions

Patient and informant ratings of ADL function using FAQ items showed moderate agreement, with only few items reaching substantial agreement. Ratings of both were associated with patient cognitive status, but also other characteristics. In addition to patient and informant reports, objective measures are needed to accurately classify ADL deficits in PD.

Cognitive predictors of a performance-based measure of instrumental activities of daily living following stroke

BACKGROUND

To inform cognitive interventions that target functional capacity for individuals who have survived stroke, an evaluation of predictors of daily functioning is necessary. The current literature is limited regarding identifying the associations between objective cognitive functioning and objective performance of Instrumental Activities of Daily Living (IADLs).

OBJECTIVES

To investigate the relationship between objectively measured cognitive domains/executive functions and performance on an objective measure of IADLs following a stroke.

METHODS

Cross-sectional examination of 52 participants who have survived strokes and completed assessments of immediate memory, visuospatial/constructional skills, language, attention, delayed memory, executive functions (i.e., inhibition and flexibility, concept-formation and problem-solving, abstract thinking, deductive thinking, and verbal abstraction), and a performance-based measure of IADLs (UCSD Performance-based Skills Assessment; UPSA).

RESULTS

Results indicated significant correlations between the UPSA and immediate memory, visuospatial/constructional skills, language, delayed memory, and executive functions (i.e., concept formation and problem-solving, flexibility of thinking, and verbal abstraction). A hierarchical multiple regression, controlling for age, severity of stroke, side of stroke, and depressive symptoms and including the cognitive measures individually significantly associated with the UPSA, explained approximately 62% of the variance in overall UPSA performance. This regression demonstrated that only language significantly predicted UPSA total score, in the context of multiple variables.

CONCLUSIONS

Cognitive functioning is significantly associated with IADL functioning post-stroke, and considering multiple domains of cognitive functioning together largely explains the performance of IADLs.

Influence of age and education on a performance-based measure of everyday functioning

Sociodemographic variables, such as age and education, influence the determination of impairment on neuropsychological tests, but their influence on impairment determinations for tests of everyday functioning is less well defined. Existing studies suggest that older age and lower education levels are associated with worse everyday functioning when assessed by self- or collateral-report. This relationship, however, has not been thoroughly investigated with performance-based methods of everyday functioning. This study aimed to determine the influence of sociodemographic factors on the Functional Impact Assessment (FIA), a performance-based measure of everyday functioning that includes measures of both accuracy and speed. Seventy-three healthy individuals, ages 42 - 88 years, completed the FIA and an additional everyday functioning self-report questionnaire (Functional Activities Questionnaire). Using a multiple regression statistical approach, age and education predicted overall FIA accuracy, while age alone predicted FIA speed. Sociodemographic variables continued to predict FIA performance when controlling for overall cognitive functioning. Sociodemographic variables were unrelated to FAQ scores. These findings indicate that age and education are associated with scores on a performance-based test of everyday functioning. Demographic corrections may improve accuracy in determining functional impairment, but more research is needed given the complex relationships among demographic factors, healthy aging, and dementia risk.

Computerized cognitive training using virtual reality on everyday life activities for patients recovering from stroke

Purpose: Recent studies argue that the use of virtual reality tasks depicting activities daily living may be effective means for cognitive rehabilitation. The aim of this study was to test an ecologically oriented approach in virtual reality resembling the demands of everyday life activities for cognitive rehabilitation following stroke. Materials and Methods: The sample comprised 30 sub-acute stroke patients recovering from stroke in a rehabilitation hospital. They were assessed in a single-arm pre-post intervention study on global cognition, executive functions, memory and attention abilities. The intervention consisted of virtual reality in a multidomain cognitive training approach depicting everyday life tasks (preparing food, choosing clothes, shopping, etc.). Results: Improvements were found in the assessed cognitive domains at 6 to 10 post-treatment sessions. In-depth analysis through reliable change scores has suggested larger treatment effects on global cognition. Conclusions: Overall results suggest that the use of virtual reality-based exercises on everyday life activities may be a useful cognitive rehabilitation approach to provide short-term gains in cognition following stroke.Implications for rehabilitationVirtual reality-based cognitive rehabilitation resembling everyday life activities may provide short-term gains in cognition of stroke patients;Consistent improvements in executive functions may require higher treatment dosage than for improvements in global cognition.

Measurement properties of instruments to assess mental function during activity and participation in individuals surviving traumatic brain injury: A systematic review protocol

Background: Most studies assessing mental function in individuals with traumatic brain injury (TBI) assess the impairments through pen and paper tests. However, weak correlation has been found between the results from pen and paper tests and the results from performance-based tests during activity and participation. Objective: To investigate measurement properties of performance-based instruments that are used to assess mental function during activity and participation in individuals with a TBI. Material and methods: PubMed, EMBASE, CINAHL, PsycINFO, and OTseeker will be searched for relevant studies reporting on measurement properties of performance-based instruments to assess mental function in individuals with a TBI. The COnsensus-based Standards for selection of Health Measurement Instruments (COSMIN) checklist will be used to evaluate the methodological quality of the included studies. The Terwee quality criteria will be applied to evaluate the study findings for each measurement property. To summarize all the evidence, a best evidence synthesis will be performed. Results: Results will be presented in text and tables. Conclusions: Conclusion will be drawn up-on the overall evidence Significance: It is expected that the findings of the review will provide evidence to guide clinicians in the selection of instruments to use in occupational therapy practice and research.

Laterality of Damage Influences the Relationship Between Impairment and Arm Use After Stroke

OBJECTIVES

To investigate whether the relationship between arm use and motor impairment post-stroke is influenced by the hemisphere of damage.

METHODS

Right-handed patients with unilateral left hemisphere damage (LHD) or right (RHD) (n=58; 28 LHD, 30 RHD) were recruited for this study. The Arm Motor Ability Test and Functional Impact Assessment were used to derive arm use patterns. The Fugl-Meyer motor assessment scale was used to quantify the level of motor impairment.

RESULTS

A significant interaction between patient group and impairment level was observed for contralesional, but not ipsilesional arm use. For lower impairment levels, contralesional (right arm for LHD and left arm for RHD) arm use was greater in LHD than RHD patients. In contrast, for greater levels of impairment, there were no arm use differences between the two patient groups.

CONCLUSIONS

When motor impairment is significant, it overrides potential effects of stroke laterality on the patterns of arm use. However, a robust influence of hemisphere of damage on the patterns of arm use is evident at lower impairment levels. This may be attributed to previously described arm preference effects. These findings suggest adoption of distinct strategies for rehabilitation following left versus right hemisphere damage in right-handers, at least when the impairment is moderate to low. (JINS, 2019, 25, 470-478).

Clinical Utility of Select Neuropsychological Assessment Battery Tests in Predicting Functional Abilities in Dementia

OBJECTIVE

Neuropsychological test performance can provide insight into functional abilities in patients with dementia, particularly in the absence of an informant. The relationship between neuropsychological measures and instrumental activities of daily living (IADLs) is unclear due to hetereogeneity in cognitive domains assessed and neuropsychological tests administered. Practical and ecologically valid performance-based measures of IADLs are also limited. The Neuropsychological Assessment Battery (NAB) is uniquely positioned to provide a dual-purpose assessment of cognitive and IADL function, as it includes Daily Living tests that simulate real-world functional tasks. We examined the utility of select NAB tests in predicting informant-reported IADLs in mild cognitive impairment and dementia.

METHODS

The sample of 327 participants included 128 normal controls, 97 individuals with mild cognitive impairment, and 102 individuals with Alzheimer's disease dementia from the Boston University Alzheimer's Disease Center research registry. Informants completed the Lawton Brody Instrumental Activities of Daily Living Scale, and study participants were administered selected NAB tests that were complementary to the existing protocol.

RESULTS

ROC curves showed strongest prediction of IADL (AUC > 0.90) for memory measures (List Learning delayed recall and Daily Living Memory delayed recall) and Daily Living Driving Scenes. At a predetermined level of specificity (95%), List Learning delayed recall (71%) and Daily Living Memory delayed recall (88%) were the most sensitive. The Daily Living Memory and Driving Scenes tests strongly predicted IADL status, and the other Daily Living tests contributed unique variance.

CONCLUSIONS

NAB memory measures and Daily Living Tests may have clinical utility in detecting informant-rated functional impairment in dementia.

Simulation of variable impedance as an intervention for upper extremity motor exploration

Current methods in robot-assisted therapy are limited in providing predictions of the effectiveness of interventions. Our approach focuses on how robotic interaction can impact the distribution of movements expressed in the arm. Using data from a previous study with stroke survivors (n=10), we performed simulations to examine how changes in hand endpoint impedance would alter exploratory motion. We present methods for designing a custom training intervention, by relating the desired change in acceleration covariance in planar motion with a corresponding change in inertia matrix. We first characterized motor exploration in terms of overall covariance in acceleration, and secondly as covariance that varies with position in the workspace. Using a forward dynamics simulation of the hand endpoint impedance, we found that the variable change in endpoint inertia resulted in better recovery of acceleration covariance compared to the fixed change in inertia method. These results could significantly impact rehabilitation firstly in terms of design principles for altering coordination patterns through direct assistance. Furthermore, our work might serve to improve therapy by facilitating access to repeated practice of independent joint motion.

Systematic Review of Measurement Property Evidence for 8 Financial Management Instruments in Populations With Acquired Cognitive Impairment

OBJECTIVES

To critically appraise the measurement property evidence (ie, psychometric) for 8 observation-based financial management assessment instruments.

DATA SOURCES

Seven databases were searched in May 2015.

STUDY SELECTION

Two reviewers used an independent decision-agreement process to select studies of measurement property evidence relevant to populations with adulthood acquired cognitive impairment, appraise the quality of the evidence, and extract data. Twenty-one articles were selected.

DATA EXTRACTION

This review used the COnsensus-based Standards for the selection of health Measurement Instruments review guidelines and 4-point tool to appraise evidence. After appraising the methodologic quality, the adequacy of results and volume of evidence per instrument were synthesized. Measurement property evidence with high risk of bias was excluded from the synthesis.

DATA SYNTHESIS

The volume of measurement property evidence per instrument is low; most instruments had 1 to 3 included studies. Many included studies had poor methodologic quality per measurement property evidence area examined. Six of the 8 instruments reviewed had supporting construct validity/hypothesis-testing evidence of fair methodologic quality. There is a dearth of acceptable quality content validity, reliability, and responsiveness evidence for all 8 instruments.

CONCLUSIONS

Rehabilitation practitioners assess financial management functions in adults with acquired cognitive impairments. However, there is limited published evidence to support using any of the reviewed instruments. Practitioners should exercise caution when interpreting the results of these instruments. This review highlights the importance of appraising the quality of measurement property evidence before examining the adequacy of the results and synthesizing the evidence.

Accuracy statistics in predicting Independent Activities of Daily Living (IADL) capacity with comprehensive and brief neuropsychological test batteries

This investigation was designed to determine the predictive accuracy of a comprehensive neuropsychological and brief neuropsychological test battery with regard to the capacity to perform instrumental activities of daily living (IADLs). Accuracy statistics that included measures of sensitivity, specificity, positive and negative predicted power and positive likelihood ratio were calculated for both types of batteries. The sample was drawn from a general neurological group of adults (n = 117) that included a number of older participants (age >55; n = 38). Standardized neuropsychological assessments were administered to all participants and were comprised of the Halstead Reitan Battery and portions of the Wechsler Adult Intelligence Scale-III. A comprehensive test battery yielded a moderate increase over base-rate in predictive accuracy that generalized to older individuals. There was only limited support for using a brief battery, for although sensitivity was high, specificity was low. We found that a comprehensive neuropsychological test battery provided good classification accuracy for predicting IADL capacity.

Validation of Taiwan Performance-Based Instrumental Activities of Daily Living (TPIADL), a Performance- Based Measurement of Instrumental Activities of Daily Living for Patients with Vascular Cognitive Impairment

Objective

Patients with cerebrovascular diseases often presented both cognitive and physical impairment. Disability in everyday functioning involving cognitive impairment among patients may be hard to completely rely on informants’ reports, as their reports may be confounded with physical impairment. The aim of this study was to validate a performance-based measure of functional assessment, the Taiwan Performance-Based Instrumental Activities of Daily Living (TPIADL), for vascular cognitive impairment (VCI) by examining its psychometric properties and diagnostic accuracy.

Methods

Ninety-seven patients with cerebrovascular diseases, including 30 with vascular dementia (VaD), 28 with mild cognitive impairment and 39 with no cognitive impairment, and 49 healthy control adults were recruited during study period. The TPIADL, as well as the Mini Mental State Examination (MMSE), Lawton-IADL and Barthel Index (BI), were performed. The internal consistency, convergent and criteria validity of the TPIADL were examined.

Results

Cronbach’s alpha of the TPIADL test was 0.84. The TPIADL scores were significantly correlated with the Lawton IADL (r = –0.587, p <0.01). Notably, the TPIADL had a higher correlation coefficient with the cognitive domain of Lawton IADL (r = –0.663) than with physical domain of Lawton IADL (r = –0.541). The area under the relative operating characteristic curve was 0.888 (95% CI = 0.812–0.965) to differentiate VaD from other groups. The optimal cut-off point of the TPIADL for detecting VaD was 6/7, which gives a sensitivity of 73.3% and a specificity of 84.5%.

Conclusion

The TPIADL is a brief and sensitive tool for the detection of IADL impairment in patients with VaD.

Systemic Lisbon Battery: Normative Data for Memory and Attention Assessments

Background

Memory and attention are two cognitive domains pivotal for the performance of instrumental activities of daily living (IADLs). The assessment of these functions is still widely carried out with pencil-and-paper tests, which lack ecological validity. The evaluation of cognitive and memory functions while the patients are performing IADLs should contribute to the ecological validity of the evaluation process.

Objective

The objective of this study is to establish normative data from virtual reality (VR) IADLs designed to activate memory and attention functions.

Methods

A total of 243 non-clinical participants carried out a paper-and-pencil Mini-Mental State Examination (MMSE) and performed 3 VR activities: art gallery visual matching task, supermarket shopping task, and memory fruit matching game. The data (execution time and errors, and money spent in the case of the supermarket activity) was automatically generated from the app.

Results

Outcomes were computed using non-parametric statistics, due to non-normality of distributions. Age, academic qualifications, and computer experience all had significant effects on most measures. Normative values for different levels of these measures were defined.

Conclusions

Age, academic qualifications, and computer experience should be taken into account while using our VR-based platform for cognitive assessment purposes.

Movement distributions of stroke survivors exhibit distinct patterns that evolve with training

Background

While clinical assessments provide tools for characterizing abilities in motor-impaired individuals, concerns remain over their repeatability and reliability. Typical robot-assisted training studies focus on repetition of prescribed actions, yet such movement data provides an incomplete account of abnormal patterns of coordination. Recent studies have shown positive effects from self-directed movement, yet such a training paradigm leads to challenges in how to quantify and interpret performance.

Methods

With data from chronic stroke survivors (n = 10, practicing for 3 days), we tabulated histograms of the displacement, velocity, and acceleration for planar motion, and examined whether modeling of distributions could reveal changes in available movement patterns. We contrasted these results with scalar measures of the range of motion. We performed linear discriminant analysis (LDA) classification with selected histogram features to compare predictions versus actual subject identifiers. As a basis of comparison, we also present an age-matched control group of healthy individuals (n = 10, practicing for 1 day).

Results

Analysis of range of motion did not show improvement from self-directed movement training for the stroke survivors in this study. However, examination of distributions indicated that increased multivariate normal components were needed to accurately model the patterns of movement after training. Stroke survivors generally exhibited more complex distributions of motor exploration compared to the age-matched control group. Classification using linear discriminant analysis revealed that movement patterns were identifiable by individual. Individuals in the control group were more difficult to identify using classification methods, consistent with the idea that motor deficits contribute significantly to unique movement signatures.

Conclusions

Distribution analysis revealed individual patterns of abnormal coordination in stroke survivors and changes in these patterns with training. These findings were not apparent from scalar metrics that simply summarized properties of motor exploration. Our results suggest new methods for characterizing motor capabilities, and could provide the basis for powerful tools for designing customized therapy.

Development and validation of a new performance-based measurement of instrumental activities of daily living in Taiwan

BACKGROUND

The performance-based instrumental activities of daily living (IADL) measurement is thought to improve the validity and reliability of conventional tools that rely on proxy reports. The aims of this study were to develop and validate a performance-based measurement of IADL for use in elderly patients with cognitive impairment in Taiwan and other Chinese-speaking communities.

METHODS

Referring to current versions of performance-based IADL, we developed the new Taiwan Performance-Based IADL (TPIADL) measurement to minimize literacy dependency and render it compatible with local culture. Participants performed tasks, including finding a telephone number, calculating the correct amount of change, reading the ingredients on a tin of food, finding food items on a shelf, and reading instructions on a medicine container. The internal consistency and convergent and criteria validity of the TPIADL were examined.

RESULTS

Altogether, 117 elderly subjects were invited to participate in this study, including 39 patients with dementia due to Alzheimer's disease, 29 with amnestic mild cognitive impairment, and 49 without cognitive impairment. The internal consistency of the TPIADL was 0.82. The TPIADL scores were significantly correlated with the Lawton Instrumental Activities of Daily Living Scale (r = 0.76, P < 0.001). The area under the relative operating characteristic curve was 0.90 (95% confidence interval = 0.84-0.97) to differentiate dementia due to Alzheimer's disease and others. The optimal cut-off point for the TPIADL was 6/7, which gives a sensitivity of 84.6% and a specificity of 75.6%.

CONCLUSIONS

The TPIADL is a validated instrument for the measurement of IADL in elderly subjects. It might replace conventional assessment as a valid and easily administered measurement.

Individual patterns of motor deficits evident in movement distribution analysis

Recent studies in rehabilitation have shown potential benefits of patient-initiated exploratory practice. Such findings, however, lead to new challenges in how to quantify and interpret movement patterns. We posit that changes in coordination are most evident in statistical distributions of movements. In a test on 10 chronic stroke subjects practicing for 3 days, we found that inter-quartile range of motion did not show improvement. However, a multivariate Gaussians analysis required more complexity at the end of training. Beyond simply characterizing movement, linear discriminant classification of each patient's movement distribution also identified that each patient's motor deficit left a unique signature. The greatest distinctions were observed in the space of accelerations (rather than position or velocity). These results suggest that unique deficits are best detected with such a distribution analysis, and also point to the need for customized interventions that consider such patient-specific motor deficits.

The neuropsychological assessment battery categories test as a measure of executive dysfunction in patients with Parkinson's disease and essential tremor: an exploratory study

Patients with Parkinson's disease (PD) and essential tremor (ET) can experience deficits in executive functioning (EF) secondary to abnormalities in fronto-striatal and cerebellar-frontal pathways respectively. The assessment of EF can be confounded in these patients due to motor difficulties and slowed processing speed. Thus, instruments which do not require speeded motor responses are potentially attractive in this population. The Neuropsychological Assessment Battery-Categories Test (NABCAT) is one such instrument. This study evaluated the convergent and divergent validity of this measure as well as its diagnostic accuracy in comparison to other commonly administered tests. Records for 28 patients with PD and/or ET who presented for evaluation pre-deep brain stimulation surgery were analyzed. The NABCAT had modest correlations with other measures of EF, as well as memory. However, it demonstrated relatively poor sensitivity and modest specificity to executive dysfunction. The NABCAT did not demonstrate adequate psychometric properties to replace traditional measures of EF in this population; however, it may have utility as a screening instrument for more significant dysfunction.

Contralesional Arm Preference Depends on Hemisphere of Damage and Target Location in Unilateral Stroke Patients

Background Previous research has shown that during simulated activities of daily living, right-handed stroke patients use their contralesional arm more after left- than right-hemisphere stroke. These findings were attributed to a hand preference effect. However, these decisions about when to use the contralesional arm may be modulated by where in the work space the task is performed, a factor that could be used in physical rehabilitation to influence recovery by decreasing learned nonuse. Objective To examine how target location and side of stroke influences arm selection choices for simple reaching movements. Methods A total of 14 right-handed stroke patients (7 with left-hemisphere and 7 with right-hemisphere damage [RHD]), with similar degrees of hemiparesis (Fugl-Meyer motor score), and 16 right-handed controls participated in this experiment. In a pseudorandom fashion, 32 targets were presented throughout the reachable horizontal plane work space, and the participants were asked to select 1 hand to reach the target on each trial. Results The group with left-hemisphere damage chose their contralesional arm significantly more often than the group with RHD. Patients with RHD also chose their left (contralesional) arm significantly less often than the control group. However, these patterns of choice were most pronounced in the center of the workspace. Conclusion Both the side of hemisphere damage and work space location played a significant role in the choice of whether to use the contralesional arm for reaching. These findings have implications for structuring rehabilitation for unilateral stroke patients.

Multiple Errands Test-Revised (MET-R): a performance-based measure of executive function in people with mild cerebrovascular accident

OBJECTIVE. This article describes a performance-based measure of executive function, the Multiple Errands Test-Revised (MET-R), and examines its ability to discriminate between people with mild cerebrovascular accident (mCVA) and control participants. METHOD. We compared the MET-R scores and measures of CVA outcome of 25 participants 6 mo post-mCVA and 21 matched control participants. RESULTS. Participants with mCVA showed no to minimal impairment on measures of executive function at hospital discharge but reported difficulty with community integration at 6 mo. The MET-R discriminated between participants with and without mCVA (p ≤ .002). CONCLUSION. The MET-R is a valid and reliable measure of executive functions appropriate for the evaluation of clients with mild executive function deficits who need occupational therapy to fully participate in community living.

Everyday cognition in older adults: associations with neuropsychological performance and structural brain imaging

The recently developed Everyday Cognition scales (ECog) measure multiple cognitively relevant functional domains (e.g., Everyday Memory, Everyday Language, Everyday Visuospatial abilities, and three everyday executive domains). The present study further evaluated the validity of the ECog by examining its relationship with objective measures of neuropsychological function, and neurobiological markers of disease as reflected by structural neuroimaging. Participants included 474 older adults (244 normals, 142 with MCI, 88 with dementia). The neuropsychological domains measured were episodic memory, semantic memory, spatial ability, and executive functioning. Brain MRI volumes included total brain (BV), hippocampus (HC) and dorsolateral prefrontal cortex (DLPFC). Neuropsychological measures of episodic memory and executive function were most consistently related to the ECog domains; spatial abilities had a specific relationship to the Everyday Visuospatial ECog domain. HC and BV volumes were related to most ECog domains, while DLPFC volume was independently related to two everyday executive domains (Everyday Planning and Everyday Organization). The pattern of associations varied somewhat as a function of diagnosis. Episodic memory and HC had more consistent associations with the ECog domains in older adults with MCI/dementia than in cognitively normal elderly.

Zur deutschen Adaptation der Neuropsychological Assessment Battery (NAB)

Standardisierte Testverfahren bilden einen wichtigen Bestandteil neuropsychologischer Diagnostik. Im deutschsprachigen Raum besteht ein großer Bedarf für eine einheitlich normierte neuropsychologische Testbatterie. Die Neuropsychological Assessment Battery (NAB) ist ein in den USA entwickeltes Verfahren zur Beurteilung der neuropsychologischen Funktionen bei Erwachsenen (Alter 18 – 97 Jahre). Die NAB besteht aus zwei äquivalenten Parallelformen, die jeweils in sechs Module untergliedert sind: Screening, Aufmerksamkeit, Sprache, Gedächtnis, Wahrnehmung und Exekutive Funktionen. Das Verfahren ermöglicht eine umfangreiche, psychometrisch fundierte und ökologisch valide Diagnostik. Die NAB wird im Hinblick auf die Entstehungsgeschichte, psychometrische Güte und bisherige Rezeption präsentiert. Die Autorengruppe arbeitet zurzeit an der deutschen Adaptation und Normierung der NAB.

Relationship between arm usage and instrumental activities of daily living after unilateral stroke

OBJECTIVE

To determine whether the preferred pattern of arm use after unilateral hemispheric damage was associated with better everyday functioning. Our previous work showed that right-handed stroke patients with right hemisphere damage (RHD) used their right, ipsilesional arm most frequently, while those with left hemisphere damage (LHD) used both arms together most frequently. This effect was explained by right-hand preference, but its relationship to functional performance is not known.

DESIGN

Observational cohort.

SETTING

Research laboratory.

PARTICIPANTS

Stroke patients (n=60; 30 RHD, 30 LHD) and healthy controls (n=52).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The Functional Impact Assessment was used to assess performance on instrumental activities of daily living (IADLs).

RESULTS

The preferred patterns of arm use were similar to those in our previous report. However, it was the greater use of both arms together that was associated with better IADL performance in both stroke groups. Ipsilesional arm use alone was not significantly associated with IADL performance in the RHD group and was associated with poorer performance in the LHD group.

CONCLUSIONS

The modal arm use pattern did not always optimize IADL functioning. Better IADL functioning in both stroke groups was associated with the use of both arms together, which is the most common arm use pattern of healthy individuals doing these same IADLs. An important practical question that arises from these findings is whether bilateral arm rehabilitation should be emphasized, because using both arms together is the best predictor of better performance on everyday tasks.