The Relationship Between the Assessment of Motor and Process Skills (AMPS) and the Large Allen Cognitive Level (LACL)Test in Clients with Stroke

Rehabilitation with intensive attention training early after acquired brain injury promotes better long-term status on health-related quality of life, daily activities, work ability and return to work

OBJECTIVE

To describe long-term effects on activity, participation, and quality of life (i) at different post-injury starting time points of attention training and (ii) of two different types of rehabilitation with attention training in patients after stroke or traumatic brain injury; and to describe their functioning level.

DESIGN

2 years after rehabilitation intervention, comparisons were made in one cohort receiving attention training subacute (< 4 months) or post-acute (4-12 months) and in one cohort with two different training methods, a process-based and an activity-based method respectively.

PATIENTS

100 patients were recruited from our earlier RCT study. They had mild to moderate stroke or traumatic brain injury with relatively limited symptomatology, and all had moderate to severe attention impairment.

METHODS

A questionnaire-based interview: EuroQol 5 dimensions, Occupational Gaps Questionnaire, Work Ability Index, self-assessed work status, self-reported employment conditions, sick leave, and experienced cognitive limitations in work performance.

RESULTS

An advantage for patients receiving subacute attention training regarding daily activities, work ability and returning to work.

CONCLUSION

The results indicate that subacute rehabilitation with attention training (< 4 months) is preferable compared to post-acute intervention (4-12 months). There were only minor differences between the training methods.

Clinical validation of the Allen's Cognitive Level Screen in acquired brain injury

BACKGROUND

The evaluation of functional cognition is a central concern in clinical practice. However, there are few standardized or validated tools, and many of them take too long, requiring screening tests.

AIMS

To explore the convergent validity of the ACLS-5 with other cognitive screening test and functional independence test in a sample of people with acquired brain injury. Moreover, to examine the prediction of ACLS-5 on functioning and cognitive performance outcomes.

MATERIALS AND METHODS

A cross-sectional design was applied following the guidelines of the STROBE checklist. A consecutive sample of people with acquired brain injury was recruited from rehabilitation centers. A cognitive screening test and daily living activity tests were implemented, such as ACLS-5, MoCA, Barthel, and FIM+FAM. Data were analyzed using non-parametric methods. In addition, a structural analysis and simple regression models were performed.

RESULTS

Eighty patients with chronic acquired brain injury, with a mean age of 52, were recruited. All tests are significantly related to the ACLS-5 score, a moderate effect size for MoCA (ρ = 0.36), and a strong effect size for the other two (ρ > 0.50).

CONCLUSIONS

ACLS-5 predicts functional and cognitive performance quickly and effectively, optimizing assessment time and avoiding mental fatigue or physical exhaustion.

Is a structured work task application for the assessment of work performance in a constructed environment, useful for patients with attention deficits?

BACKGROUND

The purpose of our study was to develop a Structured Work Task application for the Assessment of Work Performance for patients with attention deficits.

MATERIAL AND METHODS

We developed a computer-based registration task titled the Attention-demanding Registration Task. It had a structured administrative procedure with additional scoring regarding time and accuracy, also linked to the original scoring of the Assessment of Work Performance. We evaluated the Attention-demanding Registration Task for content validity. Furthermore, we investigated it concerning sensitivity and specificity in patients with attention deficits due to acquired brain injury (n = 65) against a comparison group of healthy people (n = 47).

RESULTS

Our investigation on content validity using the Assessment of Work Characteristics confirmed that the Attention-demanding Registration Task sets high demands on process skills, especially on energy, temporal organization, and adaptation. The Attention-demanding Registration Task showed high sensitivity and specificity in differing between patients with attention deficits and a healthy working group; nine out of ten participants were placed in the correct group.

CONCLUSIONS

To assess work performance, the use of a Structured Work Task application, the Attention-demanding Registration Task, linked with the Assessment of Work Performance, proved to be sensitive to attention deficits.Implications for rehabilitationA Structured Work Task application for the Assessment of Work Performance was developed for use in people with attention deficits and showing a high degree of sensitivity and specificity.Linking performance time and accuracy to the Assessment of Work Performance scoring and providing a guide for linking task performance to the Assessment of Work Performance skills in addition to the usual observations performed, may increase scoring accuracy.Reference data for a comparison group of healthy subjects are provided.The use of the Attention demanding Registration Task, while using the Assessment of Work Performance within clinical practice ensures a more accurate description of process skills in performance.

The role of executive functions and psychiatric symptom severity in the Allen Cognitive Levels

This study examined the relationship between Allen Cognitive Level (ACL) and psychiatric symptom severity, level of nursing support required to complete activities of daily living (ADLs), and post-hospitalization discharge disposition in a sample of 193 acute psychiatric inpatients. A subsample of 31 participants with acute psychotic disorders were administered three measures of executive functioning in order to examine the convergent validity between ACL and basic sequencing and shifting, phonemic fluency, and visuospatial construction. Findings indicated significant moderate positive correlations between ACL and motor processing speed, basic sequencing and shifting, and phonemic fluency, and a nonsignificant relationship with visuospatial construction. A subsample of 166 participants were administered the Brief Psychiatric Rating Scale-Expanded (BPRS-E) to assess psychiatric symptom severity. Results indicated a significant weak negative correlation between ACL and total psychiatric symptomatology, as well as significant weak negative correlations with specific symptoms. In contrast with prior research, there was no significant correlation between ACL and level of nursing assistance required to complete ADLs. A logistic regression did not identify ACL as a contributing factor to post-hospitalization discharge disposition. These findings call into question the clinical utility of the ACLS-5 as an assessment of functional cognition for those experiencing acute psychiatric illness.

Skill clusters of ability to manage everyday technology among people with and without cognitive impairment, dementia and acquired brain injury

BACKGROUND

In order to develop supporting interventions for people demonstrating problems ET use, a detailed level of description of strengths and deficits is needed.

AIMS

To explore clusters of specific performance skill required when using ET, and to evaluate if and in what way such clusters are associated with age, gender, diagnosis, and types of ETs managed.

MATERIALS AND METHODS

A secondary analysis of 661 data records from 203 heterogeneous samples of participants using the Management of Everyday Technology Assessment (META) was used. Ward's method and a hierarchical tree cluster analysis were used to determine and define the skill clusters.

RESULTS

Four distinct clusters of performance skill item profiles were found, across the 661 data records. These were then, based on each individuals' cluster profiles in managing ET, categorized into two groups. The two groups were associated with, diagnosis and type of ETs managed.

CONCLUSIONS AND SIGNIFICANCE

The findings support a more dyadic person-ET approach in evaluation of ET management. The information from the skill clusters can be used to develop targeted intervention guides for occupational therapy and healthcare.

Allen Cognitive Level Screen for the classification of subjects treated for addiction

Introduction The Cognitive Disabilities Model (CDM) is an occupational approach that can allow the classification of the functional-cognitive abilities of persons with addictions. The objective of the study was to explore the applicability of the ACLS-5 to assess a sample of persons undergoing addiction-rehabilitation treatment. Methods A sample of 232 participants was recruited from an outpatient treatment centre in Madrid (Spain). The ACLS-5, the Montreal Cognitive Assessment (MoCA), and the Prefrontal Symptom Inventory (PSI) were administered. Sociodemographic and addiction-related data were also obtained. Results Half of the sample showed serious deficits in functional cognition, which ultimately could be related to problems in their daily performance. Scores of ACLS-5 showed significant correlations with the severity of addiction, with those obtained with the MoCA, and with attentional symptoms on the PSI scale. Conclusions The data suggest the applicability of the ACLS-5 in assessing the degree of functional cognition in subjects treated for addiction, providing evidence to support ecological validity and facilitating the development of well-targeted cognitive rehabilitation programmes from an occupational perspective. The use of occupational-based instruments to assess the functioning of those with addictions is a requirement of occupational therapy professionals working in this general area.

Assessing Cognition after Stroke. Who Misses Out? A Systematic Review

Background

Cognitive impairments post-stroke are common. Assessment of cognition typically involves pen-and-paper tasks, which are often reliant on linguistic and motor function, creating barriers for many stroke survivors. The characteristics of stroke survivors excluded from cognitive assessments have never been investigated.

Aims

( 1 ) To determine if the stroke samples included in studies evaluating clinimetric properties of cognitive assessments represent the stroke population, ( 2 ) to identify the different modes of cognitive assessments, and ( 3 ) to ascertain whether the different modes of cognitive assessments influence the stroke samples used in the studies.

Summary of review

We systematically reviewed studies that evaluated at least one clinimetric property of a cognitive assessment in adult stroke survivors from January 2000 to October 2013. Eligibility criteria, reasons for drop-outs and missing data were extracted. A theming process was employed to synthesize the data. From the initial yield of 3731 articles, 109 were included. Six broad categories describing reasons for exclusion were identified. Cognitive impairments were the most common (68%), then communication issues (62%), endurance problems (42%), sensory loss (39%), psychiatric illness (38%) and motor limitations (27%). The most prevalent assessment mode was pen-and-paper (73%), then virtual reality (11%), computer (6%), observational functional performance (5%), informant (3%) and telephone (3%). Regardless of mode, issues with cognition and communication were the most frequently used exclusion criteria.

Conclusions

Our findings indicate that cognitive assessments are not tested in representative stroke samples. Research is needed to identify valid and reliable cognitive assessments that are feasible in a wider range of stroke survivors.