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Schejter-Margalit T, Binyamin NB, Thaler A, Maidan I, Cedarbaum JM, Orr-Urtreger A, Gana Weisz M, Goldstein O, Giladi N, Mirelman A, Kizony R. Validity of the Short Weekly Calendar Planning Activity in patients with Parkinson disease and nonmanifesting LRRK2 and GBA carriers. Eur J Neurol 2024; 31:e16327. [PMID: 38743695 DOI: 10.1111/ene.16327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND PURPOSE Subtle executive dysfunction is common in people newly diagnosed with Parkinson disease (PD), even when general cognitive abilities are intact. This study examined the Short Weekly Calendar Planning Activity (WCPA-10)'s known-group construct validity, comparing persons with PD to healthy controls (HCs) and nonmanifesting carriers of LRRK2 and GBA gene mutations to HCs. Additionally, convergent and ecological validity was examined. METHODS The study included 73 participants: 22 with idiopathic PD (iPD) who do not carry any of the founder GBA mutations or LRRK2-G2019S, 29 nonmanifesting carriers of the G2019S-LRRK2 (n = 14) and GBA (n = 15) mutations, and 22 HCs. Known-group validity was determined using the WCPA-10, convergent validity by also using the Montreal Cognitive Assessment (MoCA) and Color Trails Test (CTT), and ecological validity by using the WCPA-10, Schwab and England Activities of Daily Living Scale (SE ADL), and Physical Activity Scale for the Elderly (PASE). RESULTS Known-group validity of the WCPA-10 was established for the iPD group only; they followed fewer rules (p = 0.020), were slower (p = 0.003) and less efficient (p = 0.001), used more strategies (p = 0.017) on the WCPA-10, and achieved significantly lower CTT scores (p < 0.001) than the HCs. The nonmanifesting carriers and HCs were similar on all cognitive tests. Convergent and ecological validity of the WCPA-10 were partially established, with few correlations between WCPA-10 outcome measures and the MoCA (r = 0.50, r = 0.41), CTT-2 (r = 0.43), SE ADL (r = 0.41), and PASE (r = 0.54, r = 0.46, r = 0.31). CONCLUSIONS This study affirms the known-group validity for most (four) WCPA-10 scores and partially confirms its convergent and ecological validity for PD.
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Affiliation(s)
- Tamara Schejter-Margalit
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Occupational Therapy Department, University of Haifa, Haifa, Israel
| | | | - Avner Thaler
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Maidan
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Jesse M Cedarbaum
- Yale University School of Medicine and Coeruleus Clinical Sciences, Woodbridge, Connecticut, USA
| | - Avi Orr-Urtreger
- Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Genomic Research Laboratory for Neurodegeneration, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Mali Gana Weisz
- Genomic Research Laboratory for Neurodegeneration, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Orly Goldstein
- Genomic Research Laboratory for Neurodegeneration, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nir Giladi
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Rachel Kizony
- Occupational Therapy Department, University of Haifa, Haifa, Israel
- Occupational Therapy, Sheba Medical Center, Tel Hashomer, Israel
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Boone AE, Perry C, Henderson WL. Addressing Participation in Adults With Postconcussive Symptoms Using Cognitive Strategy Training: A Feasibility Trial. Am J Occup Ther 2024; 78:7802180080. [PMID: 38376251 DOI: 10.5014/ajot.2024.050396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
IMPORTANCE Some people experience persistent symptoms after a concussion that greatly affect occupational performance. OBJECTIVE To evaluate the feasibility and preliminary effect of metacognitive strategy training in a sample of adults with postconcussive symptoms. DESIGN Single-group, prospective design. SETTING University research laboratory. PARTICIPANTS Adults with persistent concussive symptoms affecting function (N = 14). INTERVENTION Ten 45-min sessions of a metacognitive strategy training intervention, Cognitive Orientation to daily Occupational Performance (CO-OP). OUTCOMES AND MEASURES Assessed feasibility outcomes included recruitment, retention, and adherence rates, and intervention acceptability was evaluated with the Client Satisfaction Questionnaire-8. The preliminary effect was measured on occupational performance (Canadian Occupational Performance Measure), concussive symptoms (Neurobehavioral Symptom Inventory), sleep (Pittsburgh Sleep Quality Inventory), vision (College of Optometrists in Vision Development-Quality of Life Outcomes Assessment), and cognition outcomes (Dysexecutive Questionnaire, Weekly Calendar Planning Activity, and National Institutes of Health Toolbox Cognition Battery). RESULTS Acceptable recruitment (32%), retention (93%), and adherence rates (100%) were observed, along with a high level of acceptability to participants. Large intervention effects were present for occupational performance, general concussive symptoms, and cognitive functioning. CONCLUSIONS AND RELEVANCE Findings suggest that the CO-OP is feasible to administer for adults with postconcussive symptoms and perceived as suitable for the needs of this population. Feasibility findings, coupled with improvements in occupational performance outcomes, provide the foundation for a future larger scale trial. Plain-Language Summary: The Cognitive Orientation to daily Occupational Performance intervention is practical to use to address the functional impact of persistent concussive symptoms in adults. Further research is needed to evaluate the efficacy of the CO-OP intervention with this population.
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Affiliation(s)
- Anna E Boone
- Anna E. Boone, PhD, MSOT, OTR/L, is Assistant Professor, Department of Occupational Therapy, University of Missouri, Columbia;
| | - Casey Perry
- Casey Perry, BHS, is Research Assistant, Department of Occupational Therapy, University of Missouri, Columbia
| | - Whitney L Henderson
- Whitney L. Henderson, OTD, MOT, OTR/L, is Associate Clinical Professor, Department of Occupational Therapy, University of Missouri, Columbia
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Puthran R, Janeslätt G, Acharya V, Ramachandran M, Dsouza SA. Cross-cultural adaptation of assessments for time-related abilities of Indian older adults and evaluation of their reliability and validity. Scand J Occup Ther 2023; 30:1153-1166. [PMID: 37200526 DOI: 10.1080/11038128.2023.2211314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/16/2023] [Accepted: 05/02/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Older adults may have difficulties in daily time management due to age-related or disease-related cognitive impairment. Standardised assessments for time-related abilities are currently unavailable in India. AIM The study aimed to adapt the Kit for Assessing Time-processing Ability-Senior (KaTid-Senior) and Time-Self rating, Senior (Time-S Senior) for daily time management of Indian older adults, translate these into an Indian language, and evaluate the reliability and validity of the adapted assessments. MATERIALS AND METHODS The two Swedish-origin assessments were reviewed, adapted for linguistic and cultural relevance into English, and translated into Kannada language. Older adults (n = 128) were conveniently selected, assessed with the Montreal Cognitive Assessment, and assigned to age and gender-matched groups: cognitively-impaired and cognitively-normal. Data was then collected with the adapted assessments. RESULTS Both adapted assessments demonstrated acceptable reliability (internal consistency) in this sample (α =0.89 - 0.90). The cognitively-impaired group had significantly (p < 0.001) lower scores on the assessments as compared to the cognitively-normal group. There was a strong to moderate correlation between the assessments supporting their convergent validity. CONCLUSIONS The adapted assessments are reliable and valid in the Indian context. SIGNIFICANCE The study would facilitate contextually-relevant assessment and management of time-related abilities in Indian older adults.
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Affiliation(s)
- Reeti Puthran
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Jupiter Hospital, Thane, India
| | - Gunnel Janeslätt
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Center for Clinical Research in Dalarna, Uppsala University, Uppsala, Sweden
| | - Vinita Acharya
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Meena Ramachandran
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Bridgepoint Collaboratory for Research and Innovation, Sinai Health, Toronto, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Sebestina Anita Dsouza
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Centre for Studies on Health Aging, Manipal Academy of Higher Education, Manipal, India
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4
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Capturing cognitive changes in multiple sclerosis by performance-based functional and virtual reality assessments. Ann Phys Rehabil Med 2022; 66:101677. [PMID: 35667625 DOI: 10.1016/j.rehab.2022.101677] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 04/25/2022] [Accepted: 05/07/2022] [Indexed: 12/03/2022]
Abstract
Cognitive impairment (CI) has been recognized as one of the core multiple sclerosis (MS) symptoms that profoundly impact lives of people with MS (PwMS). Clinical trials have begun to focus on cognition as a primary or secondary outcome, but translating improvements in cognitive testing scores to functioning in the real world is difficult. Performance-based functional assessments and virtual reality (VR) assessments, which incorporate real-world challenges, have been proposed as a way to better assess functional cognition (i.e., cognitive performance and its impact on real-life cognitive functioning of PwMS) and could address the difficulty in evaluating the impact of a treatment on real-world functioning. In this narrative review, we identify and summarize some of the promising recent research applications of performance-based functional assessments and VR tools to assess functional cognition in MS. Overall, most of the studies suggest that functional and VR assessments can detect cognitive differences between people with and without MS and between PwMS with and without CI. Furthermore, performance on some of the functional and VR assessments was associated with performance on standard cognitive assessments. However, developing any guidelines on how to implement these assessments in clinical practice is difficult because of the relatively small sample size across these studies. Performance-based functional and VR assessments represent an innovative approach to increasing sensitivity of how cognitive impairments/abilities present in the daily life of PwMS. More studies, with a larger sample size, robust research methods, and pre- and post-treatment assessments, are warranted to validate relevant, accessible functional and VR assessments before implementing these assessment approaches in clinical practice.
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5
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Foster ER, Carson L, Jonas J, Kang E, Doty T, Toglia J. The Weekly Calendar Planning Activity to Assess Functional Cognition in Parkinson Disease. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2022; 42:315-323. [PMID: 35713209 DOI: 10.1177/15394492221104075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Weekly Calendar Planning Activity (WCPA) may improve understanding of functional cognition in people with Parkinson disease (PwPD) without dementia. We aimed to determine if WCPA performance (a) discriminates between PwPD with and without cognitive impairment and healthy controls and (b) correlates with other indicators of cognition and daily function. This was a cross-sectional study. Parkinson disease (PD) participants without dementia were divided into normal cognition (PD-NC, n = 25) and possible mild cognitive impairment (PD-MCI, n = 21) groups. Their WCPA performance was compared with that of a normative sample (n = 196) and correlated with neuropsychological test performance and self-reported cognition and participation. Both the PD-MCI and PD-NC groups had impaired WCPA performance. WCPA performance correlated with executive function, processing speed, and self-reported cognition and participation. The WCPA can detect functional cognitive deficits in PwPD without dementia and can inform occupational therapy interventions to support functional cognition, occupational performance, and participation in this population.
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Affiliation(s)
| | | | - Jill Jonas
- Washington University in St. Louis, MO, USA
| | | | - Tasha Doty
- Washington University in St. Louis, MO, USA
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Jaywant A, Arora C, Toglia J. Online awareness of performance on a functional cognitive assessment in individuals with stroke: A case-control study. Neuropsychol Rehabil 2022; 32:1970-1988. [PMID: 35293836 DOI: 10.1080/09602011.2022.2050409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Unawareness is a significant barrier to cognitive rehabilitation following acquired brain injury. Little is known about online awareness of cognitively-based instrumental activities of daily living (C-IADL) after stroke, particularly C-IADLs that emphasize executive functions. Our goal was to evaluate in stroke patients (1) online awareness during and immediately after a C-IADL task that emphasizes executive functions and (2) the association between awareness and performance on the C-IADL task. Seventy-seven stroke patients on an acute inpatient rehabilitation unit and 77 control participants completed the 10-item Weekly Calendar Planning Activity (WCPA-10), a standardized C-IADL task that requires working memory, planning, shifting, and inhibition. Trained examiners observed the use of a self-checking strategy and self-recognition of errors during the task. Immediately after the task, participants estimated their accuracy, and rated their own performance, which was compared with objective accuracy. Relative to the control group, stroke patients overestimated their accuracy, less often recognized errors, and less frequently used a self-checking strategy. Overestimation was associated with worse overall performance on the WCPA-10. Findings suggest that poor online awareness of C-IADL performance is common in stroke patients undergoing acute inpatient rehabilitation. Increasing awareness through metacognitive interventions should be a core focus of early post-stroke cognitive rehabilitation.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Catherine Arora
- School of Health and Natural Science, Mercy College, Dobbs Ferry, NY, USA
| | - Joan Toglia
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA.,School of Health and Natural Science, Mercy College, Dobbs Ferry, NY, USA
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7
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Arora C, Frantz C, Toglia J. Awareness of Performance on a Functional Cognitive Performance-Based Assessment Across the Adult Lifespan. Front Psychol 2021; 12:753016. [PMID: 34803834 PMCID: PMC8602564 DOI: 10.3389/fpsyg.2021.753016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/19/2021] [Indexed: 11/15/2022] Open
Abstract
As people age, their cognitive skills and ability to complete complex instrumental activities of daily living often decline in subtle ways. Older adults who are aware of these slight cognitive and functional changes spontaneously adapt and implement strategies to maximize performance. On the other hand, older adults with limited self-awareness are less likely to adjust performance or initiate compensatory strategies as they may not recognize the need to do so. This places them at higher risk of functional decline and loss of independence. Research on awareness of functional performance in healthy adults is, however, limited, and there is a paucity of assessment tools available to address questions of awareness and strategy use in functional tasks. We used the Weekly Calendar Planning Activity (WCPA) - a performance-based assessment of functional cognition including measures of awareness and strategy use - to investigate differences in performance, awareness, and strategy use across the adult lifespan. The WCPA requires examinees to schedule appointments into a weekly calendar while following rules designed to increase task demands. Healthy adults (n=342) from ages 18-92 were observed for strategy use and error recognition, while a post-test interview probed participants' reported strategy use and estimation of accuracy. The discrepancy between participant estimation and actual accuracy provided a measure of online awareness of performance where a larger estimation discrepancy indicated over-estimation of performance. Performance on the WCPA declined across the adult lifespan. Older adults were less likely to use self-monitoring strategies and used less effective strategies overall. Overestimation was associated with use of fewer strategies and lower accuracy in all age groups. Importantly, twice as many older adults overestimated compared to younger adults. Furthermore, the subset of older adults who had good awareness of performance was more likely to use effective strategies, to recognize errors, and achieved accuracy on par with their younger counterparts. Our results emphasize the importance of examining self-awareness of performance and analyzing the strategies used to perform a complex functional task. This information can provide a foundation for early detection of functional decline in aging and for designing interventions to maximize functional independence in aging.
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Affiliation(s)
- Catherine Arora
- Department of Occupational Therapy, School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
| | - Carina Frantz
- Department of Occupational Therapy, School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
| | - Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
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8
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Dsouza SA, Ramachandran M, Nishiura Y, Venkatesh BT, Dahlberg L. Assessment of time-related deficits in older adults: a scoping review protocol. BMJ Open 2021; 11:e050521. [PMID: 34561261 PMCID: PMC8475136 DOI: 10.1136/bmjopen-2021-050521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/31/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION People with cognitive impairments often have difficulties in managing their time for daily activities. In older adults with cognitive impairments such as dementia and stroke, these may present as disorientation, poor time awareness, time perception, daily time management and so on. Time-related deficits and associated behaviours impede independent living and add considerably to caregiver strain. Several interventions are being investigated to help people with cognitive impairments orient and navigate time and do their daily activities. The provision of interventions requires the use of sound assessment tools. However, it is not clear how time-related concepts are specifically evaluated in practice, what are the available assessments and how these assessments should be selected. METHOD AND ANALYSIS This protocol follows the Joanna Briggs Institute Reviewer's Manual (2020) for scoping reviews and is registered with the Open Science Framework (https://osf.io/4ptgy/). We will include the following databases: PubMed, CINAHL, Scopus, Web of Science and PsycINFO. Two reviewers will independently screen eligible studies for inclusion against the selection criteria and then review the full-text of the selected studies. We will extract the bibliographic data, study design and setting, and details of assessments used in the studies to evaluate time-related concepts including format, mode and duration of administration, psychometric properties and so on. The identified assessments will be mapped with regard to time-related concepts being evaluated and described using narrative synthesis. ETHICS AND DISSEMINATION As secondary data analysis, ethics approval is not required for this scoping review. We plan to disseminate the results through peer-reviewed journals and conferences targeting health professionals working with older adults.
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Affiliation(s)
- Sebestina Anita Dsouza
- Department of Occupational Therapy, Centre for Studies on Healthy Aging, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Meena Ramachandran
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Yuko Nishiura
- Department of Assistive Technology, National Rehabilitation Center for Persons with Disabilities Research Institute, Tokorozawa, Saitama, Japan
| | - Bhumika Tumkur Venkatesh
- Public Health Evidence South Asia, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Lena Dahlberg
- School of Health and Welfare, Dalarna University, Falun, Dalarna, Sweden
- Aging Research Center, Karolinska Institutet and Stockholm University, Solna, Sweden
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Wingren M, Lidström-Holmqvist K, Roshanai AH, Arvidsson P, Janeslätt G, White S, Holmefur M. One-year follow-up after the time management group intervention Let's Get Organized. Scand J Occup Ther 2021; 29:305-314. [PMID: 34288758 DOI: 10.1080/11038128.2021.1954687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Time management skills are essential to maintain occupations in everyday life. People with neurodevelopmental or mental disorders often experience persistent difficulties with managing time and organizing daily life, consequently, there is a need to establish interventions with sustainable results. AIM The aim was to perform a one-year post-intervention follow-up after the intervention Let's Get Organized (LGO-S) for people with neurodevelopmental or mental disorders. METHODS The study is a one-year follow-up of a single group pre-test-post-test design. Thirty-eight persons with difficulties in time management due to neurodevelopmental or mental disorders participated. Instruments to collect data were Assessment of Time Management Skills; Weekly Calendar Planning Activity and the Satisfaction with Daily Occupations instrument. Wilcoxons's signed-rank test was used to compare data over time. RESULTS There were no significant differences in the participants' outcomes between post-intervention and one-year follow-up in time management skills and regulation of emotions, satisfaction with daily occupations, and global satisfaction. A significant improvement could be seen in the subscale organization and planning at the one-year follow-up compared to post-intervention. CONCLUSIONS Improvements in time management skills, organization, and planning, regulation of emotions, and satisfaction with daily occupations after the LGO-S can be maintained in the long term.
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Affiliation(s)
- Maria Wingren
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kajsa Lidström-Holmqvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Patrik Arvidsson
- Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden.,Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa.,CHILD, Swedish Institute for Disability Research, Jönköping University, Jönköping, Sweden
| | - Gunnel Janeslätt
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Center for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden
| | - Suzanne White
- Downstate Medical Center, State University of New York, Brooklyn, NY, United States
| | - Marie Holmefur
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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10
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Jaywant A, Arora C, Lussier A, Toglia J. Impaired Performance on a Cognitively-Based Instrumental Activities of Daily Living Task, the 10-Item Weekly Calendar Planning Activity, in Individuals With Stroke Undergoing Acute Inpatient Rehabilitation. Front Neurol 2021; 12:704775. [PMID: 34367057 PMCID: PMC8337012 DOI: 10.3389/fneur.2021.704775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022] Open
Abstract
Performance-based, functionally relevant, and standardized measures of cognitive-instrumental activities of daily living (C-IADL) can complement neuropsychological tests of cognitive impairment and provide valuable clinical information to inform rehabilitation planning. Existing measures have been validated in the outpatient setting. Here, we sought to evaluate a 10-item, short-form of a C-IADL measure, Weekly Calendar Planning Activity (WCPA-10), in inpatients with stroke undergoing acute rehabilitation. The specific goal was to determine if the WCPA-10 could differentiate between stroke patients undergoing acute inpatient rehabilitation and healthy control individuals. We also explored whether the WCPA-10 would identify C-IADL limitations in stroke patients screened as having intact cognition. Seventy-seven stroke inpatients undergoing rehabilitation and 77 healthy control participants completed the WCPA-10, which involves entering a list of simulated, fictional appointments into a weekly schedule while keeping track of and adhering to multiple task rules and ignoring built-in obstacles and distractions. Compared to the control group, stroke patients had significantly worse accuracy, made more errors, used fewer cognitive strategies, followed fewer rules, took more time to complete the task, and were less efficient. 83% of stroke patients were less accurate than predicted by their age, and 64% used less strategies than their age prediction. Among 28 participants who screened as having “normal” cognitive function on the Montreal Cognitive Assessment, the majority had deficits on the WCPA-10. Our results provide initial support for use of a brief C-IADL assessment, WCPA-10, for individuals with stroke undergoing inpatient rehabilitation. They indicate that stroke patients have deficits in C-IADL accuracy, efficiency, and strategy use at this stage of stroke recovery. Results highlight the need to use performance based, functional cognitive assessments, even for those who perform well on cognitive screening tools.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States.,Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, United States.,NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, United States
| | - Catherine Arora
- School of Health and Natural Science, Mercy College, Dobbs Ferry, NY, United States
| | - Alexis Lussier
- School of Health and Natural Science, Mercy College, Dobbs Ferry, NY, United States
| | - Joan Toglia
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, United States.,NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, United States.,School of Health and Natural Science, Mercy College, Dobbs Ferry, NY, United States
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11
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Jaywant A, Steinberg C, Lee A, Toglia J. Feasibility and acceptability of the multicontext approach for individuals with acquired brain injury in acute inpatient rehabilitation: A single case series. Neuropsychol Rehabil 2020; 32:211-230. [PMID: 32873157 DOI: 10.1080/09602011.2020.1810710] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Multicontext (MC) approach, a metacognitive intervention designed to improve awareness, strategy use, and executive functioning, may be beneficial for individuals with acquired brain injury (ABI) undergoing acute inpatient rehabilitation. The goal of this study was to provide evidence of feasibility and acceptability of the MC approach and to explore clinical outcomes. A case series of eight individuals with acquired brain injury and at least mild executive functioning impairment were recruited from an acute inpatient rehabilitation unit. The MC approach - involving guided questioning and patient self-generation of strategies practiced across everyday functional cognitive tasks - was implemented within routine occupational therapy. Occupational therapists implemented the MC approach with high adherence to the treatment protocol. Therapists' perceived challenges were the time constraints of inpatient rehabilitation as well as client factors. Participants rated the MC approach as highly satisfying and engaging. They described subjective improvements in their ability to use executive functioning strategies. The MC approach was associated with improvement in awareness, strategy use, and executive functioning at the conclusion of treatment. The MC approach may be a beneficial intervention for individuals with acquired brain injury and executive dysfunction undergoing acute inpatient rehabilitation. Further evaluation with larger samples in controlled trials is warranted.Trial registration: ClinicalTrials.gov identifier: NCT04363645..
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Affiliation(s)
- Abhishek Jaywant
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Alyson Lee
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Joan Toglia
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA.,School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, USA
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12
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Givon Shaham N, Sternberg S, Rand D. Executive Functioning of Older Adults Correlates with Performance of Touchscreen App-Based Puzzles. Games Health J 2018; 7:271-276. [PMID: 30106643 DOI: 10.1089/g4h.2017.0118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of touchscreen tablets has become common in healthcare. This technology has the potential to be used as a motivational tool for cognitive training. Age-related decline in executive functioning (EF) and dexterity may lead to poor performance using tablet applications (apps), but the impact on performance of app-based puzzles has not been studied. OBJECTIVES (1) To characterize and compare the experience performance of playing tablet apps of older and younger adults, (2) To determine if EF and dexterity contribute to performance of app-based puzzles. MATERIALS AND METHODS We performed a cross-sectional study of community-dwelling healthy older (n = 35) and younger adults (n = 34). EF was measured by the Trail Making Test (part B) (TMT-B) and the Weekly Calendar Planning Activity. Dexterity was assessed using the Nine-Hole Peg Test. Participants played three unfamiliar app-based puzzles requiring EF and filled out the short feedback questionnaire. RESULTS All participants succeeded in playing the apps and reported enjoyment, however, older adults perceived less success and control. Significant differences in EF, dexterity, and performance were found between groups. EF of older adults (TMT-B) accounted for 17.7%-36.8% (P < 0.05) of the total variance of performance. CONCLUSION These findings have implications for the use of tablet apps for older adults. Longer instruction and training periods may be required for training EF among older adults.
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Affiliation(s)
- Noa Givon Shaham
- 1 Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Shelley Sternberg
- 2 Department of Geriatric Services, Ministry of Health , Jerusalem, Israel
| | - Debbie Rand
- 1 Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
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Zlotnik S, Toglia J. Measuring Adolescent Self-Awareness and Accuracy Using a Performance-Based Assessment and Parental Report. Front Public Health 2018; 6:15. [PMID: 29456993 PMCID: PMC5801478 DOI: 10.3389/fpubh.2018.00015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/16/2018] [Indexed: 11/25/2022] Open
Abstract
Aim The aim of this study was to assess awareness of performance and performance accuracy for a task that requires executive functions (EF), among healthy adolescents and to compare their performance to their parent’s ratings. Method Participants: 109 healthy adolescents (mean age 15.2 ± 1.86 years) completed the Weekly Calendar Planning Activity (WCPA). The discrepancy between self-estimated and actual performance was used to measure the level of awareness. The participants were divided into high and low accuracy groups according to the WCPA accuracy median score. The participants were also divided into high and low awareness groups. A comparison was conducted between groups using WCPA performance and parent ratings on the Behavior Rating Inventory of Executive Function (BRIEF). Results Higher awareness was associated with better EF performance. Participants with high accuracy scores were more likely to show high awareness of performance as compared to participants with low accuracy scores. The high accuracy group had better parental ratings of EF, higher efficiency, followed more rules, and were more aware of their WCPA performance. Conclusion Our results highlight the important contribution that self-awareness of performance may have on the individual’s function. Assessing the level of awareness and providing metacognitive training techniques for those adolescents who are less aware, could support their performance.
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Affiliation(s)
- Sharon Zlotnik
- Laboratory for Innovation in Rehabilitation Technology Israel Center for Research Excellence: LINKS - Learning in a NetworKed Society, Department of Occupational Therapy, University of Haifa, Haifa, Israel
| | - Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
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