Needs Assessment of Self-Management for Individuals With Chronic Spinal Cord Injury/Disease.

Since the 1980s, survivorship for persons with spinal cord injury/disease (SCI/D) has significantly improved; however, life expectancy remains lower than the general population due to secondary health conditions (SHCs) that lead to decreased function and death. This study explored (1) facilitators and barriers to engaging in self-management (SM) for persons with SCI/D and (2) stakeholder perspectives on potential SM program components and content for intervention development. Around 38 participants with SCI/D responded to this cross-sectional study and needs assessment conducted at the University of Missouri, Columbia. Responses were analyzed to determine descriptive statistics. Participants indicated barriers to SM include transportation/distance, presence of SHCs, and a lack of local resources. Participants noted that virtual SM programs with strong psychological health/coping components were preferred. These findings should guide the development of an SM program tailored to SCI/D to reduce the prevalence and impact of SHC on the SCI/D population.

Persons with Spinal Cord Injury/Disease (SCI/D) experience secondary health conditions to a higher degree than the general population which impacts their function, quality of life, and lifespan. The factors that limit or support participation in self-management behaviors and programs were explored and we asked people with SCI/D what they would want out of a self-management program tailored to their needs. Results showed that virtual programs with a both group and individual sessions with a strong mental health component were preferred.

Methodological Issues in Advancing the Status of Functional Cognitive Assessment.

Many individuals in acute hospital and post-acute care settings experience changes in their capacity to perform complex activities of daily living associated with deficits in functional cognition. Occupational therapists regularly assess and treat these occupational performance deficits. The construct of functional cognition offers oportunities for occupational therapists to define an approach to cognition that is both distinct from that of other disciplines and that supports evidence-based interventions. This article provides a rationale for performance-based assessment of functional cognition and an overview of the methodological issues associated with the development and implementation of reliable and valid screening and comprehensive asseements of functional.

Complex Task Performance Assessment (CTPA) and Functional Cognition in People With Parkinson's Disease.

OBJECTIVE: The objective of this study was to determine how Parkinson's disease (PD) affects functional cognition as assessed by the Complex Task Performance Assessment (CTPA) and to examine the associations of CTPA performance with other indicators of executive function in people with PD. METHOD: Volunteers with PD without dementia (n = 20) and community control participants (n = 19) completed neuropsychological testing, patient-reported outcome measures, and the CTPA. RESULTS: There were no group differences for CTPA performance accuracy; however, the PD group took longer to complete the CTPA than did the control group. In the PD group, inefficient CTPA performance correlated with poorer cognitive flexibility and worse reported everyday shifting and task monitoring. CONCLUSION: Decreased executive function, namely cognitive flexibility and attentional control, may impair functional cognition in people with PD. Future studies with larger, more diverse samples are warranted to determine the discriminant validity and sensitivity of the CTPA. Use of performance-based assessments such as the CTPA may increase the understanding of functional cognition in people with PD.

Screening for Functional Cognition in Postacute Care and the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014.

Occupational therapists have a long history of assessing functional cognition, defined as the ability to use and integrate thinking and performance skills to accomplish complex everyday activities. In response to passage of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 (Pub. L. 113-185), the American Occupational Therapy Association has been advocating that the Centers for Medicare and Medicaid Services consider functional cognition for inclusion in routine patient assessment in postacute care settings, with important implications for occupational therapy. These efforts have the potential to increase referrals to occupational therapy, emphasize the importance of addressing functional cognition in occupational therapy practice, and support the value of occupational therapy in achieving optimal postacute care outcomes.

Development and Alternate Form Reliability of the Complex Task Performance Assessment (CTPA) for People With Mild Stroke.

Cognitive impairment is a common consequence of mild stroke. Current performance-based assessments for mild stroke can detect mild impairments in executive function but lack alternate forms to be used as outcome measures. This study aimed to develop an alternate form of the Complex Task Performance Assessment (CTPA-Alt), a performance-based assessment of executive function, and to establish the alternate form reliability of the CTPA-Alt. A repeated-measures study was conducted with 26 community participants. Participants were screened for eligibility and administered both forms of the CTPA; administration order was alternated. Overall performance was significantly correlated (rs = .44, p = .03), but pattern of scoring differed by CTPA form and order of administration. Our results indicate that the CTPA forms were similar but that the specific tasks in each form were different. The CTPA may be used as an ecologically valid outcome assessment with further considerations.

The reliability and validity of the Complex Task Performance Assessment: A performance-based assessment of executive function.

The objective of this study was to evaluate the inter-rater reliability, test-retest reliability, concurrent validity, and discriminant validity of the Complex Task Performance Assessment (CTPA): an ecologically valid performance-based assessment of executive function. Community control participants (n = 20) and individuals with mild stroke (n = 14) participated in this study. All participants completed the CTPA and a battery of cognitive assessments at initial testing. The control participants completed the CTPA at two different times one week apart. The intra-class correlation coefficient (ICC) for inter-rater reliability for the total score on the CTPA was .991. The ICCs for all of the sub-scores of the CTPA were also high (.889-.977). The CTPA total score was significantly correlated to Condition 4 of the DKEFS Color-Word Interference Test (p = -.425), and the Wechsler Test of Adult Reading (p = -.493). Finally, there were significant differences between control subjects and individuals with mild stroke on the total score of the CTPA (p = .007) and all sub-scores except interpretation failures and total items incorrect. These results are also consistent with other current executive function performance-based assessments and indicate that the CTPA is a reliable and valid performance-based measure of executive function.

Socioeconomic disparities in work performance following mild stroke.

PURPOSE: The purpose of this study was to investigate the relationships among the factors that influence return to work for young individuals with mild stroke from different socioeconomic backgrounds. METHODS: Prospective cohort study of working adults with mild stroke (N = 21). Participants completed an assessment battery of cognitive, work environment and work performance measures at approximately 3 weeks and 7 months post mild stroke. Individuals were placed in "skilled" and "unskilled" worker categories based on the Hollingshead Index. RESULTS: Unskilled workers had significantly poorer scores on the majority of the cognitive assessments. Unskilled workers also perceived less social support (p = 0.017) and autonomy (p = 0.049) in work responsibilities than individuals in the skilled worker group and also reported significantly poorer work productivity due to stroke than those in the skilled group (p = 0.015). CONCLUSIONS: Individuals from low socioeconomic backgrounds have more difficulty returning to work following mild stroke than individuals from higher socioeconomic backgrounds. Future work is needed to identify factors that can increase long-term work success and quality of work performance following a mild stroke that specifically targets the needs of individuals who have a lower socioeconomic status.

Development and pilot-testing of a work readiness assessment battery.

OBJECTIVE: To develop a work readiness assessment battery that can be used in the course of work rehabilitation and to pilot test the battery to determine its ability to measure the effectiveness of work rehabilitation treatment. PARTICIPANTS: All participants were recruited from the patient population at the Occupational Performance Center (OPC) at The Rehabilitation Institute of St. Louis (TRISL) (n = 7). METHODS: A work readiness assessment battery was constructed using the Readiness to Return to Work theory and then pilot-tested using a repeated-measures design. RESULTS: Participants showed significant improvement on all measures including in the battery with the exception of the depression measure. CONCLUSIONS: These results demonstrate that it is feasible to construct a work readiness battery of assessments using the Readiness to Return to Work theory and that the measures included capture the effect of work rehabilitation on the constructs identified in the literature to effect work performance. Further investigation is necessary to validate this form of assessment for use in a work rehabilitation setting.

Initial development of a work-related assessment of dysexecutive syndrome: the Complex Task Performance Assessment.

UNLABELLED: This article describes the initial development of the Complex Task Performance Assessment (CTPA) as a work-related assessment of dysexecutive syndrome. METHODS: A cross-sectional case-control pilot study using the Complex Task Performance Assessment (CTPA) and a neuropsychological battery consisting of subtests from the Delis Kaplan Executive Function System (DKEFS) were used with a population of adults with mild stroke and a control group of healthy community participants (n = 9). RESULTS: A correlation matrix between the DKEFS and the CTPA found no significant relationships between overall performance efficiency on the CTPA compared to the DKEFS scaled scores. In contrast, four of the six variables tested on the CTPA were found to have significant differences between the mild stroke group and the controls (p < 0.05). CONCLUSION: The sensitivity of the CTPA in this pilot sample justifies future study to provide a link between traditional neuropsychological assessment and rehabilitation professionals' observation of performance related to return to work. Neuroperformance assessment such as the CTPA will provide clinicians with a way to identify dysexecutive syndrome and higher-level cognitive processing deficits in the context of care.