Cognitive strategies utilised by early learners when writing alphabet-letters from memory.

INTRODUCTION: Occupational therapy handwriting studies have shown cognitive instructional techniques are effective methods to assist beginning or challenged handwriters. However, information about how children's cognitive (thinking) skills impact their handwriting development is scarce. This study examined the cognitive strategy efficiency of early learners while writing the alphabet-letters from memory. METHODS: Participants included 408 mainstream children in their first two years of formal schooling (Year 1 and Year 2). Children were asked to write the 26-lowercase alphabet-letters from memory. Data were collected using alphabet-letters generated by the children and observation of their cognitive strategy use while writing. The measurement tool employed was the Perceive, Recall, Plan, and Perform (PRPP) System of Task Analysis (Stage Two). RESULTS: The results found that Year 1 and Year 2 children had difficulties applying cognitive strategies across all four PRPP quadrants while writing the lowercase alphabet-letters from memory. Application of the cognitive strategies from the Plan and Recall quadrants showed the most inefficiencies. The lowest PRPP subquadrant scores were observed in Evaluating, Recall Facts, Sensing, and Programming. Except for the Attending subquadrant and the descriptor 'Regulates', Year 2 children were significantly better than Year 1 children at applying cognitive strategies from all other PRPP quadrants and subquadrants. CONCLUSION: The findings provide beginning evidence that efficient use of cognitive strategies from all four PRPP quadrants is important for children achieving proficiency in accurate and automatic alphabet-letter-writing skills. Recommendations for occupational therapy handwriting assessment and intervention are provided. PLAIN LANGUAGE SUMMARY: Research suggests that occupational therapists can best help children with handwriting difficulties by using a cognitive approach. This approach involves instructing children how to form letters correctly, encouraging self-evaluation, and providing opportunities to practice handwriting. However, the cognitive (thinking) skills required for children to write alphabet-letters accurately are not well understood. To investigate this, a study was conducted on 408 mainstream children in their first two years of formal schooling (Year 1 and Year 2). The study examined how accurately the children could write lowercase alphabet-letters from memory and which cognitive skills they used to do so. The cognitive skills investigated were related to attention, perception, recalling, planning, and performing. The assumption tested was that mistakes in correctly writing alphabet-letters could be attributed to difficulties in using these cognitive skills effectively. The study found that Year 1 and Year 2 children made errors in over half of the 26-lowercase alphabet-letters they wrote. The cognitive skills, which scored the lowest were children's ability to evaluate their writing, recall how and where to write letters, gather information from their vision, and think carefully to ensure accuracy while writing. This implied that these thinking skills had the most impact on the children's ability to write alphabet-letters correctly. More research is needed to confirm these findings and determine the reliability of the tool used in this study to measure the children's thinking skills.

Supports that help me to live well in the community: experiences of people living with schizophrenia.

INTRODUCTION: People with schizophrenia are more likely to be hospitalised than any other psychiatric diagnosis. Occupational therapists working in mental health are often required to assess and recommend supports that will assist people with schizophrenia to live successfully in the community. There is little research exploring consumer perspectives regarding the support they find useful to stay out of the hospital. The aim of this study was to explore what supports people living with schizophrenia identify as helping them to live in the community and stay out of the hospital. METHOD: Qualitative data were collected via semi-structured interviews with adult consumers (N = 18) diagnosed with schizophrenia. Data were thematically analysed using constant comparative analysis methods. Inductive analysis was followed by a deductive phase of analysis. FINDINGS: Participants highlighted personal-, occupational- and environmental-focused supports. Person-focused supports addressed cognitive and psychological needs. Occupation-focused supports included assisting people to manage daily life with a mental illness; engage in social activities; and engage in meaningful activities. Environment-focused supports included access to financial security; accommodation security; and community of choice. In addition to types of support, participants highlighted the importance of quality of support including the need for flexible; timely; and non-judgemental support. CONCLUSION: These results emphasise the multifaceted nature of support required by people living with schizophrenia to stay out of the hospital. Both type and quality of support are important. People in this study were able to clearly articulate the types and qualities of support that were important to them. Occupational therapists may benefit from greater collaboration with consumers during assessments of support needs and the development of recommendations. Further exploration of how occupational therapists identify people's multifaceted support needs is required.

Goal attainment of children with cerebral palsy participating in multi-modal intervention.

AIM: We aimed to determine if there was a significant difference in the functional performance of family requested daily tasks by a heterogeneous group of children with cerebral palsy following a programme of neuro-developmental treatment and in comparison to a randomly control group. BACKGROUND: There are considerable challenges in conducting research into the functional performance of children with cerebral palsy. These include the highly heterogeneous nature of the population group, poor ecological and treatment fidelity, floor and ceiling effects in assessments, and insensitivity to the diverse functional needs and goals of children and families. Therapists and families identified functional goals and specified all aspects of performance details for each goal on five point goal attainment scales. Children with cerebral palsy were assigned randomly to treatment and alternate treatment groups. Children were video recorded attempting to perform targeted functional skills at pre-test, post-pest and follow-up. Videos were recorded and rated by expert clinicians blind to experimental condition. RESULTS: After the first round of target intervention and alternate treatment had been completed, a significant difference in the goal attainment was noted between the control group and the treatment group at the post test, indicating that intervention was associated with a higher level of goal attainment than that attained by the control group (p = 0.0321) with a large effect size. CONCLUSIONS: The study provided evidence of an effective way to investigate and to enhance the available motor capacity of children with moderate to severe cerebral palsy during participation in requested daily task performance, as reflected in goal attainment. Goal attainment scales were a reliable measure that was able to be used to detect changes in functional goals among a highly heterogeneous population group with individualized goals that were meaningful to each child and family.

Functional Performance and the Allen Cognitive Level Screen for Adults With Mental Illness: A Scoping Review.

IMPORTANCE: Research involving the use of the Allen Cognitive Level Screen (ACLS) in mental health practice has been available for more than 40 yr, yet there has been no comprehensive synthesis and review of this body of literature. OBJECTIVE: To review, summarize, compare, and evaluate the existing literature regarding the relationship between the ACLS and the functional and adaptive functional performance of adults living with mental illness. DATA SOURCES: Searches with no date limits were conducted in the CINAHL, MEDLINE, PsycINFO, ProQuest, and OTseeker databases. Study Selection and Data Collection: A five-stage scoping review methodology was used to examine peer-reviewed English-language literature reporting on the relationship between ACLS scores and functional and adaptive functional performance of adults with mental illness. Information from 15 studies was charted, collated, and numerically and thematically summarized. FINDINGS: A positive relationship between ACLS scores and in-the-moment performance was consistently reported. The relationship of ACLS scores to community living performance was less consistent. Methods of assessing performance, complexity of tasks assessed, and timing of assessments affected relationships with cognition as measured by ACLS. Gaps in the literature were identified. CONCLUSIONS AND RELEVANCE: Findings raise questions about how, why, and when occupational therapists use the ACLS. Increased examination is needed of what aspects of performance and functional cognition reliably determine people's ability to live successfully in the community. What This Article Adds: This article provides the first synthesis of the existing literature on the relationship between ACLS scores and functional and adaptive functional performance of people living with mental illness.

Cognitive strategy use in adults with acquired brain injury.

Objective: Difficulty applying cognitive strategies during task performance is a hallmark feature of brain injury. This study aimed to develop a cognitive strategy profile of people living in a transitional living unit for people with brain injury.Research design: Prospective, longitudinal study (n = 16)Method: Cognitive strategy application was assessed using the Perceive, Recall, Plan, and Perform (PRPP) System of Task Analysis. Functional measures were also administered. Data were examined using Rasch analysis (FACETS 3.71.4) and relationships between variables were analyzed.Results: Rasch analysis of PRPP data generated a hierarchy of cognitive strategies: from the most complex executive processing strategies to the simplest perceptual and recall strategies. The functional profile revealed a more impaired group of clients than has been previously reported in similar residential programs. Cognitive strategy use (PRPP Total score) was correlated with functional independence (r = .61), the performance of instrumental activities of daily living (r = .45), and community participation (r = -.63).Conclusions: The PRPP System enabled assessment of cognitive strategy difficulties and generation of individual profiles that allowed for individualized intervention planning. More efficient and effective application of cognitive strategies was related to the improved functional performance of everyday tasks and activities, greater independence and community participation.

Applied cognitive strategy behaviours in people with parkinson's disease during daily activities: A cross-sectional study.

OBJECTIVE: To explore the use of applied cognitive strategy behaviours during performance of daily activities in people with Parkinson's disease. DESIGN: Quantitative cross-sectional design. METHODS: A total of 190 persons living at home with non-dementing Parkinson's disease were videotaped while performing a self-chosen activity in their natural environment. The videotaped performance was scored using the "Perceive, Recall, Plan and Perform System of Task Analysis" to measure: (i) performance mastery; and (ii) effective use of 34 cognitive strategy behaviours covering: attention and sensory processing (Perceive), accessing task-related knowledge (Recall), response planning and evaluation (Plan) and performance control (Perform). Mean performance mastery and a hierarchy of least to most effective applied cognitive strategy behaviours were determined for the total group and for 2 sub-groups based on disease severity. A multi-faceted Rasch model was used for data analysis. RESULTS: Mean performance mastery was 56% (standard deviation (SD) 28). Least efficient cognitive strategy behaviours were those used for planning, evaluating and controlling performance and most efficient strategies were those used for sensory discrimination and recalling factual information. More advanced disease indicated less efficient use of applied cognition. CONCLUSION: The results suggest that the efficiency of applied cognitive strategy behaviours is compromised in a certain pattern in people with Parkinson's disease, and that it declines with disease progression.

Patterns of cognitive strategy use common in children with reduced social competence derived from parent perceptions.

INTRODUCTION: Occupational therapists are increasingly being referred children who experience reduced social competence. Ineffective use of cognitive strategies during social interactions is known to contribute to reduced social competence in children who have difficulty learning. Little is known about the nature of social cognitive strategy use or how it may be observed in children during performance of school occupations. This study aimed to explore the type of difficulties in cognitive strategy use that children experience during performance of social tasks as perceived by their parents. METHODS: A retrospective chart review was used to analyse 306 PRPP@HOME (Primary) Parent/Caregiver Questionnaire responses targeting parent perceptions of their child's cognitive strategy use during social interactions. The children were in the first four years of formal schooling and identified by their teachers as having difficulties with social skills. Factor analysis was used to discover conceptual groupings amongst cognitive strategy use items. RESULTS: Four factors emerged from the analysis. Factor One grouped PRPP cognitive strategy items related to organised thinking, attention and processing external sensory details during social performance. Factor Two grouped items related to higher level thinking for internal self-evaluation of behaviour. Factor Three grouped items related to focused and dual attention during social interactions. Factor Four grouped items related to performance and adjustment of behaviour to match the context of social interaction. CONCLUSION: Parent perceptions indicate that children with reduced social competence experience inefficient use of cognitive strategies which organise attention, sensory perception and planning. This information can be used to specifically target programs which better support the thinking strategies which facilitate children's participation during social activities at school.

Cognitive aspects of social competence in the current New South Wales Kindergarten to Grade Six Syllabuses.

BACKGROUND/AIM: Occupational therapists are commonly referred children who find reduced social competence a barrier to participation in school activities. Little is known about the social skills expected of children at school and the thinking strategies children use during social interactions. This study aimed to investigate the social skills expected of children during school-based learning activities in the current NSW K-6 Syllabuses and the types of cognitive strategies expected during social interactions. METHODS: A qualitative text-based approach was adopted to explore the range of social skills expected of children at school. A content analysis of text-based data was used to identify specific social skills represented in the current NSW K-6 Syllabuses and the types of cognitive strategies required. Cognitive strategy use items from the PRPP System of Task Analysis were used to identify expected ways of thinking that related to social competence outcomes as stated in the Syllabus. RESULTS: Findings revealed a high number of social skills represented in expected learning outcomes for all six subjects included in the analysis. Four categories representing expected social behaviours across the syllabuses were identified: intrapersonal skills: communication by language; interpersonal skills and responding to others. Each desired social competence phrase embedded within syllabus objectives aligned with at least one item from the PRPP System of Task Analysis. The highest representation of expected strategy use was items from Recall (memory) and Planning (problem solving and evaluating) Quadrants. CONCLUSION: Investigation into the types of cognitive strategies embedded within Syllabus objectives which relate to social competence can assist therapists more accurately target social skills and associated cognitive strategies required for occupational performance at school. Findings from the study support the use of the PRPP System of Task Analysis for identifying and addressing cognitive strategy use during occupational therapy assessment and intervention.

Listening to teachers: Views on delivery of a classroom based sensory intervention for students with autism.

BACKGROUND/AIM: Occupational therapists consider the impact of autism spectrum disorder on occupational performance at school. Occupational therapists work with teachers to support student participation. Atypical sensory processing is common in children with autism. Therefore, collaborating with teachers to enable students with autism to appropriately process sensory information within classrooms may be necessary. This qualitative pilot study aimed to capture teachers' perceptions of using a Sensory Activity Schedule, a sensory based intervention, in the classroom. METHODS: A qualitative descriptive approach was used to analyse semi-structured interview responses from 19 qualified teachers who taught children with autism from seven different autism specific special schools in NSW. Teachers were asked about their motivation to complete the intervention as well as helpful and difficult aspects of the intervention. FINDINGS: Three main categories and eight sub-categories were identified from the 19 respondents who reported that helping their students was an important motivation for using a Sensory Activity Schedule as well as the opportunity to evaluate whether sensory based intervention was beneficial. Teachers reported that learning new ideas, working with an occupational therapist and seeing an increase in concentration and a reduction in undesired behaviours were positive aspects of utilising the intervention. Timing, staffing and fidelity of the intervention were areas of concern. CONCLUSION: Collaboration with classroom teachers is an essential part of school-based occupational therapy. Insights from teachers who implemented a sensory based intervention in the classroom assist occupational therapists to better support students with autism spectrum disorder in schools.

Quantifying patterns of upper limb motor change following BTX-A injection in adult spasticity management.

OBJECTIVE: To evaluate the capacity of the Upper Limb Performance Analysis: Comparative Analysis of Performance-Motor (CAP-M) to quantify change in adults with focal spasticity following injection of Botulinum Toxin-A (BTX-A) as a focal treatment for positive Upper Motor Neuron (UMN) features. METHODS: Twenty-three adults with moderate-to-severe spasticity were assessed pre- and post-BTX-A injection using CAP-M. Post-hoc video analysis of three sub-tests from the Action Research Arm Test were analysed against expected movements for each task. RESULTS: Post-injection, spasticity as measured by Modified Ashworth and Tardieu Composite scores decreased significantly (p < 0.001). Grouped CAP-M data showed a significant reduction (z = 2.1-2.7, ES = 0.51-0.56) in positive UMN features, with 145 fewer Excessive movements recorded. In addition, 31 more Expected movements were demonstrated (z = 2.9, ES = 0.60), consistent with 'unmasking' of movements. CONCLUSION: CAP-M analysis revealed that BTX-A injection decreased unwanted movement almost 5-times more frequently than 'unmasking' hidden voluntary muscle activity during active simulated tasks. In this way, CAP-M was able to simultaneously assess positive and negative UMN features. This quantitative framework may have greater functional relevance than traditional uni-dimensional, passive spasticity measures such as MAS and Tardieu Scale.

Measuring task performance after acquired brain injury: Construct and concurrent validity of 'Upper Limb Performance Analysis'.

OBJECTIVE: This preliminary investigation studies selected aspects of validity of the Upper Limb Performance Analysis (ULPA), an occupation-based functional upper limb (UL) measure. METHODS: The study investigated the ULPA-Task Performance Mastery (ULPA-TPM) in 35 community dwelling adults with upper motor neuron syndrome following acquired brain injury and 26 healthy controls. Construct and concurrent validity of the ULPA were determined via group discrimination between adults with and without ABI; and ABI participants who were and were not referred for UL spasticity management with botulinum toxin-A injections (injected and non-injected group). Concurrent validity was examined by investigating the relationships between the ULPA and an existing functional UL measure, the Action Research Arm Test, using Spearman's rank-order correlation. RESULTS: Significant differences in UL performance were demonstrated between the ABI and the Control group on all ULPA sub-scales (including: Omission (z = -2.6 to -3.6, rspb = 0.37-0.48), Accuracy (z = -5.8 to -6.0, rspb = 0.78-0.82), Repetition (z = -5.1 to -5.4, rspb = 0.63-0.73) and Timing errors (z = -5.9 to -6.2, rspb = 0.77-0.88). Those in the Injected group demonstrated more task performance errors than the Non-injected group, with significant differences in Accuracy (z = -2.1 to -2.4, rspb = 0.37-0.45), Repetition (z = -2.5 to -2.1, rspb = 0.43) and Timing (z = -2.0, rspb = 0.37). CONCLUSIONS: This study demonstrated good construct and concurrent validity of the ULPA-TPM.

Computerised pinch dynamometry in the assessment of adult hand spasticity.

BACKGROUND/AIM: The hand engages with the environment through the grasp, stabilisation, manipulation and release of objects during everyday tasks, activities and routines. Upper motor neuron syndrome following acquired brain injury may negatively impact hand function, reducing strength, range of motion and motor control. It is important for clinicians to reliably measure such impacts, particularly for the impact of intervention and to monitor change in performance over time. Therefore, the aim of this study was to investigate the test-retest reliability and construct validity of Dynamic Computerised pinch Dynamometry for measuring fine hand motor performance following acquired brain injury. METHODS: The Dynamic Computerised pinch Dynamometry protocol was completed by 36 community dwelling adults and 27 healthy adults using a simulated pinch and release task in lateral and pincer grip positions. Measurements were conducted over two testing occasions approximately five weeks apart. Dynamic Computerised pinch Dynamometry output was evaluated to determine the test-retest reliability and construct validity of the measure. RESULTS: Test-retest reliability scores using Kendall coefficient of concordance ranged from W = 0.61-0.94. Dynamic Computerised pinch Dynamometry discriminated between participants with and without acquired brain injury (z = 4.97-6.50, P < 0.05) and between the affected and non-affected hand of participants with acquired brain injury (z = 3.37-5.22, P < 0.001). CONCLUSIONS: Dynamic Computerised pinch Dynamometry in both lateral and pincer positions had fair to excellent test-retest reliability, and had good construct validity for discrimination between participants with and without acquired brain injury as well as between the affected and non-affected hand of participants with acquired brain injury.

Measuring spasticity and fine motor control (pinch) change in the hand after botulinum toxin-A injection using dynamic computerized hand dynamometry.

OBJECTIVES: To evaluate change in fine motor hand performance and to investigate the relationship between existing clinical measures and dynamic computerized dynamometry (DCD) after botulinum toxin-A (BTX-A) injections for adults with upper limb spasticity. DESIGN: Pretest/posttest clinical intervention study. SETTING: Hospital outpatient spasticity clinics. PARTICIPANTS: A convenience sample of adults (N=28; mean age, 51y) with upper limb spasticity after acquired brain injury. INTERVENTIONS: BTX-A injections for upper limb spasticity management. MAIN OUTCOME MEASURES: DCD protocol using a piezoelectric pinch meter (termed DCD[pinch]); current clinical upper limb measures: Modified Ashworth Scale, Tardieu Scale, Action Research Arm Test, Michigan Hand Outcomes Questionnaire, and Goal Attainment Scale. RESULTS: BTX-A produced a significant change on DCD(pinch) and some current clinical measures, with correlations observed between DCD(pinch) and current clinical measures. CONCLUSIONS: DCD(pinch) sensitively and objectively assessed the effects of BTX-A on upper limb spasticity during a simulated functionally based pinch and release task.

Test-retest reliability of computerised hand dynamometry in adults with acquired brain injury.

BACKGROUND/AIM: The ability to objectively and reliably measure hand performance over time is critical to monitor patient performance and evaluate treatment efficacy. Current spasticity measures are subjective in nature and fail to capture the complexity of the multi-faceted upper motor neuron syndrome. This study examined the test-retest reliability of dynamic computerised hand dynamometry for simultaneously measuring multiple aspects of positive and negative features of the upper motor neuron syndrome during an active grasp and release task. METHODS: Community-living adults with upper motor neuron syndrome following acquired brain injury attending metropolitan spasticity clinics for management of upper limb spasticity (N = 36; mean age 50 years ±15) and control participants (N = 27, mean age 40 years ±12) completed a computerised hand dynamometry protocol across two testing occasions 5 weeks apart. Objective measurement of Isometric Force, Cycle Duration and Isometric Grip Work, Force Velocity, was completed during a repeated grasp and release test protocol with a computerised hand dynamometer to evaluate the reliability and reproducibility of hand performance. RESULTS: Kendall Coefficient of Concordance W scores ranged from W = 0.69-0.98 for motor elements of grasp and release, including Isometric Force, Cycle Duration, Isometric Grip Work and Force Velocity. CONCLUSIONS: The investigated dynamic computerised hand dynamometry protocol showed fair/good to excellent levels of test-retest reliability in control participants and in subjects with upper motor neuron syndrome following acquired brain injury.

Children who experience difficulties with learning: mother and child perceptions of social competence.

There is an emphasis on the social competence of children who have difficulties with learning as a significant percentage also experience reduced social skills. Social competence in the classroom is becoming increasingly important as the school curriculum incorporates group work and socially directed activities for purposes of learning. A goal of occupational therapy for children with learning difficulties and their parents is that they 'fit' into their social group and form friendships. While teachers are able to identify social skills that are required for life at school, less is known about how children perceive their interactions. This study aimed to explore social interaction during occupational performance at school and at home from the perception of children with learning difficulties and their mothers. Participants included 10, 8- to 12-year-old children who had difficulties with learning and their 10 mothers. Children were interviewed using semi-structured focus groups. Mothers participated in semi-structured interviews. Four main themes emerged from this study, including the importance of social skills, effects of poor social skills, difficulties with planning and problem solving in social situations and impact of social competence on a child's occupational performance. The study revealed that social participation is perceived to be an integral part of the child's ability to participate in occupational performance, and that children have definite perspectives on the importance of social competence. Children in this study indicated that their social skills were adequate when in an one-to-one situation but not in a group.

Clinical assessment of hand motor performance after acquired brain injury with dynamic computerized hand dynamometry: construct, concurrent, and predictive validity.

OBJECTIVE: To assess the construct, concurrent, and predictive validity of dynamic computerized hand dynamometry. DESIGN: Prospective correlational study between dynamometry and functional upper limb performance. SETTING: Hospital outpatient spasticity clinics. PARTICIPANTS: Adults with upper motor neuron syndrome affecting the upper limb after acquired brain injury (ABI) (n=38; median age, 50 y; range, 18-81 y) and healthy adult control participants (n=27; median age, 37 y; range, 22-62 y). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Dynamic computerized dynamometry elements of hand performance (isometric force, force velocity, isometric grip work, contraction and relaxation duration) and the Action Research Arm Test. RESULTS: Motor elements of hand performance objectively measured by the dynamic computerized dynamometry protocol achieved moderate to good validity when correlated with standardized measures of functional hand performance. Dynamic computerized dynamometry identified clear differences in hand performance between participants with and without ABI. Within the ABI group, dynamic computerized hand dynamometry achieved fair to moderate predictive validity with regards to whether a participant would be referred for botulinum toxin A injections. CONCLUSIONS: This study provides support for the construct, concurrent, and predictive validity of the dynamic computerized dynamometry protocol.

Patterns of agitated behaviour during acute brain injury rehabilitation.

OBJECTIVE: To monitor daily shift-by-shift changes in agitated behaviour during adult brain injury rehabilitation. DESIGN: A prospective, descriptive study. METHODS: Eight participants were monitored daily for up to 28 days. The Agitated Behaviour Scale (ABS) evaluated behaviour during three nursing shifts (morning, afternoon, night). Severity of agitation, peak intensity and concomitant behaviours were calculated. Shift differences and patterns of behavioural changes were analysed. RESULTS: Four hundred and seven recordings were taken with the ABS. All participants demonstrated multiple agitated behaviours (between 3-13 concomitant behaviours per person); the most common behaviours were representative of the ABS Disinhibition sub-scale. Weekly peak intensity ranged from 14-55 on the ABS. Mean ABS scores were highest during the afternoon shift and lowest at night. Improved cognition was associated with resolving agitated behaviour; while persistent agitated behaviour was associated with low levels of cognition. Minimal agitated behaviour was observed in participants who emerged from post-traumatic amnesia. CONCLUSIONS: Agitated behaviour during acute brain injury rehabilitation has a complex clinical presentation. High levels of agitation observed during the afternoon shift may be associated with low levels of structured activities available at that time, higher levels of environmental stimuli during visiting times and increased cognitive fatigue. Lower cognitive ability was related to consistently higher levels of agitated behaviour and vice-versa.

Difficulties with multitasking on return to work after TBI: a critical case study.

Work performance research highlights that psychometric cognitive measures and cognitive component information processing measures are strong predictors of success in multitasking work environments [14]. People with a mild to moderate traumatic brain injury (TBI) returning to a job requiring multitasking, may have difficulty succeeding despite pre-morbid equivalent cognitive scores. A critical case study is presented to begin to determine what aspects of information processing contribute to difficulties in multitasking work performance, for people with a TBI. The Perceive Recall Plan and Perform (PRPP) System of Task Analysis: Workplace Interview (i.e. PRPP@WORK) is used with the employer to obtain information processing scores. Results indicate substantial information processing deficits were perceived by the employer for the employee with a TBI. Future larger studies of people with a TBI who return to work that requires multitasking are needed to more clearly indicate: the level of multitasking they perform; what aspects of information processing hinder their work performance; the impact on performance of perceived cognitive load by the person with a TBI and the type and impact of support provided to improve their work performance.

Assessment of productivity performance in men with HIV Associated Neurocognitive Disorder (HAND).

OBJECTIVES: The purpose of this paper is to review what is known about return to productivity roles for people who have HIV/AIDS and HIV Associated Neurocognitive Disorder (HAND), to highlight gaps in knowledge and practice for assisting people with HAND to engage in productivity roles, to describe an occupational therapy assessment system that overcomes some of the limitations of current research and practice, and to demonstrate the clinical utility of this instrument for use with clients who have HAND. PARTICIPANTS: The participant in this study is a man with HIV Associated Dementia (HAD), one sub-type of HAND. METHODS: The real-world impact of HAD on productivity role participation was assessed using the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis, an ecological assessment method. Productivity tasks assessed were those associated with this man's desire to become a volunteer grocery shopper. The assessment took place under naturalistic conditions in a grocery store. RESULTS: The participant demonstrated 28.6% mastery of the grocery shopping task. Performance was impacted on primarily by errors of accuracy and timing. Reasons for these errors centered on the participant's difficulties in applying cognitive strategies to perceive, recall, plan and perform the task. CONCLUSIONS: The PRPP System of Task Analysis shows promise in being able to identify errors in task mastery and the underlying cognitive strategy application errors that impact on mastery in people with HAND.