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Advanced Neurology Cognitive assessment using performance-based tests

to return to previously valued life roles as a worker or performance assessment difficult or high-risk. The scope
student and impacts community participation. Therefore, of occupational therapy practice in acute care settings
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observation of IADL performance can provide a useful can also be limited by organizational factors, such as
means of assessing cognitive function. 2 funding models, which dictate the type and amount of
Some consider accurate assessment of cognition in acute occupational therapy provided. Occupational therapy
care to be the starting point for rehabilitation, with the in acute care practice may also be limited by access
end goal of community participation. However, cognitive to physical resources, such as kitchens available for
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impairments are often invisible, making them difficult to assessment purposes. Therefore, the identification of
detect in acute stages post-injury. An occupational therapist appropriate PBTs for patients with TBI in acute care
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can infer cognitive impairments from performance errors settings may be useful for clinicians.
observed during IADLs and make recommendations for A systematic review of cognitive assessments used
rehabilitation. Without occupational therapy assessment, in TBI research identified 728 assessments. This large
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functional implications of cognitive impairments may number makes it difficult for clinicians to decide which
not be detected until a patient leaves the hospital and has assessment to use with a patient. A scoping review
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difficulty with more complex activities in a less supportive of assessments of executive functioning identified 12
environment. Therefore, one of the purposes of assessing tools suitable for acquired brain injury (ABI) patient
cognition in acute care is to predict an individual’s real- populations, summarizing psychometric data, applicability,
world functioning and consequently facilitate early and the components of executive function that each tool
rehabilitation to maximize rehabilitation. This scoping addresses. This study concluded that clinicians’ decision-
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review aims to explore occupation-based approaches for making should be based on information provided by
cognition assessment that may have clinical applicability research evidence, but may be affected by external
for acute care TBI settings to provide clinicians with pragmatic factors due to resource requirements. A
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evidence-based assessment options. systematic review identified 21 assessments of functional
cognition for older adults and found that evidence of their
2. Literature review psychometric properties was lacking and that further
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In occupational therapy practice, performance-based research on existing assessments is warranted. Similarly, a
testing (PBT) refers to using an occupation-based systematic review of PBT for TBI patients evaluating their
approach for assessing actual performance against known measurement properties found that most instruments had
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or standard criteria to evaluate competency. PBT can be limited or unknown evidence for validity and reliability.
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an observation of an actual activity that a patient needs to While systematic reviews evaluating psychometric
perform in their daily life, such as using a phone to obtain properties assist occupational therapists in making
information, or a simulation of a real-world task that may informed decisions, further information about clinical
or may not be directly relevant to their current situation, feasibility was recommended by authors to determine
such as filling a pillbox with medications for independent which assessments are recommended for clinicians. 14
medication management. PBT allows a patient to respond Clinical applicability refers to practical considerations
to novel situations or interruptions, using whatever of an assessment that impact on assessment choice for a
strategies they have available to them, as in real life. PBTs clinician. Applicability includes pragmatic qualities of
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include a range of assessments from brief screening tests assessments and is differentiated from commonly used
to comprehensive evaluations, which measure a patient’s terms, such as clinical utility, which includes psychometric
occupational performance across various activities in properties (e.g., validity and reliability). For the purposes
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home environments. Occupational therapists use PBTs to of this review, applicability focused on assessment tool
analyze and infer a person’s functional cognition based on information available in the data, primarily relating to
task performance, errors observed, and strategies used, examiner burden, such as assessment availability, cost,
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thereby informing rehabilitation plans. specific resources, environmental requirements, and
When it comes to the assessment of cognitive administration time. Descriptions of cognitive domains
function using PBT, the acute care environment presents addressed, categorization of assessments, and information
additional challenges due to time constraints and other on underlying models or approaches all provide additional
organizational or practical issues. Acute patients may important information for clinicians. Explicit information
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not be able to leave the ward or even their bed, their on an assessment’s content and applicability may add
medical status may fluctuate, and they may require further considerations for clinicians and enable comparison
a high level of nursing care, making occupational of assessments and informed decision-making. In addition
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Volume 4 Issue 1 (2025) 54 doi: 10.36922/an.4508