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Advanced Neurology Cognitive assessment using performance-based tests

small sample sizes and mixed participant samples, where model are more likely to choose an assessment aligned
TBI patients were not clearly differentiated. These factors with that model to guide their practice. Of the identified
should be considered when concluding the generalizability assessments, eight were not based on an approach or model;
of assessment tools and comparability of assessments. The two were based on Lezak’s model of executive functioning;
time required to complete assessments was documented and one assessment was based on the multiple errands
for a minority of assessments, which limited comparison test. Variety in theoretical approaches underlying these
between assessments. While this review documented assessments may reflect the input of multiple professions
all available data on participant samples and assessment involved in assessing cognition and their differing reasons
details, the variability in studies makes it difficult to make for assessment.
clear recommendations about the assessments’ clinical Executive function assessments, including five of the
utility for acute care TBI populations. Therefore, given 18 assessments, encompass complex individual cognitive
the heterogeneity and complexity of TBI presentations, domains and make a substantial contribution to estimates
clinicians are encouraged to use an individualized approach of a patient’s cognition. In a review of the most frequently
to assessment selection. assessed cognitive domains following TBI, 34 of 40
The quality of the included studies was mixed; eight studies assessed executive function. Executive function
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studies scored between 10 and 20 and 10 studies scored 20 – deficits correlate with impairment in IADLs, highlighting
30 on QuADS, where the maximum possible score was 39. interconnections between executive function, IADLs, and
Although intended to provide a brief overview of reported cognitive function in everyday tasks. Although many
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assessment methodological quality, appraisal scores may of these assessments were not designed to assess the
have been impacted by a lack of published methodology impact of cognitive deficits on real-world functioning,
detail, which may not be an accurate reflection of the tasks simulating real-life ADLs or IADLs provide valued
individual study’s overall quality. information on an individual’s cognitive function.
Patients who have sustained TBI have complex and Simulating the multi-faceted demands of everyday
varied cognitive deficits, resulting in a wide range of adult life from within an acute hospital ward is difficult.
levels of functional ability and disability. This makes This is particularly relevant to clinicians assessing cognitive
accurate assessment challenging and highlights the role function in the acute care setting, as international incidence
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of occupational therapists in investigating an individual’s data have indicated that most TBIs occur in adult males.
cognitive functioning to determine readiness for discharge There are few age-appropriate, challenging assessments
home or the need for rehabilitation. The AMPS and the for young to middle-aged adults. These adults may be
PPRP assessments are flexible and can be individualized to running a household, working, studying, raising children,
suit patients with varying levels of TBI severity. However, and caring for aging family members simultaneously.
such assessments are a minority among those reviewed. Three recently developed assessments, including the menu
The remainder of the 18 assessments was either single task, actual reality test, and weekly calendar planning
prescribed tasks or groups of prescribed subtasks. Where activity, attempt to assess the real-life demands of young
subtasks are grouped to form one assessment, they may form to middle-aged adults using tasks that may be of relevance
a collection of seemingly unrelated tasks. Occupational to this group. Of the assessments reviewed, the menu task,
therapists work within a client-centered practice model, actual reality test, and weekly calendar planning activity
which encourages client-centered goals, outcomes, and present good options for PBTs that can assess the ability
assessments. Practically, this suggests choosing assessments to use cognitive function, as their content approximates
that closely relate to an individual’s occupational roles and real-life tasks for young to middle-aged adults. Emerging
tailoring assessments to relevant ADL or IADL tasks. PBTs not developed specifically for use in the acute care

Assessments of cognitive function have emerged setting require further investigation to determine if they
from a broad range of theoretical approaches within are feasible to implement in acute care in their current
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occupational therapy and neuropsychology. Models have form, or need to be adapted to suit acute care settings.
been identified as a factor influencing clinicians’ decisions Emerging assessments, such as the menu task, actual reality
to use assessments, as they can frame the way we interpret test, and weekly calendar planning activity, may be easy to
information and discuss practice. As registered health use practically in an acute care setting at the bedside and
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professionals, occupational therapists are expected to have warrant further investigation to determine psychometric
the skills and knowledge to decide when to apply or refrain strengths or weaknesses for use with patients with TBI.
from using an assessment or intervention with complex With regard to the second research question (i.e., the
patients. Clinicians working within a particular practice clinical applicability of the assessments for acute care), the
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Volume 4 Issue 1 (2025) 65 doi: 10.36922/an.4508