Performance Assessment Of Self-Care Skills Research Articles

Clinical Manifestations.

The preclinical stage of Alzheimer disease (AD) is a clinically silent period that is detectable through neuroimaging and biofluid biomarkers of amyloid, tau, and neurodegeneration. We evaluated whether performance on cognitively-focused complex daily tasks is associated with cerebrospinal fluid (CSF) biomarkers of brain amyloidosis or tau pathology in cognitively normal (CN) older adults. In this cross-sectional analysis of an ongoing longitudinal cohort study, CN older adults performed three cognitively-focused complex tasks of daily living (shopping, checkbook balancing, and medication management) from the Performance Assessment of Self-Care Skills (PASS) in their home. PASS tasks were scored for independence (cues required to complete task) and adequacy of performance (quality and process, efficiency, redundant actions). Participants also had a CSF sample obtained within two years of completing the PASS. CSF amyloid (Aβ42, Aβ40) and CSF tau phosphorylated at position 181 (p-tau181) were measured with Lumipulse immunoassays. Nonparametric partial correlations were used to examine the associations between task performance and biomarkers of AD (CSF Aβ42/Aβ40 and CSF p-tau181), controlling for age, gender, and level of education. 122 CN participants (mean age 74.4 years, 53% female, 88% white) were included. After controlling for age, gender, and years of education, worse performance on complex daily tasks was associated with lower CSF Aβ42/Aβ40 (more cues required: Spearman rho = -0.213, p = 0.03), and there was a trend towards lower adequacy (rho = 0.161, p = 0.08). There were no significant associations with CSF p-tau181. This study suggests that worse performance on complex daily tasks in CN older adults may be associated with greater amyloid burden. These findings could lead to a better understanding of functional changes that may be associated with amyloidosis prior to the onset of noticeable memory symptoms in AD or related dementias.

9 Predictive Ability of the Performance Assessment of Self-Care Skills (PASS) in a Sample of Predominantly Low-Income, Community Dwelling, African American Older Adults

Objective:Mild decline in independent functioning is a core diagnostic criterion for Mild Cognitive Impairment. Performance-based assessments have been considered the gold standard to identify subtle deficits in functioning. Existing assessments were largely designed using demographically homogenous samples (white, highly educated, middle class) and often assume tasks are performed similarly across populations. The current study aimed to validate the utility of the Performance Assessment of Self-Care Skills (PASS) in determining cognitive status in a sample of predominantly African American, low-income older adults.Participants and Methods:Cognition and functional capacity were measured in n=245 older participants (aged 50+ years) who were recruited from a larger community study located in Pittsburgh, PA. Cognitive status was defined by a mean split on the Modified Mini Mental Status Examination (3MS) score (84/100). Participants above the cutoff were classified as unlikely cognitive impairment (UCI) and those below classified as potential cognitive impairment (PCI). Functional capacity was assessed using the number of cues provided on three PASS subtasks: shopping, medication management, and critical information retrieval (higher score = worse functioning). Self-reported cognitive and functional decline was assessed via the Everyday Cognition (ECog) questionnaire (higher score = greater decline). Generalized linear models compared performance scores between groups adjusting for literacy (WRAT3), age, and education. Receiver operating characteristic curve (ROC) analyses were run for select functional performance scores to assess their predictive ability in discriminating between PCI and UCI.Results:Compared to the UCI group (N = 179), the PCI group (N = 66) was older (68 vs. 65 years, p = 0.05), less educated (11 years vs. 12 years, p < 0.01), had lower WRAT3 z-scores (0.19 vs. -0.55, p < .01), and required more cues on the shopping (4.33 vs. 8.54, p < 0.01) and medication management PASS subtasks (2.74 vs. 6.56, p < .01). Both groups reported elevated levels of subjective cognitive complaints on the ECog (1.46 vs. 1.56, p = .09) and performed similarly on the critical information retrieval PASS subtask (0.25 vs 0.54, p = .06). When discerning between UCI and PCI groups, the PASS Shopping subtask had an optimal cut-off score of 4, sensitivity of 0.86, specificity of 0.47, positive predictive value (PPV) of 0.37, and area under the curve (AUC) of 0.71. PASS Medication Management had an optimal cut-off score of 3, sensitivity of 0.77, specificity of 0.56, PPV of 0.39, and AUC of 0.74.Conclusions:Subjective functional decline and performance on the critical information retrieval subtask were not associated with cognitive groups. PASS shopping and medication management had moderately high AUCs, suggesting they can reliably distinguish between groups. However, both tasks also exhibited low PPVs, low levels of specificity, and high levels of sensitivity, making them strong “rule-out” tests but poor “rule-in” tests in this sample. Because accurate assessment of functioning is useful for MCI and critical to dementia diagnosis, it is imperative we understand how these tasks function across different populations. Future work should 1) validate measures of functional ability across different populations and 2) develop population-appropriate assessments for use in clinical and research settings.

Predictive Validity & Diagnostic Performance of the EFPT-E & the PASS to Real-World Medication Adherence

Abstract Date Presented 04/22/2023 This poster explores the predictive validity and diagnostic performance of the Executive Function Performance Test-Enhanced (EFPT–E) and the Performance Assessment of Self-Care Skills (PASS) medication management subtests on real-world medication adherence at home. Primary Author and Speaker: Jaclyn K. Schwartz Additional Authors and Speakers: Katherine Aylmer, Samara Green

11 Clinical Manifestations of Neuroaxonal Injury

OBJECTIVES/GOALS: The preclinical stage of Alzheimer disease (AD) is a clinically silent period that can be detected through neuroimaging and biofluid biomarkers. The goal of this study was to determine whether performance of complex daily tasks is associated with plasma biomarkers of brain amyloidosis or neuroaxonal injury in cognitively normal (CN) older adults. METHODS/STUDY POPULATION: This is a cross-sectional analysis of an ongoing longitudinal cohort study. CN older adults performed three complex daily tasks (shopping, checkbook balancing, medication management) from the Performance Assessment of Self-Care Skills in their home. Tasks were scored for independence, with more assistance required indicating worse performance. Participants had a plasma sample obtained within two years of completing the tasks. Plasma amyloid (Aβ42 and Aβ40) were evaluated by high precision immunoprecipitation mass spectrometry assays and neurofilament light (NfL) was measured with single molecule array (Simoa) assays. Nonparametric partial correlations were used to quantify the associations between task performance and plasma AD biomarkers, controlling for age and gender. RESULTS/ANTICIPATED RESULTS: 105 CN participants (mean age 74.7 years, 55% female, 88% white) were included. After controlling for age and gender, worse performance of complex daily tasks (more assistance required) was associated with increased plasma NfL (Spearman’s: 0.23, p=0.04) but not plasma Aβ42/Aβ40. DISCUSSION/SIGNIFICANCE: This study suggests that worse performance of complex daily tasks in CN older adults may be associated with increased plasma NfL a marker of neuroaxonal injury, but not with plasma amyloid. These findings could lead to a better understanding of clinical changes that may occur prior to the onset of noticeable memory symptoms in AD or related dementias.

Worse Performance of Complex Daily Activities is associated with Plasma Neurofilament Light

AbstractBackgroundThe preclinical stage of Alzheimer disease (AD) is a clinically silent period that is detectable through neuroimaging and biofluid biomarkers of amyloid, tau, and neurodegeneration. We evaluated whether performance of cognitively‐focused complex daily activities is associated with plasma biomarkers of brain amyloidosis or neuroaxonal injury in cognitively normal (CN) older adults.MethodIn this cross‐sectional analysis of an ongoing longitudinal cohort study, CN older adults performed three cognitively‐focused complex daily activtites (shopping, checkbook balancing, and medication management) from the Performance Assessment of Self‐Care Skills (PASS) in their home. PASS tasks were scored for independence of performance, with more assistance required indicating worse performance. Participants also had a plasma sample obtained within two years of completing the PASS. Plasma amyloid (Aβ42 and Aβ40) were evaluated by high precision immunoprecipitation mass spectrometry assays and neurofilament light (NfL), a marker of neuroaxonal injury, was measured with single molecule array (Simoa) assays. Amyloid Probability Score (APS) was calculated from a combination of plasma Aβ42/Aβ40, APOE status, and age and reflects the likelihood that an individual will be amyloid positive on an amyloid positron emission tomography (PET) scan. Nonparametric partial correlations were used to examine the associations between PASS performance and biomarkers of AD (plasma Aβ42/Aβ40, APS, and plasma NfL), controlling for age and sex.Result105 CN participants (mean age 74.7 years, 55% female, 88% white) were included. After controlling for age and sex, worse performance of complex daily tasks (more assistance required) was associated with increased plasma NfL (Spearman’s ρ: 0.234, p = 0.04) but not plasma Aβ42/Aβ40 or APS.ConclusionThis study suggests that worse performance of complex daily activities in CN older adults may be associated with increased plasma NfL, a marker of neuroaxonal injury, but not with other plasma biomarkers of brain amyloidosis (plasma Aβ42/Aβ40 or APS). These findings could lead to a better understanding of functional changes that may associate with neuroaxonal injury prior to the onset of noticeable memory symptoms in AD or related dementias.

Promoting Medication Management Skills Among Home Health Occupational Therapists: A Quality Improvement Project

Medication management is a national patient safety goal for home care practice. Medication management is an occupation within the scope of occupational therapy. Occupational therapists are able to assess and provide intervention for cognitive, visual, motor, process, environmental and personal factors that impact an individual’s ability to manage their medication independently. This quality improvement project describes a program developed to promote medication management competence in occupational therapists practicing in a large, academic home health agency. The quality improvement project consisted of an online module providing education on the Performance Assessment of Self-Care Skills (PASS) and a 1-hour training session combining didactic education with case-based learning. Pre-post assessment surveys revealed a 25% increase in perceived medication management competence after the intervention. Occupational therapists identified 4 barriers to medication management practice: role ambiguity, documentation challenges, pharmacology knowledge deficit, and reconciliation process barriers.

254 Markers of Neurodegeneration Associate with Worse Performance of Complex Daily Tasks

OBJECTIVES/GOALS: In preclinical Alzheimer disease (AD), biomarkers such as amyloid protein, decreased hippocampal volume, and weaker network connections are apparent in the brain, but memory symptoms assessed by paper and pencil tests have not yet appeared. Performance tests of complex daily tasks may be more sensitive and detect early functional impairment. METHODS/STUDY POPULATION: This is a cross-sectional analysis of an ongoing cohort study. Cognitively normal (CN) older adults completed 3 standardized complex daily tasks from the Performance Assessment of Self-Care Skills (PASS) in their home. Biomarkers of AD were assessed within 2-3 years of an individuals completion of the PASS and include: amyloid accumulation, hippocampal volume, and resting-state functional connectivity (rs-fc) signature. Associations between performance on PASS tasks and the biomarkers of AD were quantified by Pearson point-biserial correlations, as biomarker data was normally distributed and PASS scores fell between two categories (acceptable or optimal quality of performance). Correlations with a 95% confidence interval (CI) that did not include 0 were considered significant. RESULTS/ANTICIPATED RESULTS: 161 CN participants (mean age 74.3 years, 55% female) were included. Mean score on the 3 PASS tasks ranged from 2.67 [standard deviation (SD): .47] to 2.90 (SD: .16) out of 3. Mean amyloid PET on Centiloid scale was 23.8 (SD: 34.8); mean partial volume corrected hippocampal volume was 7448.5 (SD: 909.8); mean rs-fc signature was .805 (SD: .164). After controlling for age and gender, worse performance of complex daily activities was associated with smaller hippocampal volumes (Pearsons r: 0.302, p=.02, 95% CI: .179 to .416) and weaker rs-fc network connections (Pearsons r: 0.276, p=.03, 95% CI: .078 to .453), but not amyloid accumulation. DISCUSSION/SIGNIFICANCE: This study suggests that worse performance of complex daily tasks may be associated with markers of neurodegeneration. These findings could lead to a better understanding of functional changes that may occur during the preclinical stage of AD.

The Performance Assessment of Self-Care Skills to Predict Adverse Events Post-Discharge.

Background. The Performance Assessment of Self-Care Skills (PASS) is a standardized assessment of the ability to perform daily activities. Purposes. This preliminary exploratory study aimed to 1) explore the ability of four PASS tasks to predict adverse events (readmissions and injuries) in older adults following hospitalization; 2) compare PASS's predictive validity to that of a generic tool (SMAF) and OT clinical judgement. Method.Twenty-two older patients were assessed in hospital at discharge and at home one week later. Adverse events were documented for six months post-discharge. Sensitivity and specificity analyses (ROC curves, Fisher's exact tests) were performed. Findings. Two PASS tasks (telephone, medication), the SMAF-Social and OT clinical judgement could identify individuals at risk of readmission (AUC > 0.7; p < 0.05). Implications. Using the PASS to assess more cognitively demanding tasks could be a promising way to predict adverse events after discharge, as a complement to clinical judgment.

Amyloid accumulation associated with worse performance of complex task

AbstractBackgroundThe preclinical stage of Alzheimer disease (AD) is largely considered a clinically silent period that is detectable primarily through neuroimaging and biofluid biomarkers of amyloid and tau. We evaluated whether performance of complex daily activities is associated with amyloid accumulation as measured by positron emission tomography (PET) among cognitively normal (CN) individuals with or without preclinical AD.MethodCN participants (Clinical Dementia Rating 0) from the Knight Alzheimer Disease Research Center performed three activity subtasks (shopping, checkbook balancing, and medication management) from the Performance Assessment of Self‐Care Skills (PASS) at their homes. They also had an amyloid PET scan using Pittsburgh Compound‐B within one year of completing the PASS. PASS subtasks were scored for independence, adequacy, and safety of performance. Nonparametric correlations were used to determine the associations between amyloid accumulation and performance on each subtask.ResultFifty‐six CN participants (mean age 74.8 years, 61% female, 87% white) were included. Median amyloid PET was 1.17 (interquartile range 1.07–1.63; standard cutoff for preclinical AD: 1.42). Amyloid PET accumulation was not associated with performance on the checkbook balancing or medication management subtasks of the PASS. Higher amyloid PET accumulation was associated with worse performance on the shopping subtask of the PASS.ConclusionThis study suggests that a complex task, measured using a performance‐based test, may be associated with higher amyloid deposition. Performance‐based measures could potentially serve as a less expensive method for screening individuals who may likely benefit from further evaluation (plasma amyloid or PET amyloid). They could also lead to a better understanding of functional changes that may be occurring during the preclinical stage of AD.

Cultural Adaptation and Validation of the Performance Assessment of Self-care Skills among Older People in Community

Background: The Performance Assessment of Self-care Skills (PASS-Home) is a client-centered, performance-based, criterion-reference, observational form designed to capture client’s performance skills in completing daily task activities. The aim of the study was to describe the process of translating, adapting and validating the PASS-Home from English language version into a Malay language version. Methods : The development of the translated Malay version of the PASS-Home consisted of two stages. Stage one involved the exclusion of the items that were not culturally relevant to the Malaysian culture. Stage two involved the translation process. The five steps of the cross-cultural adaptation process were followed: a) initial forward version; b) a summary of recommendations by the expert panels; c) the back-translation; d) modifications of the translated Malay version of PASS and a summary of problems found during the pre-testing, and e) the final version of the PASS Malay Version (M-PASS). Results: A total of five items from the PASS-Home were omitted in the Malay version (M-PASS) and another five items that were considered as suitable in Malaysian context were added in the M-PASS. The Content Validation Index (CVI) showed perfect agreement with an average of I-CVI was reported at 0.99 and S-CVI/universal agreement (S-CVI/UA) was at 0.93. Test-retest reliabilty showed that the M-PASS were highly reliable reported of its three main constructs of Independence (0.706), Safety (0.906) and Adequacy (0.950). Conclusion: M-PASS showed strong evidence as a valid and reliable assessment in evaluating the functional level of older people who live independently in community. DOI : http://dx.doi.org/10.17576/JSKM-2021-1902-14

Self-Care Skills between Institutionalised and Home Dwelling Older Adults: A Preliminary Study

Background: Self-care is defined as activities perfomed by individuals, families, and communities to enhance their health, prevent diseases, limit illnesses, and restore health. Previous research has mainly focused on self-care skills of older adults in either institution or residential homes separately but limited studies have compared between both these settings. This study aimed to compare the self-care skills between institutionalized and home dwelling older adults at selected area in Malaysia. Design and methods : A total of 43 participants aged 60 years old and above were recruited in our study; (23 participants were home-dwelled older adults and 19 participants were recruited from two private elderly home located in Kuala Lumpur). Malay Version of Performance Assessment of Self-Care Skills (M-PASS-HOME) 4.0 was used focusing on four main subtests of self-skills; oral hygiene, trimming toenails, house mobility and shower mobility. Results: The differences in self-care skills between institutionalized and home dwelling older adults are statistically significant (p<0.01) in the aspects of independency for all self-care activities (oral hygiene, trimming toenails, house mobility and shower mobility). Conclusion: The results of this study revealed that home dwelling older adults group are more independent in self-care activities of oral hygiene, trimming toenails, indoor walking; bathroom and shower mobility compared to institutionalized group. DOI : http://dx.doi.org/10.17576/JSKM-2021-1902-15

The Portuguese Performance Assessment of Self-Care Skills Measure: Validity and Reliability.

Performance Assessment of Self-Care Skills (PASS) is a performance-based scale developed in the United States. Because of cultural differences, a Portuguese version was developed, then validated in the Portuguese population and tested ensuring reliability. The objective of this study was to create and test psychometric properties of a Portuguese version of PASS. A linguistic validation on older adults with physical/cognitive disabilities enabled us to validate P-PASS. Some original tasks were changed. Data were analyzed by PASS constructs (independence-safety adequacy), age, and gender. Construct validity (known-group analyses, factor analyses), with 98 individuals yielded excellent results. Reliability between two observers for 30 participants yielded almost perfect agreement for all three constructs. Independence scores were highest, followed by safety and adequacy. Men presented greater independence, as well as participants <60 years. We obtained results comparable with the original version. Conclusion. P-PASS is valid and reliable for the Portuguese population, enabling effective assessment of function and measurement of health outcomes.

Occupational therapy assessment and treatment approach in patients with subacute and chronic stroke: A single-blind, prospective, randomized clinical trial

Objectives The aim of this study was to examine the effects of occupational therapy (OT) combined with standard rehabilitation (SR) on the activities of daily living, quality of life, and psychological symptoms of hemiplegic patients.Patients and methods Between August 2014 and February 2016, a total of 35 hemiplegic patients with post-diagnostic periods (19 males, 16 females; mean age 58.3 years; range 37 to 77 years) were included. The patients were randomized into two groups as OT+SR group (n=17) and SR only group (n=18). The study was completed by 16 patients in each group. The patients in the OT group were given 45-min SR five days a week plus 45-min OT three days a week over an eight-week period, while the patients in the SR group received SR only (of the same duration and frequency as the OT group). The patients were assessed at enrolment (pre-treatment), and again after eight weeks of treatment using the Pinch and Grip Strength and the Purdue Pegboard tests, Global Daily Living Activities Scale, Performance Assessment of Self-care Skills (PASS), Nottingham Extended Activities of Daily Living (NEADL) Scale, Quality of Life Short Form (SF-36) Questionnaire, and Hospital Anxiety and Depression Scale (HAD) for their psychological state.Results Significant improvements were observed in within-group scores for PASS, Pinch and Grip Strength Test, NEADL Scale, and Purdue Pegboard test (p<0.05). After treatment, a significant increase was found in the SF-36 physical function, general health and physical total in-group scores of the OT group, whereas a significant increase was observed only in the physical total scores of the SR group (p<0.05). There was no significant improvement in the HAD scores within both groups (p>0.05). Inter-group comparisons revealed a further significant improvement in PASS instrumental daily activity index-physical subscale and Purdue Pegboard Test scores of the OT group (p<0.05). However, there was no significant difference in PASS activity, self-care and instrumental daily activity cognitive subscale, SF-36, HAD and hand grip and pinch strength scores between the groups (p>0.05).ConclusionOccupational therapy combined with SR applications has a beneficial impact on certain daily living activities and hand functions. Occupational therapy does not have any additional benefits on the quality of life, pinch and grip strength, and the psychological state.

Functional Competence and Cognition in Individuals With Amnestic Mild Cognitive Impairment.

The objective of this study is to characterize functional competence (measure of assistance needed for independence) on Performance Assessment of Self-Care Skills (PASS) Cognitively Mediated Instrumental Activities of Daily Living (C-IADL), in individuals with amnestic mild cognitive impairment (aMCI). It aims to determine: (1) the association of functional competence on PASS C-IADL tasks with neurocognitive test performance in aMCI, (2) its ability to discriminate individuals with aMCI from healthy control (HC) individuals, and (3) its added value in discriminating aMCI from HC individuals when combined with neurocognitive test performance. Cross-sectional secondary analysis of baseline data from a cohort of individuals enrolled in a clinical trial (NCT02386670). Five university-affiliated outpatient clinics in Toronto, Canada. aMCI (N = 137) and HC (N = 51) participants, all aged 60 years or older. We assessed the relationship between functional competence on three C-IADL PASS tasks (shopping, bill paying, and checkbook balancing) and neurocognitive tests in 137 participants with aMCI using multiple linear regressions. Additionally, we constructed receiver operating characteristic curves to assess the role of PASS functional competence in discriminating between 137 aMCI and 51 HC participants. Functional competence on PASS was significantly associated with tests of verbal memory, information processing speed, and executive function. It demonstrated 79% accuracy in discriminating aMCI from HC participants. Combining functional competence on PASS with individual neurocognitive tests significantly increased the discriminant accuracy of individual tests, and neurocognitive test scores combined with functional competence on PASS had the highest discriminant accuracy (94%). Functional competence on PASS is predicted by the underlying cognitive deficits and possibly captures additional element of effort that could improve the diagnostic accuracy of aMCI when combined with neurocognitive tests. Thus, PASS appears to be a promising tool for assessment of functional competence in aMCI in clinical or research settings. J Am Geriatr Soc 68:1787-1795, 2020.

Can Brief Cognitive or Medication Management Tasks Identify the Potential for Dependence in Instrumental Activities of Daily Living?

Background and Objectives: The identification of functional performance deficits is critical to the community independence of older adults. We examined whether a combined cognitive and performance-based medication management measure would be able to better classify an individual’s functional cognitive status and potential for instrumental activities of daily living (IADL) impairment than either measure alone.Research Design and Methods: Community-dwelling adults age 55 and older (n = 185) were administered the Mini-Cog, the Medication Transfer Screen-Revised (MTS-R), a combination measure the Medi-Cog-Revised (Medi-Cog-R), the Performance Assessment of Self-Care Skills (PASS) Checkbook Balancing and Shopping tasks (PCST), additional cognitive screening measures, and a self-report daily living scale. Receiver operating characteristic (ROC) curve analyses were computed for the Mini-Cog, MTS-R and the Medi-Cog-R using the PCST performance as the criterion measure. The area under the curve (AUC), sensitivity, and specificity were computed for each measure.Results: The Medi-Cog-R most accurately identified individuals as impaired on the PCST. An AUC statistic of 0.82 for the Medi-Cog-R was greater than either the Mini-Cog (0.75) or the MTS-R (0.73). The Medi-Cog-R demonstrated a sensitivity of 0.71 and a specificity of 0.78 in classifying individuals with impaired IADL as measured by the PCST.Discussion and Implications: The Mini-Cog, the MTS-R, and the Medi-Cog-R all show discriminant validity, but the combined measure demonstrates greater sensitivity and specificity than either component measure alone in identifying IADL impairment. The Medi-Cog-R appears to be a useful screening measure for functional cognition and can be used to prompt further assessment and intervention to promote community independence.

VALIDATION OF A NEW FUNCTIONAL COGNITION SCREENING MEASURE

Identification of cognitive deficits that contribute to functional dependence in acute and post-acute care settings is important. The Menu Task (MT) is a brief cognitive 12 item screening measure designed to identify older adults at risk for IADL impairment in community settings. The objective was to compare the psychometric properties of the Menu Task a series of neurocognitive and functional cognitive performance measures including the Brief Interview of Mental Status (BIMS), the Montreal Cognitive Assessment (MoCA) the Weekly Calendar Planning Activity (WCPA) and the Performance Assessment of Self-Care Skills (PASS) in a sample of 200 community dwelling older adults. Participants were administered the MT, BIMS, MoCA, WCPA, and the PASS checkbook and shopping tasks. ROC analysis identified an MT cut score, sensitivity and specificity. We computed Cronbach’s alpha, correlations among study measures and t-tests between groups impaired or unimpaired on the MT. Mean age of participants was 70.44(SD 8.3), the sample was predominately female ((76%), and white (81%). Mean MT score was 8.22 (SD 2.01) and the mean completion time was 185.5 sec (SD 108.11). The Menu Task has moderate internal consistency (α= 0.65). The AUC statistic was 0.83 with an optimal MT cut score of “7” and sensitivity of .90 and specificity of .70. Significant differences (p < 0.01) were observed between impaired and not impaired MT groups on BIMS, MoCA, WCPA, and PASS. The Menu Task has moderate to strong evidence supporting its psychometric properties and the value of screening for functional cognitive deficits.

Effect of Leap Motion-based 3D Immersive Virtual Reality Usage on Upper Extremity Function in Ischemic Stroke Patients.

Immersive virtual reality (VR) is a technology that provides a more realistic environmental design and object tracking than ordinary VR. The aim of this study was to investigate the effectiveness of immersive VR on upper extremity function in patients with ischemic stroke. Sixty-five patients with ischemic stroke were included in this randomized, controlled, double-blind study. Patients were randomly divided into VR (n = 33) and control (n = 32) groups. The VR group received 60 minutes of the upper extremity immersive VR rehabilitation program and the control group received 45 minutes of conventional therapy and 15 minutes of a sham VR program. Rehabilitation consisted of 18 sessions of therapy, three days per week, for six weeks. The outcome measures were the Action Research Arm Test (ARAT), Functional Independence Measure (FIM), Fugl-Meyer Upper Extremity Scale (FMUE) and Performance Assessment of Self-Care Skills (PASS). In both the VR and control groups all parameters except the PASS improved over time. However independent t-test results showed that all of the FMUE, ARAT, FIM and PASS scores were significantly higher in the VR group compared with the control (p < 0.05). The minimal clinically important difference (MCID) scores of the FMUE and ARAT were higher than the cut-off MCID scores described in the literature in the VR group, whereas the FIM scores were below the cut-off MCID scores. All scores in the control group were below the cut-off scores. Immersive VR rehabilitation appeared to be effective in improving upper extremity function and self-care skills, but it did not improve functional independence.

A pilot investigation of anterior tilt use among power wheelchair users

Purpose To examine the influence of use of the anterior tilt-in-space power seat function on performance of functional activities, physical health, and user satisfaction on among power wheelchair users. Materials and methods Ten full-time power wheelchair users with a seat elevator on their current chair participated in a mixed-methods, repeated measures study. At Visit 1 participants completed the Wheelchair Outcome Measure, Functional Mobility Assessment, Wheelchair Users Shoulder Pain Index, Fatigue Severity Scale, and the Spinal Cord Injury Secondary Conditions Scale. Physical assessments were performed to examine transfer quality (transfer assessment instrument), functional reach, activities of daily living (performance assessment of self-care skills), seated balance (function in sitting test), spasticity, respiratory function, and speech production. Approximately 3 days later (Visit 2), participants were trained on use and provided a power wheelchair with anterior tilt to trial for two weeks. After two weeks (Visit 3), the Visit 1 protocol was repeated and a semistructured interview conducted. Results Participants lived with disabilities of cerebral palsy, spinal muscular atrophy and multiple sclerosis. With use of anterior tilt, significant improvements were seen among safety of meal preparation, p = 0.033, dz = 0.91 and functional reach in the vertical direction, p = 0.000, dz = 2.62. Subjectively, participants found anterior tilt helpful in performance of reaching tasks in but found the safety equipment restrictive. Conclusion Preliminary results indicate that use of the anterior tilt may help to improve performance of functional activities. Additional research is needed to examine the long-term influence of the technology. Implications for rehabilitation The anterior tilt seat function changes the seat angle orientation in relation to the ground in the sagittal plane and angles the seat forward. As a result, the individual using the assistive technology is positioned in a semistanding position. Preliminary results of this study indicate that with use of anterior tilt, safety of meal preparation and functional reach in the vertical direction significantly improved. Subjectively, participants found anterior tilt helpful in performance of reaching tasks but found the safety equipment restrictive. Additional research is needed to examine the long-term influence of anterior tilt on functional activities, physical health and user satisfaction on among a large and diverse group of power wheelchair users.

Instrumental Activities of Daily Living Changes in Deaf and Hard-of-Hearing Individuals After an 8-Week Yoga Intervention

Abstract Date Presented 4/19/2018 This study provides quantitative data showing the functional limitations of deaf and hard-of-hearing individuals in instrumental activities of daily living (IADLs) before and after an adapted 8-wk yoga intervention. IADL performance was measured using the Performance Assessment of Self-Care Skills. Primary Author and Speaker: Sarah Curtis Additional Authors and Speakers: Lisa Leppla Contributing Authors: Sarah Dietrich, Grace Hovde, Muhammad Al-Heizan, Kristen Pickett

The feasibility of an automatic prompting system in assisting people with traumatic brain injury in cooking tasks

Purpose: Individuals with traumatic brain injury (TBI) often experience difficulties in performing kitchen-related sequencing tasks due to cognitive deficits. The primary aim of this study is to examine the feasibility of a context-aware automatic prompting system in assisting individuals with TBI in multi-step cooking tasks.Method: Sixteen individuals with TBI participated in the study. A randomized cross-over design was used to compare the automatic prompting method with a conventional user-controlled method through a tablet device. Participant performance under each prompting method was assessed using the Performance Assessment of Self-Care Skills in terms of independence, safety, and adequacy. Subjective workload and qualitative feedback were also collected.Results: The automatic method, when compared with the user-controlled method, significantly decreased the amount of external assistance required by participants, received higher ratings in user perceived ease-of-use, and was considered less stressful for participants. However, the user-controlled method showed strengths in offering participants more flexibility in terms of controlling on the timing of prompts.Conclusions: The results provided insight into the potential benefits and user perceptions of a context-aware prompting system. The information could contribute to the future development of advanced prompting technology for people with cognitive impairments in completing sequential tasks.Implications for RehabilitationFor people with traumatic brain injury, the context-aware prompting method showed advantages in improving user performance, receiving better ratings on ease-of-use, and decreasing stress levels, compared to the user-controlled prompting method in completing multi-step cooking tasks.Future prompting systems for people with cognitive impairments may allow users to control the pace of prompting and use sensing information as back-up assistance in critical situations. In this way, the system may help users monitor their actions and offer confirmations, especially at steps with safety concerns, thus enhancing the sense of security and reducing the stress from self-monitoring.