Performance-based Measures Research Articles

Distinct Constructs Underlie Patient-Reported and Performance-Rated Outcomes after Stroke.

Patient-reported outcome measures (PROMs), which capture patients' perspectives on the consequences of health and disease, are widely used in neurological care and research. However, it is unclear how PROMs relate to performance-rated impairments. Sociodemographic factors are known to affect PROMs. Direct damage to brain regions critical for self-awareness (i.e., parietal regions and the salience/ventral-attention network) may also impair self-report outcomes. This study examined the relationship between PROMs and performance-based measures in stroke survivors with arm motor impairments. We hypothesized that PROMs would be distinct from performance-based outcomes, influenced by sociodemographic factors, and linked to damage in brain circuits involved in self-perception. We longitudinally assessed 54 stroke survivors using patient-reported and performance-rated measures at 4 timepoints. We used factor analysis to reveal the outcome battery's factorial structure. Linear regression examined the association between classes of measures and sociodemographics. Voxel-lesion-symptom-mapping, region-of-interest-based analysis, and voxel-lesion-network-mapping investigated the relationship between classes of outcomes and stroke-related injury. Performance-based and patient-reported measures formed distinct factors, consistent across recovery phases. Higher education (β1 = 0.36, p = 0.02) and income adequacy (β2 = 0.48, p = 0.05) were associated with patient-reported, but not performance-rated outcomes. Greater parietal lobe injury, irrespective of hemisphere, was associated with worse patient-reported outcomes; greater corticospinal tract injury related to worse performance-rated outcomes. Lesions with greater functional connectivity to the salience/ventral-attention network were associated with worse patient-reported outcomes (r = -0.35, p = 0.009). Our findings reveal important differences between performance-rated and patient-reported outcomes, each with specific associated factors and anatomy post-stroke. Incorporating sociodemographic and neuroanatomic characteristics into neurorehabilitation strategies may inform and optimize patient outcomes. ANN NEUROL 2024.

Personalised exercise rehabilitation in cancer survivorship: Findings from a triage and referral feasibility study.

Screening, triage and referral systems are proposed as efficient, needs-based models of cancer rehabilitation. This study aimed to evaluate the feasibility of the PERCS triage and referral system. Utilising a pre-post design, the feasibility of PERCS was evaluated quantitatively in the context of a physiotherapy-led clinic for patients diagnosed with cancer during COVID-19. Assessments at baseline and 12weeks (T1) included medical, social and physical activity history; patient-reported outcomes and performance-based measures. Following the assessment, the PERCS system allocated participants to one of three exercise pathways. Sixty-four participants were recruited over 5months (25.2% recruitment rate; female n = 39; mean age 61.4 (12.4) years). Almost all participants (90.6%) required support to become more physically active. The majority (n = 43, 66%) were referred to community exercise programmes, and n = 15 (23%) required physiotherapy rehabilitation. Five required medical pre-clearance, and one was re-triaged at 1week. The mean cost per participant for community exercise services was €107.70. At T1, adherence to physical activity guidelines increased for aerobic (44 to 83%) and resistance (13 to 67%) exercise. Improvements were observed in hand grip strength (x̄ 2.59kg, p = 0.001), 30-s sit-to-stand (x̄ + 3.7 stands, p < 0.001) and 6-min walk test (x̄ + 37.3m, p = 0.001). PERCS appropriately triaged patients to the right level of exercise and rehabilitation for individual needs. Participants experienced improvements in physical activity and physical functioning metrics. The PERCS triage and referral system is feasible to complete and may support the effective and patient-centred implementation of exercise into cancer care. ClinicalTrials.gov registration: NCT05615285.

Multi-centre Modified Delphi Exercise to Identify Candidate Items for Classifying Early-Stage Symptomatic Knee Osteoarthritis

To generate a list of candidate items potentially useful for discriminating individuals with Early-stage Symptomatic Knee Osteoarthritis (EsSKOA) from those with other conditions and from established osteoarthritis (OA), and to reduce this list based on expert consensus. We conducted a three-round online international modified Delphi exercise with OA clinicians and researchers ("OA experts"). In Round 1, participants reviewed 84 candidate items and nominated additional item(s) potentially useful for EsSKOA classification; those nominated by ≥3 participants were added. In Round 2, participants rated perceived usefulness of 108 items (1 [not at all useful] to 9 [extremely useful]). In Round 3, participants could revise their ratings after reviewing Round 2 group median and quartiles. Following Round 3, we retained items with a median usefulness score >5 and ≥33.3% of participants categorized the item as useful (7 to 9), overall and in subgroup analysis by clinician field. There were 128 participants in Round 1 and 113 (88%) completed all rounds. We retained 77 items that spanned multiple domains (demographics, symptoms, physical exam, performance-based measures, imaging, laboratory investigations, and gross inspection/arthroscopy). Highly rated items included (median usefulness score): prior knee joint injury (8), diagnosis of OA in a different joint (7), and activity-related knee pain (7). The interquartile range was most often 3. We identified 77 items that OA experts consider potentially useful for EsSKOA classification. The results highlight experts' uncertainty around item usefulness. Next, candidate items will be further assessed and reduced using data-driven and multicriteria decision analysis methods.

Too much of a good thing: How varying levels of automation impact user performance in a simulated intrusion detection task

Cyber analysts face a demanding task when prioritizing alerts from intrusion detection systems, balancing the challenge of numerous false positives from rule-based methods with the critical need to detect genuine cyber threats, necessitating unwavering vigilance and imposing a significant cognitive burden. In this field, there exists pressure to incorporate artificial intelligence techniques to enhance the automation of analyst workflows, yet without a clear grasp of how elevating the Level of Automation impacts the allocation of attentional and cognitive resources among analysts. This paper describes a simulated AI-assisted intrusion detection task which varies five degrees of automation as well as the sensitivity of the assistant, evaluating performance-based (e.g., accuracy, response time, sensitivity, response bias) and subjective (e.g., surveys on workload and trust) measures. Participants white-listed a series of time-sensitive alerts in a simulated Snort® environment. Our findings indicate that elevating the level of automation altered participants’ behavior, evident in their tendency to display a response bias towards rejecting hits (reduced hit rate and false alarm rate) when overriding an AI’s decision. Additionally, participants subjectively reported experiencing a decreased cognitive workload with a more precise algorithm, irrespective of any variance in their actual performance. Our findings suggest the necessity for additional research before implementing further automation into analyst workflows, as the demands of tasks evolve with escalating levels of automation.

Reliability of the Star Excursion Balance Test with End-Stage Knee Osteoarthritis Patients and Its Responsiveness Following Total Knee Arthroplasty.

Background/Objectives: The Star Excursion Balance Test (SEBT) is a simple and feasible tool for assessing dynamic balance in individuals with knee osteoarthritis (KOA). It has an advantage as it replicates dynamic balance better than other static balance tools. This study aims to determine how reliable SEBT is among people with end-stage KOA, as well as how responsive it is and how well it correlates with performance-based outcome measures after TKA. Methods: Patients on the waiting list for TKA performed SEBT in the anterior, posteromedial and posteriorlateral directions twice within 7 days. The measurements were repeated 6 and 12 months after TKA. The participants completed performance-based outcome measurements (PBOMs) and the Oxford Knee Score (OKS) before and after TKA to estimate correlation. Results: In all directions, the intraclass correlation coefficient range (ICC) was 0.998-0.993, and there were no significant differences between the test and re-test mean SEBT scores. The standard error of measurement (SEM) ranged from 0.37% to 0.68%, and the minimum detectable change (MDC) ranged from 1.02% to 1.89%. The post TKA SEBT results show significant improvement, with a large effect size. There were large-to-medium correlations between SEBT and PBOMs before and after TKA, while OKS correlated only before surgery. The magnitude of change in SEBT, PBOMs and OKS did not correlate. Conclusions: SEBT is an extremely reliable tool for assessing dynamic balance in all three directions of severe KOA patients. It is sensitive enough to detect balance changes at 6 and 12 months post TKA. SEBT cannot be used to reflect the change in functional outcome improvement after TKA.

Does School Education Improve Children’s Health Literacy? Evidence from a Performance-Based Survey

Abstract Background Children begin using digital sources of health information at a young age and are quickly exposed to a variety of unmoderated health content. Health literacy helps children navigate, understand, evaluate, and act on this content. But is the educational system preparing young people for these tasks? This study develops a validated, performance-based measure of health literacy and applies it to a sample of 9- to 13-year-old children (grades 4 to 7). Methods A performance-based tool to measure children’s health literacy was developed through expert consultation and qualitative and quantitative pretesting. The tool uses vignettes and quizzes and captures three dimensions of health literacy: nutrition, physical activity, and psychosocial health. The validated tool was then used in a cross-sectional survey of Austrian children aged 9 to 13 years (n = 780): Diet, Physical Activity, and Psychosocial Health. Results Results show that the performance-based health literacy scores do not correlate with self-reported scores. Girls (vs. boys) and native speakers perform better on the performance-based literacy test, while boys and children reporting more robust financial backgrounds overestimate their literacy on self-reported questions. Most importantly, the data do not show meaningful increases in performance-based health literacy across grade levels. For nutrition literacy, the study even shows a slight negative trend across grade levels. Conclusions This study questions the heavy reliance on self-reported health literacy, which is often confounded with self-efficacy and social environment. Performance-based instruments are needed to measure health literacy as an educational outcome. This study presents one of the first validated instruments. Most importantly, the study shows that the current educational system may not produce meaningful increases in performance-based health literacy, calling for deeper educational reforms. Key messages • Performance-based health literacy is a distinct concept from the subjective health literacy measures that dominate current health literacy research. • Performance-based health literacy did not increase with grade level, indicating a poor performance of the education system in strengthening health literacy.

Early In-Bed Cycle Ergometry With Critically Ill, Mechanically Ventilated Patients: Statistical Analysis Plan for CYCLE (Critical Care Cycling to Improve Lower Extremity Strength), an International, Multicenter, Randomized Clinical Trial.

Survivors of critical illness are at risk of developing physical dysfunction following intensive care unit (ICU) discharge. ICU-based rehabilitation interventions, such as early in-bed cycle ergometry, may improve patients' short-term physical function. Before unblinding and trial database lock, we describe a prespecified statistical analysis plan (SAP) for the CYCLE (Critical Care Cycling to Improve Lower Extremity Strength) randomized controlled trial (RCT). CYCLE is a 360-patient, international, multicenter, open-label, parallel-group RCT (1:1 ratio) with blinded primary outcome assessment at 3 days post-ICU discharge. The principal investigator and statisticians of CYCLE prepared this SAP with approval from the steering committee and coinvestigators. The SAP defines the primary and secondary outcomes (including adverse events) and describes the planned primary, secondary, and subgroup analyses. The primary outcome of the CYCLE trial is the Physical Function Intensive Care Unit Test-scored (PFIT-s) at 3 days post-ICU discharge. The PFIT-s is a reliable and valid performance-based measure. We plan to use a frequentist statistical framework for all analyses. We will conduct a linear regression to evaluate the primary outcome, incorporating randomization as an independent variable and adjusting for age (≥65 years versus <65 years) and center. The regression results will be reported as mean differences in PFIT-s scores with corresponding 95% CIs and P values. We consider a 1-point difference in PFIT-s score to be clinically important. Additionally, we plan to conduct 3 subgroup analyses: age (≥65 years versus <65 years), frailty (Baseline Clinical Frailty Scale ≥5 versus <5), and sex (male versus female). CYCLE was funded in 2017, and enrollment was completed in May 2023. Data analyses are complete, and the first results were submitted for publication in 2024. We developed and present an SAP for the CYCLE RCT and will adhere to it for all analyses. This study will add to the growing body of evidence evaluating the efficacy and safety of ICU-based rehabilitation interventions. ClinicalTrials.gov NCT03471247; https://clinicaltrials.gov/ct2/show/NCT03471247 and NCT02377830; https://clinicaltrials.gov/ct2/show/NCT02377830. RR1-10.2196/54451.

An Examination of Episodic Future Thinking and Episodic Memory Among Suicidal and Nonsuicidal Adolescents

ABSTRACT Objective Suicidal individuals experience ambivalent states where they simultaneously consider death and the continuation of their lives. But we have little understanding of how suicidal individuals, particularly youth, mentally construct their future lives. To address this knowledge gap, we aimed to examine episodic future thinking and the related cognitive process of episodic memory among suicidal and nonsuicidal adolescents. Method We administered a performance-based measure of episodic future thinking to community-based adolescents (N = 176, 15–19 years; 69.3% female at birth, 57.1% identifying with a racial minoritized group) and examined the concurrent and predictive validity of details generated within an imagined future event in relation to suicidal ideation (SI; ranging from passive desire of wanting to be dead to active desire to kill oneself). Results Greater difficulty imagining discrete actions within an imagined positive future event was associated with past and subsequent SI, although these associations were largely accounted for by depressive symptoms. In contrast, greater difficulty imagining action-related details tied to either positive or negative future events predicted SI 6 months later controlling for symptoms of both anxiety and depression, SI history, and narrative style. Conclusions Findings from this study offer an initial glimpse into how suicidal adolescents imagine their future and may inform the design of interventions intended to promote a stronger desire for life than death.

Maximizing the "Functional" in the Functional External Memory Aid Tool for Patient-Centered Treatment Planning in Mild Cognitive Impairment.

The Functional External Memory Aid Tool (FEMAT) is an 11-item performance-based measure that simulates everyday tasks (e.g., medication management) to measure one's use of compensation (e.g., pill organizer). The FEMAT is not a norm-referenced diagnostic tool; rather, it is designed to provide clinicians with information about a patient's function and compensation in a standardized format. To provide further evidence for validity of the FEMAT, the purpose of this study was to conduct a mixed-methods analysis of FEMAT responses to operationalize the types of behaviors elicited during test administration. We adopted an embedded single-case study design to analyze the FEMAT administrations of 12 community-dwelling female participants, ages 73-90 years, who met criteria for mild cognitive impairment. These participants were part of the original validation sample during which they completed the FEMAT (Version 1.0) in a single session with an assessor. Sessions were video-recorded and transcribed. We analyzed the data qualitatively in two phases using theme and subtheme codes and then quantitatively analyzed the data for response trends. Our thematic analysis revealed four themes to operationalize participants' verbal and behavioral FEMAT responses: (a) used an external memory aid (EMA), (b) described using a strategy, (c) discussed memory and comprehension, and (d) discussed functional information. While completing the FEMAT, most participants described using a strategy (85%) and discussed their self-perceived memory and comprehension (33%). Several subthemes also emerged within each theme (e.g., self-perceived memory strengths and barrier). Our analysis suggests that beyond a 4-point item score, the FEMAT elicits behavioral (e.g., used an EMA) and verbal (e.g., discussion of health information) content that may be useful for person-centered treatment planning. This study is part of a comprehensive research agenda establishing the evidence for the validity of the FEMAT to support its use to inform person-centered treatment approaches.

Association between working memory performance and parent and teacher ratings of working memory in 11-year-old children born preterm

ABSTRACT Working memory (WM) difficulties are often observed in children born preterm. We examined whether performance-based measures of WM components are associated with parent- and teacher-rated WM difficulties in the everyday life of children born very preterm and/or at very low birth weight (VPT/VLBW) at 11 years (n = 165). The WM components as defined in the original Baddeley’s model – phonological loop (PL), visuospatial sketchpad (VS), and central executive (CE) – were assessed with tasks from the Working Memory Test Battery for Children (WMTB-C) and the Wechsler Intelligence Scale for Children – Fourth edition (WISC-IV). Parents and teachers completed the WM subscale of the Behavioral Rating Inventory for Executive Functions (BRIEF). Measures of WM components were modestly associated with BRIEF scores, explaining 18.9% of the variance in parent-rated and 14.0% of teacher-rated WM difficulties. CE was the component most consistently associated with parent- and teacher-rated everyday WM. To conclude, our results suggest that tasks that utilize CE functions may best reflect WM outside of controlled test settings in the follow-up of VPT/VLBW children. However, performance and rating-scale measures provide unique information and are both needed to comprehensively assess WM skills.

Concurrent Validity of Performance-Based Measures of Daily Functioning with Cognitive Measures and Informant Reported Everyday Functioning.

Despite the substantial need for reliable and valid assessment of functional ability in older adults, there is currently limited research on the emergence of early functional declines during prodromal dementia stages, such as subjective cognitive decline (SCD) and mild cognitive impairment (MCI). This study uses novel performance-based assessments to characterize subtle, yet clinically meaningful, changes in functional ability. A sample of 93 older adults classified as cognitively unimpaired (CU; n = 30, Mage = 73.57 ± 6.66), SCD (n = 34, Mage = 72.56 ± 6.43), or MCI (n = 29, Mage = 78.28 ± 7.55) underwent neuropsychological testing along with an informant-rated daily functional skills measure (Assessment of Functional Capacity Interview). Participants also completed the Night Out Task (NOT), an open-ended performance-based measure of functional assessment, and the Financial Capacity Instrument-Short Form (FCI-SF) that assesses financial skills. The MCI group performed worse on the NOT and FCI-SF relative to SCD and CU. NOT and FCI scores were associated with measures of global cognitive function, executive function, processing speed, language and memory, and FCI-SF overall score was correlated with informant-rated functional ability. The NOT and FCI-SF were also predictive of informant-reported daily functioning over and above traditional cognitive data and demographics. Performance-based measures of IADL may allow for earlier detection of subtle functional changes that might not be adequately captured by traditional measures. The measurement of early functional changes is an important global outcome to evaluate the efficacy of interventions in dementia research.

Adolescent Executive Function Measurements in Indonesia : Systematic Review and Implications in Educational Settings

This study examines the landscape of executive function (EF) assessments for Indonesian adolescents, focusing on their psychometric properties. The adolescent development phase, marked by cognitive growth, presents opportunities and risks, especially in education settings where well-developed EF is beneficial. This research used a qualitative approach, with a systematic literature review method using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis), analyzing peer-reviewed empirical studies from databases such as SCOPUS and others, focusing on EF measurements for adolescents in Indonesia from 2014 to 2024. Nine studies met the inclusion criteria, highlighting tools like the Behavior Rating Inventory of Executive Function (BRIEF)-Indonesian version, Executive Skills Questionnaire-Revised (ESQ-R), Executive Function Questionnaire (EFQ), and performance-based measures like the Wisconsin Card Sorting Test and Stroop Test. Using content analysis, this study reveals that while the BRIEF is widely used in clinical studies, its applicability in educational settings requires improvement. The findings highlight the importance of adapting EF tools with cultural sensitivity and developing new comprehensive assessments with clear psychometric properties regarding all critical EF components. In recommendations, the study pinpoints a multi-method approach combining inventory-based and performance-based measures to provide a thorough understanding of EF while maintaining practicality for educational settings. The implications for advancing EF research and practice in Indonesia, particularly in education, are discussed, emphasizing the need for reliable, valid, culturally sensitive, and accessible assessment tools.

Executive Function and Adherence in Children and Adolescents Living with HIV: Evidence from the HIV-associated Neurocognitive Disorders in Zambia (HANDZ) Study.

Executive function (EF) may be impaired in people with human immunodeficiency virus (HIV) infection, and poor EF may affect medication adherence. However, there is little data on EF in children with HIV in sub-Saharan Africa. 208 children/adolescents with perinatally acquired HIV and 208 HIV-exposed uninfected controls were recruited in Zambia for this prospective cohort study. EF was measured using performance-based, self-report, and parental report measures. Adherence over one year of follow-up was assessed through questionnaires and viral load measurement. Children with HIV performed significantly worse on all three measures of EF. Lower parental rating of EF was associated with poorer antiretroviral therapy adherence (OR: 1.5, 95% CI = 1.02 - 2.2, p = 0.04). Children with HIV have EF impairments which may lead to consequences like poor medication adherence and treatment failure. Interventions to improve EF or compensate for impaired EF may be necessary in this population.

A - 83 Concordance between Informant Measures, Executive Functioning, and Functional Ability in an Older Adult Population

Abstract Objective Informant-report measures often do not correlate with neuropsychological tests measuring the same cognitive construct, yet they may offer insight into everyday difficulties not captured by objective tests. Performance-based measures of functional ability, developed to capture real-world skills, may better align with informant-report measures. Clarifying the relationship between subjective and objective assessment tools in older adults could enhance precision in selecting the most appropriate measures. Method As part of a comprehensive neuropsychological battery, community-dwelling older adults who were cognitively unimpaired or who presented with subjective cognitive decline or mild cognitive impairment completed tests of executive functioning (EF), (D-KEFS Trail Making Test 4, Letter Fluency, WCST, WAIS-Comprehension) and financial capacity, Financial Capacity Instrument (FCI-SF). Informants responded to measures of functional ability, Amsterdam Instrumental Activities of Daily Living Questionnaire Short Version (A-IADL-Q-SV) and Assessment of Functional Capacity Interview (AFCI) and items capturing EF on the Brief Informant Form of Neurobehavioral Symptomatology (BINS). Results Participants’ (N = 97, Mage = 74.64 ± 7.42 years; Meducation = 15.76 ± 2.42 years; 74.2% female) FCI-SF performance significantly correlated with higher A-IADL-Q-SV (r = 0.403, p &amp;lt; 0.01) and AFCI (r = −0.294, p &amp;lt; 0.01) scores, whereas there was no significant correlation between a composite Z-score for traditional neuropsychological tests and select EF items from the BINS, (r = −0.119, p = 0.252). Conclusion We found greater alignment between objective and subjective measures of functional ability than EF, possibly due to the observable nature of functional tasks. Objective and informant measures of EF do not align, potentially targeting different aspects of cognition in non-demented older adults. This should be considered when selecting instruments measuring specific constructs of interest.

Associations between changes in leg extensor muscle power and physical function after supervised exercise in patients with hip osteoarthritis. Secondary analysis from the hip booster trial

ObjectiveTo investigate associations between changes in leg extensor muscle power of the affected limb (ΔLEP) and changes in physical function after 12 weeks of progressive resistance training (PRT) or neuromuscular exercise (NEMEX) in patients with hip osteoarthritis. DesignSecondary analyses of a randomized controlled trial. From 160 participants enrolled in the clinical trial and cluster randomized to PRT (n ​= ​82) or NEMEX (n ​= ​78), a total of 147 (92%) had complete follow-up data and were included in the analyses. Simple linear and multivariate linear regression models estimated the crude and adjusted associations between ΔLEP normalized to body weight (watt/kg) and changes in performance-based and patient-reported measures of physical function. ResultsAdjusted estimates [95% confidence intervals] showed associations between ΔLEP (watt/kg) and changes in 30-s chair stand test (β: 2.34 [1.33; 3.35], R2: 0.13), 9-step timed stair climb test (β: −1.47 [-2.09; −0.85], R2: 0.38), 40-m fast paced walking test (β: −2.20 [-3.30; −1.11], R2: 0.09), Activities of Daily Life function (β: 8.63 [3.16; 14.10], R2: 0.23) and Sport and Recreation function (β: 10.57 [2.32; 18.82], R2: 0.21) subscales from the Hip disability and Osteoarthritis Outcomes Score. Group allocation to PRT did not lead to greater regression coefficients than in NEMEX. ConclusionsChanges in leg extensor muscle power after supervised exercise are consistently associated with changes in physical function across performance-based and patient-reported measures in patients with hip osteoarthritis. These associations seem to be independent of allocation to PRT or NEMEX.

A Preliminary Examination of a Novel Telepractice Screening Protocol for Poststroke Aphasia.

The delivery of telepractice interventions for people with poststroke aphasia has been found effective and feasible compared to traditional, in-person interventions; however, telepractice assessments, particularly screening protocols, which may foster convenient access to aphasia diagnostic services, have received limited examination within the aphasia literature. Therefore, the purpose of this study was to examine a novel telepractice screening protocol for people with poststroke aphasia that assesses both language and extralinguistic cognitive abilities via both performance-based and patient-reported measures. Twenty-one participants with previously diagnosed poststroke aphasia completed the telepractice administration of the Frenchay Aphasia Screening Test (FAST), the Aphasia Impact Questionnaire-21 (AIQ-21), the Oxford Cognitive Screen (OCS), and the Cognitive-Communication Checklist for Acquired Brain Injury (CCCABI). Care partners of the participants completed the Communicative Effectiveness Index (CETI). After the telepractice session, each participant completed a feasibility questionnaire to rate their overall experience. All participants screened as having aphasia. Pearson correlation analyses yielded a strong positive relationship between OCS and FAST scores (r = .74), a strong relationship between OCS and CCCABI scores (r = -.71), and a moderate relationship between FAST and AIQ-21 scores (r = -.35). Moderate relationships were noted between the performance-based measures and the CETI (r = .30). The overall feasibility of telepractice administration was rated positively by each participant. No significant relationships were found between the feasibility responses and participant characteristics. Overall, the telepractice screening protocol yielded an effective and feasible way to identify poststroke aphasia. Similar to in-person administration of screening measures, it was more difficult to identify milder levels of aphasia severity. Future research should examine whether this telescreening protocol can identify poststroke aphasia within the broader stroke population.

How do long combination vehicles perform in real traffic? A study using Naturalistic Driving Data

This paper evaluates the performance of two different types of long combination vehicles (A-double and DuoCAT) using naturalistic driving data across four scenarios: lane changes, manoeuvring through roundabouts, turning in intersections, and negotiating tight curves. Four different performance-based standards measures are used to assess the stability and tracking performance of the vehicles: rearward amplification, high-speed transient offtracking, low-speed swept path, and high-speed steady-state offtracking. Also, the steering reversal rate metric is employed to estimate the cognitive workload of the drivers in low-speed scenarios. In the majority of the identified cases of the four scenarios, both combination types have a good performance. The A-double shows slightly better stability in high-speed lane changes, while the DuoCAT has slightly better manoeuvrability at low-speed scenarios like roundabouts and intersections.

Association between visual attention and parent-reported social problems in pediatric cancer survivors

ABSTRACT Social deficits in pediatric cancer survivors have been well documented and have been linked to neurocognitive late effects, particularly attention deficits. The purpose of this study was to examine the association between components of attention, both parent-report and a performance-based measure, with parent-reported social functioning in survivors of pediatric cancer. The study included data from outpatient neuropsychological evaluations of 76 survivors of pediatric cancer. The Integrated Visual and Auditory (IVA) continuous performance test was used to evaluate the components of attention with variables corresponding to Posner’s model of attention. Assessment of inattention and peer problems were derived from the Conner’s Parent Rating Scale, third edition. Parent-reported attention symptoms were significantly associated with worse auditory prudence (r = −0.382, p < .001) and visual consistency (r = −0.234, p = .046) and higher parent-reported peer problems (r = 0.302, p = .008). Auditory attention domains were not significantly predictive of peer problems (p > .05). When controlling for FSIQ and type of cancer, worse visual consistency (p = .029) and visual speed (p = .036) were significantly associated with more peer problems. Parent-reported inattention was associated with only some domains of performance-based attention, highlighting the importance of using multi-modal assessments of attention. This study also revealed an important relationship between visual attention and peer problems.

The relationship of neurocognitive and social cognitive performance to social competence and appropriateness on a performance-based social skills assessment in individuals with psychosis and unaffected controls

Social deficits are common in psychosis. The Social Skills Performance Assessment (SSPA) is a performance-based measure used to approximate an individual's social skills. Those with psychosis perform worse than do unaffected controls. Prior work has examined two social skills domains derived from the SSPA: social competence and social appropriateness. Social competence and appropriateness are associated with neurocognition and functioning outcomes. However, no study to date has examined the relationship of social cognition to social competence and appropriateness. We aimed to examine the relationships among different aspects of social cognition and performance-based social functioning and hypothesized that social cognitive performance would be related to social competence and appropriateness. We also hypothesized that after controlling for neurocognition, social cognition would account for unique variance in social competence and appropriateness in separate regression models. Forty-one participants who had experienced psychosis and 42 unaffected controls completed a comprehensive battery of neurocognitive, social cognitive, and social functioning measures. Social competence was associated with neurocognition and some aspects of social cognition, while social appropriateness was only marginally associated with neurocognition. Regression models revealed that social cognition did not account for additional and unique variance in social competence or appropriateness, after adjusting for demographic covariates and neurocognition. Findings suggest that aspects of social functioning performance are differentially related to neurocognitive and social cognitive skills. Social skill interventions may be most effective when targeting both neurocognitive and social cognitive skills in treatment.

Severe Cognitive Impairment in Trauma-Affected Refugees-Exploring the Impact of Traumatic Brain Injury.

Background/Objectives: This study explores the relationship between cognitive performance measured by the Symbol Digit Modality Test (SDMT) and the severity of self-reported head injury, traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), depression, pain, and psychosocial dysfunction in a population of trauma-affected refugees. Refugees, especially those who have been subjected to torture, often face various difficulties, such as PTSD, depression and somatic disturbances (e.g., pain), which can significantly impact their day-to-day functioning. Methods: Participants included 141 adult refugees (38% women) with a mean age of 45.4 years (SD = 9.4) and 9.7 years (SD = 4.9) of education who were referred for treatment of post-traumatic distress to DIGNITY, Danish Institute Against Torture. Participants completed standardized self-report measures of PTSD, anxiety, depression, pain, and health-related disability and measures of trauma history, physical injuries including head injury and loss of consciousness, and the SDMT, a quick standardized performance-based measure of cognitive impairment. Results: Eighty-eight percent of participants evidenced signs of substantial cognitive impairment as indexed by lower SDMT scores. Those with a self-reported history of TBI, marked by loss of consciousness, exhibited lower SDMT scores and higher health-related disabilities. Severity of PTSD, depression, anxiety, and pain were highly correlated with lower SDMT scores. TBI history was not significantly associated with the severity of PTSD, depression, anxiety, or pain, suggesting a complex interplay among these factors. Conclusions: Cognitive impairments are prevalent in trauma-affected refugees, interacting with symptoms of post-traumatic stress and pain, likely explaining the high disability levels in this population. Further research should employ a broader range of cognitive measures and detailed investigations of head injury/TBI experiences to investigate their impact on overall functioning, treatment response, and longer-term outcomes. This study adds to a small but growing body of studies documenting cognitive impairments in trauma-affected refugees, highlighting the importance of addressing cognitive impairments in treatment for trauma-affected refugees, particularly those with histories of torture and TBI. Clinicians working with trauma-affected refugees should consider the assessment of cognitive difficulties as part of comprehensive care planning.