Computerized Assessment of Cognition for Persons With Traumatic Brain Injury

PURPOSE: The Standardized Touchscreen Assessment of Cognition (STAC; Cognitive Innovations, 2013) is an innovative iPad-based assessment tool. The initial phase of this investigation involved validation of this assessment on adults ages 18–85 yr with typical cognitive function. The purpose of this investigation is to continue the validation of this assessment tool in individuals with traumatic brain injury (TBI). In this phase, the STAC will be compared with two frequently utilized assessments in rehabilitation settings, specifically the Montreal Cognitive Assessment (MoCA; Wong, Ngai, Wong, Mok, & Poon, 2013) and the Cognitive Linguistic Quick Test (CLQT; Helms-Estabrooks, 2001). Additionally, we will identify the relationship between outcomes on the STAC and self-perceived level of disability. Qualitative description of the experience of using the STAC versus pencil-and-paper assessments is included.

RATIONALE: Although there are many assessment tools to measure cognitive abilities, most provide limited qualitative data and require significant time to score. The STAC seeks to address accuracy and efficiency in assessing cognitive abilities while also providing qualitative information about the individual.

DESIGN: This mixed-methods study uses a within-participant design to compare the outcomes of the STAC with established tests.

PARTICIPANTS: The initial phase included neurotypical participants between the ages of 18 and 85 yr (N = 84). Participants self-reported no hearing or vision impairments, had upper-extremity use within functional limits, and passed the Mini-Mental State Examination. We are continuing validation of the STAC for persons with TBI between ages 18 and 65 yr who are ≥6 mo post-TBI and present with no severe impairments in language, fine motor, or vision.

METHOD: In the initial phase, participants completed the CLQT, STAC, and Cognitive Assessment of Minnesota (CAM; Rustad et al., 1993) in a randomized order. Similarly, in the second phase participants will complete the CLQT, MoCA, and STAC in a randomized order. A modified Post-Study System Usability Questionnaire (Lewis, 1993) will be completed to assess participants’ personal satisfaction with the use of the STAC in comparison with pencil-and-paper–based assessments. The Craig Handicap Assessment and Reporting Technique–Short Form (CHART–SF; Whiteneck, Charlifue, Gerhart, Overhosler, & Richardson, 1992) will then discern the participants’ perceived level of disability.

ANALYSIS: Data for the first phase was entered into a secure electronic database and analyzed using statistical software. In Phase 1, scores for the STAC were correlated with subsets of items on the CLQT and CAM. For Phase 2, the scores on the STAC will be correlated with the scores on the MoCA, CLQT, and CHART–SF. The researchers will analyze the usability survey Likert-scale results descriptively and collect themes from responses to the comments section.

RESULTS: Preliminary analysis from the initial phase suggests strong correlations between several areas measured by the STAC, CAM, and CLQT.

DISCUSSION: The STAC has the potential to augment the clinical evaluation process of cognitive abilities. Preliminary findings suggest that in a neurotypical sample, the STAC operates similarly to current assessments of cognition. The second phase of this investigation for individuals with TBI will determine the STAC’s validity and clinical utility in this clinical population.

IMPACT STATEMENT: If the STAC demonstrates concurrent validity against the gold standard of cognitive assessments, the use of this assessment through an electronic tablet can greatly increase a clinician’s efficiency and influence the ease and accuracy of evaluating cognitive abilities, specifically for people with TBI.

References

Cognitive Innovations. (2013). Standardized Touchscreen Assessment of Cognition. Retrieved from http://www.cognitive-innovations.com

Helms-Estabrooks, N. (2001). Cognitive Linguistic Quick Test. San Antonio: Psychological Corporation.

Lewis, J. R. (1993). IBM Computer Usability Satisfaction Questionnaires: Psychometric evaluation and instructions for use (Technical Report 54.786). Boca Raton, FL: IBM Corporation.

Rustad, R. A., DeGroot, T. L, Junkunz, M. L., Freeberg, K. S., Browick, L. G., & Wanttie, A. M. (1993). Cognitive Assessment of Minnesota. San Antonio: Therapy Skill Builders.

Whiteneck, G. G., Charlifue, S. W., Gerhart, K. A., Overhosler, J. D., & Richardson, G. N. (1992). Quantifying handicap: A new measure of long-term rehabilitation outcomes. Archives of Physical Medicine and Rehabilitation, 73, 519–526.

Wong, G., Ngai, K., Wong, A., Mok, V., & Poon, W. (2013). Validity of the Montreal Cognitive Assessment for traumatic brain injury patients with intracranial hemorrhage. Brain Injury, 27, 394–388. http://dx.doi.org/10.3109/02699052.2012.750746