Date Presented 04/07/19
Adults with ABI on an inpatient rehabilitation unit were significantly less accurate and efficient, used fewer strategies, and followed fewer rules, compared to healthy controls on the short Weekly Calendar Planning Activity (WCPA-10). The WCPA-10 was quick, feasible, and provided functionally relevant information on those that exhibited mild to no cognitive impairments on a cognitive screening tool, highlighting the importance of performance-based tools in identifying functional cognitive deficits.
Primary Author and Speaker: Alexis Lussier
Additional Authors and Speakers: Joan Toglia
PURPOSE: This study examined the utility and discriminant validity of a short version of the Weekly Calendar Planning activity (WCPA-10) (Toglia, 2015) by comparing WCPA scores of rehabilitation inpatients with acquired brain injury (ABI) to healthy controls (HC). The relationship between the WCPA-10 and the Montreal Cognitive Assessment (MoCA) was examined in the ABI sample. Relationships between strategy use and WCPA variables were also explored in each group. The WCPA is a performance-based test of functional cognition that requires scheduling appointments into a weekly calendar while managing time conflicts and adhering to rule constraints. The WCPA assesses complex functional performance that may be affected by subtle deficits in executive function, and that can be easily missed in clinical practice. In addition to completion of a multi-step task, the WCPA provides information on strategies used to cope with cognitive challenges. Although the WCPA has been researched with other populations (Toglia & Berg, 2013; Zlotnik et al., 2018), there are no studies on the WCPA-10, or for adults with ABI. There is evidence that functional cognitive tests have advantages over cognitive screening tools in identifying areas to address during rehabilitation, predicting discharge IADL needs and health utilization resources. Therefore, the development of standard functional cognitive assessment tools that are feasible within an inpatient setting is a priority for occupational therapy (Giles et al., 2017).
DESIGN: Descriptive, group comparison.
METHOD: 120 persons with ABI and HC matched for age and gender (60 per group) participated. The sample included 52% female with a mean age of 63 ± 15 in each group. Participants with ABI were already receiving occupational therapy services on an inpatient rehabilitation unit, met inclusion criteria (oriented, 10-minute attention span, read and write legibly in English), and provided written consent. Age matched HCs were randomly obtained from a larger normative database. The normative sample included adults who were living independently in the community, had a MoCA score of > 24 if > 65 and recruited via snowballing techniques by graduate occupational therapy students. Assessments: 1. WCPA-10 2. MoCA. Statistical analysis: Descriptive statistics, Mann-Whitney U test examined differences between groups. Spearman correlations to examine the relationships between variables in each group.
RESULTS: The ABI group (median MoCA score = 24) demonstrated significantly less accuracy (U=656.0, Z=-5.8, p=.0 0) less efficiency (U=714.0, Z=-4.1, p=.00), followed less rules (U=959.0, Z=-4.3 p=.00), used less strategies (U=989, Z=-3.7, p=.00) compared to controls. Total time required for WCPA completion was similar (9-10 minutes) in both groups. Relationship between WCPA accuracy and MoCA was significant but weak (rho=.37, p=.004) in the ABI group. Strategy use was significantly related to WCPA accuracy in the HC group (rho=.46, p =.000) but not in the ABI group. Consistency of strategy use differed between groups. For example, 70% of HC checked off items on the list consistently, while only 35% of persons with ABI consistently used this strategy.
CONCLUSIONS: The WCPA-10 was quick (10-minute average) and feasible in an inpatient setting. Results support discriminant validity of the WCPA-10 for people with ABI and highlight the need to use performance based, functional cognitive assessments, even for those who score high on cognitive screening tools. Furthermore, HC’s strategy use was more consistent, effective, and significantly related to accuracy compared to persons with ABI. This suggests that strategy training may be an important ingredient in enhancing functional cognitive abilities.
References
Giles, G. M., Edwards, D. F., Morrison, M. T., Baum, C., & Wolf, T. J. (2017). Screening for functional cognition in postacute care and the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. American Journal of Occupational Therapy, 71(5), 7105090010. https://doi.org/10.5014/ajot.2017.715001
Toglia, J. (2015). Weekly calendar planning activity. AOTA Press: Bethesda, MD.
Toglia, J., Lahav, O., Ben Ari, E., & Kizony, R. (2017). Adult Age and Cultural differences in the Weekly Calendar Planning Activity (WCPA). American Journal of Occupational Therapy. 71(5), 7105270010p1-7105270010p8. doi:10.5014/ajot.2016.020073.
Zlotnik, S., Schiff, A., Ravid, S., Shahar, E., & Toglia J. (2018). A new approach for assessing executive functions in everyday life, among adolescents with Genetic Generalized Epilepsies (GGE's). Neuropsychological Rehabilitation. doi: 10.1080/09602011.2018.1468272.
