Absence Within the Neurological Community of Executive

¶ … absence within the neurological community of executive function performance testing for various real-world activities (that include multi-tasking) on subjects who have suffered brain damage (Baum & al, 2008). By testing real-world functioning via the EFPT, the researchers, as occupational therapists, hoped to provide more accurate information on the ability of subjects to function independently in their day-to-day existence and to perform functions within society (Baum & al, 2008). This study served as a test of the validity and reliability of the EFPT model on patients with mild to moderate stroke, as a follow-up to previous studies of EFTP validity and reliability on subjects with multiple sclerosis and schizophrenia (Baum & al, 2008). Hypothesis: Stroke will have a negative effect on executive functioning in real-world tasks.

Research study design and characteristics

This was an empirical, quantitative, conclusion-oriented, lab/simulation research study using the EFTP. The EFTP measures executive cognitive functions (initiation, organization, sequencing safety, judgment, and task completion) via a "structured cueing and scoring system" (Baum & al, 2008. p.446). The five specific cognitive functions are assessed as participants complete four separate tasks: "cooking, using the telephone, managing medications, and paying bills" (Baum & al, 2008, p. 446). These activities were structured based on the existing "Kitchen Task Assessment," using simple instructions and materials in a simulated lab environment (Baum & al, 2008). The EFTP was administered to 73 subjects who had previously suffered a mild to moderate stroke, and 22 healthy control-group volunteers matched for age and education level and tested for physical and cognitive health (Baum & al, 2008). The experimental group was participants in a research program at a nearby hospital, and verified by a neurologist for the diagnosis of stroke (Baum & al, 2008). Testing was conducted six months after stroke onset, while none of the patients were undergoing rehabilitative care (Baum & al, 2008). Dependent variables were measured using a "standardized cueing system," based on "the progressive need for assistance associated with increasing levels of cognitive impairment," and analyzed statistically using ANOVA and chi-square analyses, resulting in a concise table of data/results (Baum & al, 2008).

Distinguishing characteristics of the EFPT compared to current/existing performance based assessments?

The EFTP differs from existing performance assessments in several ways. First, it is easy for occupational therapists to learn, conduct, and score (Baum & al, 2008). Second, it measures the amount of support the subject will need in order to successfully carry out four daily activities which are essential to "daily community life" (Baum & al, 2008). Third, during the four activities, the study measures key executive functions in terms of cognitive components, allowing for the development of effective treatment plans (Baum & al, 2008). Finally, the EFTP "uses a top-down approach that allows the practitioner to objectively assess the client during the performance of a task, and unlike many other instruments assessing instrumental activities of daily living (IADLs), it assesses actual performance rather than rely on proxy or self-report" (Baum & al, 2008, p. 447)

Variables: How classified and operationalized

The independent variable in this study was stroke, classified as either mild or moderate based on the NIHSS, and controlled with a group of healthy individuals, also tested for cognitive and physical health functions (Baum & al, 2008). These variables were further classified based on age, gender, race, and education level (Baum & al, 2008).

The dependent variables studied were classified under five categories: "initiation, organization, sequencing safety, judgment, and task completion" (Baum & al, 2008, p. 446). These variables were operationalized in terms of their role in the successful completion of four daily tasks: "cooking, using the telephone, managing medications, and paying bills," and measured via a "standardized cueing system" (Baum & al, 2008, p. 446). The cueing system rates the subject on a scale of 0 -- 5, with 0 being "no assistance needed," and 5 being "tester must complete the task for the participant" (Baum & al, 2008). This cueing system results in three quantitative scores:

"(1) the executive function (EF) component score, (2) the task score, and (3) a total score. The EF component score is calculated by summing the numbers recorded on each of the four tasks for initiation, organization, sequencing, safety and judgment, and completion. Scores on each EF component can range from 0 to 5, and the total for all four tasks can range from 0 to 20. The task score is calculated by summing the five scores for each task. The range for each task is 0 to 25. The total score is the sum of the performance on all four tasks; the total score of performance on all four tasks can range from 0 to 100." (Baum & al, 2008, p. 449)"

Based on this score, testers can determine quantitatively how much support the subject will require in everyday life (Baum & al, 2008).

Define reliability. Discuss the means by which the reliability of the instrument/measure was assessed in this study.

Reliability is the opposite of random error; it tells researchers how consistent a test is at producing valid results. In this study, reliability was determined in two ways: by measuring test result consistencies via ICC scores on the four tasks across different "raters," by having three trained raters simultaneously test participants (with stroke and controls); and by measuring the internal consistency of the EFTP via Cronbach's alpha coefficients for each task, correlated to the five test domains (Baum & al, 2008).

Define validity. How was the validity of the instruments assessed in this study?

In scientific research, validity refers to the degree to which the measurements taken (or results concluded) in a study correspond to the truth in reality. The instruments in this study were tested for validity in two ways: for construct validity based on one-way ANOVA testing across the three groups (control, mild stroke, moderate stroke), to ensure that the test could discriminate between subjects "with and without a known trait"; and for criterion validity (in the form of concurrent validity) by comparing scores from various neuropsychological tests to the EFTP scores (Baum & al, 2008). This testing was done only on participants with stroke, in order to make sure the EFTP scores match reasonably with other cognitive performance tests (Baum & al, 2008).