Occupational therapy’s focus on functional cognition offers a distinct approach to the assessment of and intervention for occupational performance deficits that may follow coronavirus disease 2019 (COVID-19). Although the majority of people survive COVID-19, many people experience persistent functional cognitive sequelae severe enough to interfere with occupational performance. After COVID-19, people may be categorized as either (1) those who experience severe or critical illness requiring hospitalization or (2) those with mild to moderate presentations of the virus without hospitalization. A third group of those who do not have ongoing signs of active infection but who experience new, lasting, or deteriorating symptoms has begun to emerge and may represent a distinct COVID-19 long-haul syndrome. By following the Occupational Therapy Practice Framework and using established processes for occupational therapy assessment and treatment of functional cognition, occupational therapy practitioners can tailor assessments and interventions to meet clients’ needs.

Age at first stroke is decreasing, and most strokes are mild to moderate in severity. Executive function (EF) deficits are increasingly recognized in the stroke population, but occupational therapists have not altered their evaluation methods to fully accommodate changing patient needs. We present a hierarchical performance-based testing (PBT) pathway using data to illustrate how PBT could identify patients with mild stroke-related EF deficits in need of occupational therapy intervention. Data suggest that a substantial number of patients with EF deficits after mild stroke could benefit from occupational therapy services.

OBJECTIVE. This article describes a performance-based measure of executive function, the Multiple Errands Test–Revised (MET–R), and examines its ability to discriminate between people with mild cerebrovascular accident (mCVA) and control participants. METHOD. We compared the MET–R scores and measures of CVA outcome of 25 participants 6 mo post-mCVA and 21 matched control participants. RESULTS. Participants with mCVA showed no to minimal impairment on measures of executive function at hospital discharge but reported difficulty with community integration at 6 mo. The MET–R discriminated between participants with and without mCVA (p ≤ .002). CONCLUSION. The MET–R is a valid and reliable measure of executive functions appropriate for the evaluation of clients with mild executive function deficits who need occupational therapy to fully participate in community living.

OBJECTIVE. The goal for this study was to determine methods to modify outcome measures for people with aphasia and to provide beginning support for the efficacy of these suggested modifications. METHOD. Twenty-nine community-dwelling people with aphasia participated. Modified outcome measures included the Stroke Impact Scale, the 36-item short form Medical Outcomes Study, Reintegration to Normal Living Scale, and Activity Card Sort. Participants were supported in their responses by systematically applying a hierarchy of support. An Independence Scale score was determined for each measure for each participant. RESULTS. Data from an examiner-rated Independence Scale, internal consistency of participants’ responses, correlations among subscale scores across measures, and correlations between aphasia severity and reported outcome provide evidence that people with aphasia are able to understand and respond with these supports. CONCLUSION. We provide key recommendations for making self-report measures accessible for people with aphasia.

OBJECTIVE. We investigated participation levels and relationships among cognition, depression, and participation for people with severe congestive heart failure (CHF). METHOD. People with severe CHF (New York Heart Association Class III or IV) awaiting heart transplantation (N = 27) completed standardized tests of cognition and self-report measures of executive dysfunction, depressive symptoms, and participation. RESULTS. Possible depression (64%) and cognitive impairment (15%–59%) were prevalent. Participants reported significant reductions in participation across all activity domains since CHF diagnosis (ps < .001). Worse executive dysfunction and depressive symptoms were associated with reduced participation and together accounted for 35%–46% of the variance in participation (ps < .01). CONCLUSION. Participation restrictions associated with CHF are not limited to physically demanding activities and are significantly associated with executive dysfunction and depression. Cardiac rehabilitation should address cognitive and psychological functioning in the context of all life situations instead of focusing solely on physical function and disability.

This study examined the reliability and validity of the Executive Function Performance Test (EFPT). The EFPT assesses executive function deficits in the performance of real-world tasks. It uses a structured cueing and scoring system to assess higher-level cognitive functions, specifically initiation, organization, sequencing safety and judgment, and task completion. Seventy-three participants with mild to moderate stroke and 22 age- and education-matched controls completed the 4 EFPT tasks (cooking, using the telephone, managing medications, and paying bills). Significant differences were found between participants with mild and moderate stroke and healthy control participants. The EFPT can help occupational therapists determine the level of support needed by people with cognitive impairments to perform complex instrumental tasks. Objective information derived from this assessment is an essential part of the process of determining whether the person can live independently and helping families understand how to support the performance of their family members at home.

The Kitchen Task Assessment (KTA) is a functional measure that records the level of cognitive support required by a person with Senile Dementia of the Alzheimer’s Type (SDAT) to complete a cooking task successfully. The results allow the clinician to help caregivers understand the level of support the impaired person needs to perform daily living tasks. This paper presents the validity, and internal consistency of the KTA. Data were collected from 106 persons diagnosed with SDAT. Construct validity was established by examining the relationship between subjects’ performance on the KTA and standard neuropsychological measures.