Importance: Evidence of the effectiveness of cognitive activity and preparatory tasks in improving the cognitive skills and functional performance of people with cognitive decline is limited. Objective: To examine the efficacy of a high-ecological cognitive intervention. Design: Quasi-experimental, pretest–posttest design with nonequivalent control. Setting: Community. Participants: Older adults with mild cognitive impairment from two senior centers. Intervention: Twelve 90-min weekly group sessions of a high-ecological cognitive intervention using simulated everyday cognitive tasks (experimental group) and of nutrition education (active control group). Outcomes and Measures: Cognitive skills were measured with the Color Trails Test (CTT), the Contextual Memory Test (CMT; Immediate Recall [CMT–Im] and Delayed Recall [CMT–De] tasks), and the Wechsler Adult Intelligence Scale–Fourth Edition Digit Span subtest (Digits Forward and Digits Backward). Cognitive–functional performance was measured with the Rivermead Behavioural Memory Test–Third Edition (RBMT–3; Immediate Recall [RBMT–3–Im] and Delayed Recall [RBMT–3–De] tasks) and the Cognitive Failures Questionnaire (CFQ). Results: Thirty-seven participants (M age = 70.84 yr; 70.3% women) met the inclusion criteria for analysis (20 participants in the intervention group, 17 participants in the control group). Multivariate linear regression showed that the intervention group improved significantly more than the control group on the CTT, CMT–Im, and RBMT–3–Im but not on the CMT–De, RBMT–3–De, and CFQ. Conclusions and Relevance: Twelve 90-min weekly group sessions of a high-ecological cognitive intervention improved attention, executive function, immediate memory, and objective cognitive–functional performance with immediate-memory task demands. What This Article Adds: Carefully designed and structured simulated everyday cognitive tasks can be used as a cognitive training agent to improve both cognitive skills and objective cognitive–functional performance. The effectiveness of group-based cognitive interventions depends on the skills of occupational therapy practitioners in activity analysis and grading.

Date Presented 04/22/21 OTs are trained to identify cognitive impairments in individuals diagnosed with specific diseases or who have sustained injuries or experienced a neurological event such as stroke. However, the presenters’ research demonstrates that OTs are underutilizing formal cognitive assessments and more often relying on observations and screening tools. Presenters discuss survey findings, setting influences, and potential solutions for OTs to increase the use of cognitive assessments in practice. Primary Author and Speaker: Amanda J. Blattman Contributing Authors: Jacqueline Schechter, Anne Spence, Susan S. Hayashi, Kara Sauerburger, Molly Houdeshell, Jennifer Henry, Judith Lieu, Robert Hayashi, and Allison King

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Time management is a key OT intervention component. Valid and reliable instruments are essential for evaluating rehabilitation and OT interventions. The results of this study show that the Assessment of Time Management Skills has good measurement properties and consistent and replicable items and is useful in English-speaking countries. It can provide valid measures of time management skills, organization and planning skills, and regulation of emotion in a general population and presumably also a population with cognitive impairment. Primary Author and Speaker: Afsaneh Roshanai Contributing Authors: Gunnel Janeslätt, Suzanne Marie White, Kajsa Lidstroem Holmqvist, Marie Holmefur

Date Presented 04/7/21 This study describes the feasibility of a combined telehealth intervention of computerized cognitive training together with occupation-based treatment for patients with cancer-related cognitive impairment (CRCI). The intervention was found feasible, and positive outcomes on occupational performance, cognitive functions, quality of life, and mood were revealed. This treatment can possibly add to the therapeutic landscape of CRCI, which currently impairs the life of millions worldwide. Primary Author and Speaker: Yafit Gilboa Contributing Authors: Anita Tollen, Marie Holmefur

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Cancer-related cognitive decline (CRCD) is not well understood in the oncology population, and evaluation for cognitive dysfunction while inpatient is not routine. The aims of this project are to (1) identify the prevalence of CRCD in an inpatient hospital, utilizing the Trail Making Test Part B, and (2) identify differences between individuals experiencing CRCD and those scoring within normal limits. Primary Author and Speaker: Erika Dobson Additional Authors and Speakers: Malarie Chant

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The current guideline criteria for diagnosing people with Parkinson's disease with mild cognitive impairment include neuropsychological tests to assess cognitive functioning. Assessments that reflect real-life confrontations can identify functional cognitive decline. OTs can contribute in implementing evaluations and developing performance-based interventions to promote daily life performance and quality of life and prevent the onset of increased disability. Primary Author and Speaker: Sonya Meyer Additional Authors and Speakers: Sara Rosenblum Contributing Authors: Netta Gemerman, Ariella Richardson, Tal Nevo, and Sharon Hassin-Baer

Date Presented 04/21/21 Community-dwelling individuals with chronic stroke experience participation limitations in cognitively demanding activities, which can be partially explained by apathy, executive function, and social support. Increased recognition of apathy, analysis of cognitive activity demands, and access to social support networks may further advance OTs’ ability to address participation limitations among individuals poststroke. Primary Author and Speaker: Amy Ho Additional Authors and Speakers: Desiree Taylor, Nicole Klans, Alexandra Reynolds, and Lucia Kissinger Contributing Authors: Emily Skaletski, Joshua Brown

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This study examines the effects of intimate-partner-violence-related acquired brain injury (IPV-related ABI) symptoms on activities of daily living (ADLs) and social relationships. Thirty-seven survivors ages 17–73 years were evaluated within 30 days of brain injury. Post-IPV-related ABI cognitive symptoms predicted difficulties in ADLs and interpersonal relationships. Identifying the impact of specific symptoms on ADLs may result in targeted OT interventions with IPV-related ABI survivors. Primary Author and Speaker: Ghazala T. Saleem Additional Authors and Speakers: Jessica M. Fitzpatrick

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The Menu Task Assessment is a brief, reliable, and valid functional cognitive assessment designed for use by OTs in both the acute- and the postacute-care environment. This poster describes the feasibility of its use in an inpatient heart failure population, as well as the prevalence of cognitive dysfunction and association between Menu Task Assessment score and discharge disposition. Primary Author and Speaker: Malachy James Clancy Additional Authors and Speakers: Megan Drollinger

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. People with Parkinson’s disease (PD) without dementia often have cognitive deficits that impact daily function. This study explored functional cognition and its neural substrates in PD without dementia. We found dissociable relationships between aspects of daily cognitive function and functional connectivity of cognitive brain networks. This information may ultimately guide OT practice that will improve or maintain functional cognition in those with PD. Primary Author and Speaker: Anneliese Schlesinger Additional Authors and Speakers: Erin Foster

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.

Importance: Psychometrically sound instruments are needed to evaluate executive functioning in the population of people with cancer. Objective: To develop and evaluate the reliability and validity of the Executive Function Performance Test–Enhanced (EFPT–E) in women after being treated for breast cancer. Design: Cross-sectional. Setting: University research laboratory. Participants: Women treated for breast cancer who had cognitive impairment (n = 12) and community control participants (n = 13). Outcomes and Measures: Evaluators (n = 8) independently scored a recorded administration of the EFPT–E to evaluate interrater reliability. An assessment battery, including the EFPT–E, was administered to evaluate the EFPT–E’s known-groups validity and concurrent validity. Results: Excellent interrater reliability was observed for the EFPT–E total score and each subtask score (intraclass correlation coefficient = .90–.98). Moderate effect sizes were noted for the EFPT–E total score (Cohen’s d = 0.5) and the total number of cues (d = 0.4) between the breast cancer group and the control group, with the breast cancer group demonstrating poorer performance. A limited correlation was found between the EFPT–E and the other cognitive measures. Conclusions and Relevance: The results support the EFPT–E’s interrater reliability and warrant continued investigation to further establish its reliability and validity. What This Article Adds: Assessments are needed to quantify the impact of cognitive processes within functional tasks. The EFPT–E has been developed to assess the functional impact of mild cognitive impairment; initial testing with women with cancer showed excellent agreement between raters and promising results for validity.

The American Occupational Therapy Association (AOTA) asserts that occupational therapists and occupational therapy assistants, through the use of occupations and activities, facilitate clients’ cognitive functioning to enhance occupational performance, self-efficacy, participation, and perceived quality of life. Cognitive processes are integral to effective performance across the broad range of daily occupations such as work, educational pursuits, home management, and play and leisure. Cognition plays an integral role in human development and in the ability to learn, retain, and use new information to enable occupational performance across the lifespan. This statement defines the role of occupational therapy in evaluating and addressing cognitive functioning to help clients maintain and improve occupational performance. The intended primary audience is practitioners ¹ within the profession of occupational therapy. The statement also may be used to inform recipients of occupational therapy services, practitioners in other disciplines, and the wider community regarding occupational therapy theory and methods and to articulate the expertise of occupational therapy practitioners in addressing cognition and challenges in adapting to cognitive dysfunction.

Importance: Previous research has calculated normative data for the Dynavision D2 Visuomotor Training (D2) System among healthy athletes to understand concussion management, but to date no studies have identified the norms for healthy adults over a large age range (18–80 yr) for physical response speed. Objective: To provide normative data for the D2 for physical response speed in adults ages 18–80 yr. Design: Cross-sectional, descriptive study to obtain normative data on physical response speed using the D2 for adults in age categories 18–40, 41–60, and 61–80 yr. Setting: Genesis Physical Therapy and Wellness Center, a Midwestern outpatient hospital–based therapy center. Participants: Three hundred adults, stratified into three different age categories. Normal standards with quartiles were identified for each age and sex category. Outcomes and Measures: Multiple regression model of the inverse response times. Results: The results showed a significant difference in physical response speed between men and women and between the different age groups. Women in all age categories were slower than men. Physical response speed increased with age in both sexes, but each had significantly different age and sex main effects (p < .0005). Conclusions and Relevance: Occupational therapy practitioners can use the normative standards identified in this study in their assessment of clients with visual and cognitive deficits after a brain injury, stroke, or other neurologic pathology. What This Article Adds: This study’s results can be added to the battery of other common evaluation measures that occupational therapists use to evaluate visual and cognitive deficits after neurological impairments.

The Cognitive Performance Test (CPT) is a standardized occupational therapy assessment that examines cognitive integration with functioning in an instrumental activities of daily living context. Conventional cognitive measures provide diagnostic utility but do not fully address the functional implications. Ninety-one veterans diagnosed with cognitive impairment were evaluated. We compared the predictive value of the CPT with the Large Allen Cognitive Level Screen (LACLS), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA) for the need to retire from driving versus ability to pass an on-road exam. Measures were also analyzed by diagnostic classification. CPT correctly classified a mild versus major neurocognitive disorder, whereas MMSE, MoCA, and LACLS did not differentiate the groups. A CPT cutoff score of <4.7/5.6 showed 89% sensitivity for failing the road exam and 75% specificity for ability to pass. CPT discriminated functional level in neurocognitive disorders and had better predictive value for fitness to drive compared with conventional cognitive measures.

OBJECTIVE. Poor self-awareness co-occurs with cognitive impairments after stroke and may influence independence in daily activities. Strategy training promotes independence after stroke, but poor awareness may attenuate treatment response. We examined the degree to which awareness status affected changes in independence attributed to strategy training. METHOD. We conducted a secondary analysis of 30 participants with cognitive impairments after acute stroke randomized to strategy training or attention control in addition to typical inpatient rehabilitation. We measured awareness with the Self-Awareness of Deficits Interview and independence with the FIM™. Data were analyzed using general linear models. RESULTS. Poor awareness attenuated improvements in independence over time, F(3, 55) = 3.04, p = .038. Strategy training promoted greater improvements in independence over time relative to attention control, F(3, 55) = 5.93, p = .002. However, the interaction between awareness and intervention was not significant, F(1, 19) = 0.025, p = .877. CONCLUSION. Awareness status may not affect the response to strategy training, indicating that strategy training may benefit people with poor awareness.

OBJECTIVE. We investigated how everyday technology use related to activity involvement over 5 yr in people with mild cognitive impairment. METHOD. Thirty-seven older adults with mild cognitive impairment were evaluated regarding everyday technology use and involvement in activities over time. Information on diagnostic changes was collected from medical files. Linear mixed-effects models were used in data analysis. RESULTS. Ability to use everyday technology showed a significant effect on activity involvement (p = .007) beyond the effects of time, diagnostic change, and age. Decreases in number of everyday technologies used (p < .001) and share of accessible and relevant everyday technologies used (p = .04) were associated with decreasing activity involvement. However, these two aspects did not reinforce each other. CONCLUSION. When monitoring activity involvement in clients with cognitive decline, health care professionals should take into account clients’ ability to use everyday technologies and the amount of everyday technologies they use.

OBJECTIVE. To determine the effectiveness of interventions addressing cognitive impairments to improve occupational performance for people with traumatic brain injury. METHOD. A total of 37 studies met inclusion criteria: 9 Level I systematic reviews, 14 Level I studies, 5 Level II studies, and 9 Level III studies. RESULTS. Strong evidence supports use of direct attention training, dual-task training, and strategy training to optimize executive functioning, encoding, and use of memory compensations, including assistive technology. However, in most studies, occupational performance was a secondary outcome, if it was evaluated at all. CONCLUSION. Although evidence supports many intervention approaches used by occupational therapy practitioners to address cognitive impairments of adults with traumatic brain injury, more studies are needed in which occupational performance is the primary outcome of cognitive intervention.

OBJECTIVE. This study seeks to (a) compare Cognitive Behavioral Driver’s Inventory (CBDI) scores for clients who passed and failed a driving evaluation and for diagnostic groups (left cerebrovascular accident [CVA], right CVA, traumatic brain injury [TBI], and cognitive decline); (b) determine sensitivity, specificity, and positive and negative predictive values of the CBDI; (c) compare validity of the CBDI with other tools; and (d) identify factors associated with outcome. PARTICIPANTS. This historical cohort study included clients with neurological conditions who completed a driving evaluation. MEASURES. CBDI, Motor-Free Visual Perception Test (MVPT), Bells test, and driving results were extracted from the charts. RESULTS. Mean CBDI (p < 0.0001) and MVPT (p < 0.0001) scores were significantly worse for those failing compared to passing the driving evaluation. Sensitivity of the CBDI was 62%, specificity was 81%, positive predictive values were 73%, and negative predictive values were 71%. Results varied according to diagnostic group. CONCLUSIONS. The CBDI is not sufficiently predictive of outcome to replace a driving evaluation, and is predictive only for clients with R-CVA and TBI. Evaluation of driving should vary according to diagnosis.

OBJECTIVE. Alternative education programs are schools that accept students who have not been successful in the general education setting. This study focuses on developing a better understanding of the needs of students in three area alternative education schools. METHODS . A needs assessment was created and distributed to the staff of each school regarding the problem areas of alternative education students. Data were analyzed descriptively. RESULTS. Thirty-nine of 47 surveys were returned resulting in an overall return rate of 83%. The staff identified several potential deficit areas faced by the students in these alternative education programs. The most frequently identified deficits included poor time management skills, decreased healthy participation in hobbies and leisure activities, and a lack of healthy lifestyle behaviors. In addition, the staff reported that many students had cognitive deficits including reduced ability to follow multistep directions, impaired higher-level thinking skills, reduced attention span, and limited memory. CONCLUSION. The results of this study are consistent with literature that suggests the students in alternative education settings may have underlying deficits that interfere with learning and produce misbehaviors. The alternative education programs should be further explored as a potential practice area for occupational therapists.