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Conceptualizing Functional Cognition in Stroke
Neila J. Donovan, PhD1*,
Diane L. Kendall, PhD2,
Shelley C. Heaton, PhD3,
Sooyeon Kwon, PhD4,
Craig A. Velozo, PhD1,
and
Pamela W. Duncan, PhD1
1 VA HSR&D/RR&D Rehabilitation Outcomes Research Center, Gainesville, FL
2 VA RR&D Brain Rehabilitation Research Center, and University of Florida Department of Communication Sciences and Disorders, Gainesville, FL
3 Clinical and Health Psychology, University of Florida, Gainesville, FL
4 Pharmacy Healthcare Administration, University of Florida, Gainesville, FL
* To whom correspondence should be addressed. E-mail: neilad{at}phhp.ufl.edu.
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Abstract |
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Background. Up to 65% of individuals demonstrate poststroke cognitive impairments, which may increase hospital stay and caregiver burden. Randomized stroke clinical trials have emphasized physical recovery over cognition. Neuropsychological assessments have had limited utility in randomized clinical trials. These issues accentuate the need for a measure of functional cognition (the ability to accomplish everyday activities that rely on cognitive abilities, such as locating keys, conveying information, or planning activities). Objective. The aim of the study was to present the process used to establish domains of functional cognition for development of computer adaptive measure of functional cognition for stroke. Methods. Functional cognitive domains involved in identifying relevant neuropsychological constructs from the literature were conceptualized and finalized after advisory panel feedback from experts in neurology, neuropsychology, aphasiology, clinical trials, and epidemiology. Results. The following 17 domains were proposed: receptive aphasia, expressive aphasia, agraphia, alexia, calculation, visuospatial, visuoperceptual, visuoconstruction, attention, language usage, executive functions, orientation, processing speed, memory, working memory, mood, awareness and abstract reasoning. The advisory panel recommended retaining the first 12 domains. Recommended changes included: to address only encoding and retrieval of recent information in the memory domain; to add domains for limb apraxia and poststroke depression; and to keep orientation as a separate domain or reclassify it under memory or attention. The final 10 domains included: language, reading and writing, numeric/calculation, limb praxis, visuospatial function, social use of language, emotional function, attention, executive function, and memory. Conclusion. Conceptualizing domains of functional cognition is the first step in developing a computer adaptive measure of functional cognition for stroke. Additional steps include developing, refining, and field-testing items, psychometric analysis, and computer adaptive test programming.
First published on August 30, 2007, doi:10.1177/1545968307306239
Neurorehabilitation and Neural Repair 2008;22:122.
A more recent version of this article appeared on April 1, 2008
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