Assessing Adults with Mild Acquired Brain Injury In the Community Environment
Occupational Therapy Department, National Rehabilitation Hospital, Rochestown Ave., Dun Laoghaire, Co. Dublin
The Community Outing Performance Appraisal (COPA) is a community-based assessment, developed from clinical practice, to assess executive functions with an acquired brain injury population. Subjects included 18 adults with mild acquired brain injury from a rehabilitation centre in Dublin. Ethical approval was sought and granted from the Ethics Committee of the Faculty of Health Sciences Trinity College. Medical approval for participants to participate in the study was sought by the subjects Medical Consultant and granted by the Ethics Committee of the Rehabilitation Centre.
The Behavioural Assessment of the Dysexecutive Syndrome (BADS) was initially administered to all subjects, to determine executive dysfunction. Researchers have cited the validity of the BADS as an effective standardised test of executive functions (1,2). The subjects (n=18) were then assessed in the community setting using the COPA. The subject’s scores on their performance in the community (The COPA) were compared to their scores on the standardised assessment (The BADS). 16 of the 18 subjects were reassessed in the community and the initial scores were compared to the follow-up scores. Wilcoxon Signed Ranks Test indicated a statistically significant difference on retesting in the community (p=0.038). Mann Whitney U tests indicated no statistical significance in age (0.263), time since onset (0.958), the time between testing (0.377) and the assessment environment (1.00).
The Executive Functions Component of the COPA was found to be sensitive to differences in the subject’s performance in the everyday environment, supporting its validity in measuring executive functions. Data analysis showed 10 of the 18 subjects scored better in the community, using the COPA, when compared to scores achieved on the BADS, 3 subjects showed no difference in their scores on either test.
In conclusion, the results suggest that traditional pen and paper assessments may not always represent an individual’s occupational functioning in everyday life.
- Manchester, D., Priestley, N. & Jackson, H. (2004). The assessment of executive functions: coming out of the office. Brain Injury. 18 (11), 1067-1081.
- Norris, G. & Tate, R.L. (2000). The behavioural assessment of the Dysexecutive syndrome (BADS): Ecological, concurrent and construct validity. Neuropsychological Rehabilitation. 10 (1), 33-45.
Final Report presented to the NRH Ethics Committee – July 2006