Using game authoring platforms to develop screen-based simulated functional assessments in persons with executive dysfunction following traumatic brain injury

Abstract

Highlights:1. Functional assessments are helpful in clinical decision-making.2. No practical, widely available everyday functional assessments currently exist.3. Serious game platforms such as eAdventure can be used to develop screen-based simulated functional assessments.4. The development of the SBS-COT required three professionals who required a total of 49 hours to finish the SBS-COT, which cost approximately US$1,821, taking into account the cost/person-hour. 5. The SBS-COT shows good feasibility as a pre-screening test of executive dysfunction assessment as well as good acceptability and usefulness for therapists and patients. Abstract:The assessment of functional status is a critical component of clinical neuropsychological evaluations used for both diagnostic and therapeutic purposes in patients with cognitive brain disorders. There are, however, no widely adopted neuropsychological tests that are both ecologically valid and easily administered in daily clinical practice. This discrepancy is a roadblock to the widespread adoption of functional assessments. In this paper, we propose a novel approach using a serious game authoring platform (eAdventure) for creating screenbased simulated functional assessments. We created a naturalistic functional task that consisted of preparing a cup of tea (SBS-COT) and applied the assessment in a convenience sample of eight dyads of therapists/patients with mild executive dysfunction after traumatic brain injury. We had three main aims. First, we performed a comprehensive review of executive function assessment in activities of daily living. Second, we were interested in measuring the feasibility of this technology with respect to staffing, economic and technical requirements. Third, a serious game was administered to patients to study the feasibility of this technology in the clinical context (pre-screening test). In addition, quantitative (Technology Acceptance Model (TAM) questionnaires) and qualitative (semistructured interviews) evaluations were applied to obtain user input. Our results suggest that the staffing, economic and technical requirements of the SBS-COT are feasible. The outcomes of the pre-screening test provide evidence that this technology is useful in the functional assessment of patients with executive dysfunction. In relation to subjective data, the TAM questionnaire showed good user acceptability from a professional perspective. Interview analyses with professionals and patients showed positive experiences related to the use of the SBS-COT. Our work indicates that the use of these types of authoring platforms could have positive long-term implications for neuropsychological research, opening the door to more reproducible, cooperative and efficient research by allowing the facilitated production, reuse and sharing of neuropsychological assessment tools.

Measurement properties of performance-based instruments to assess mental function during activity and participation in traumatic brain injury: A systematic review

“…Study characteristics are described in Table 1. Of the 28 articles included in the review, 16 were from the USA [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47], four from Australia [48][49][50][51] and one from UK [52], Brazil [53], Canada [54], New Zealand [55], Chile [56], Netherlands [57], Italy [58] and Spain [59], respectively. Sample sizes varied in the included studies from 2 [48] to 8,136 [39] participants and ages ranged from 14 to 86 years [47].…”

“…In total 24 instruments were evaluated in the 28 included articles. The instruments were the Baycrest Multiple Errands Test (BMET) [32], the Behavioural Dysregulation Rating Scale (BDRS) [33], a cognitive test battery [57], Disability Rating scale (DRS) [34,35], the Executive Function Route-finding Task (EFRT) [36], the Functional Assessment Measurement (FAM) [58], the Functional Cognition Index (FCI) [37], the Functional Cognitive task (FCT) [38], the FIM [39], a combination of FIM þ FAM [52], the Test of Functional Executive Abilities (TOFEA) [40], the Hotel Task [53], Levels of Cognitive Functioning Scale (LCFS) [59], the Mayo-Portland Adaptability Inventory-4 (MPAI-4) [41,42], the Measure of Executive Functioning [55], the Neurobehavioural Cognitive Status Examination (NCSE) [43,47], the Neuropsychological Assessment Battery daily living tests (NAB-DL) [44], an Occupation-based Online Awareness Assessment [48], the PRPP [49], the Screen-Based Simulated Cup Of Tea (SBS-COT) [56], the Virtual Library Task (VLT) [50], the Virtual Planning Test (VIP) [45], a Virtual Reality Kitchen Task [46] and the Virtual Reality Shopping Task (VRST) [51].…”

Using Game Technology to Automatize Neuropsychological Tests and Research in Active Aging

“…Evidence of these signs may contribute to the early diagnosis of cognitive pathologies in older people. Therefore, the computer versions of the test are another alternative in clinical practice, as they can offer the expert additional and objective information that can help to determine and improve the clinical diagnosis [15].…”

Assessment of cognitive instrumental activities of daily living: a systematic review

“…Some disadvantages of virtual reality tasks have been described: (1) they can cause dizziness (e.g., discomfort, nausea, vomiting, headache, fatigue) due to their inability to accurately simulate movements in the environment; (2) they involve costly technology, particularly if they are immersive; (3) they require regular maintenance; (4) their development requires multidisciplinary work involving computer engineers, neuropsychologists, occupational therapists and others; and (5) they have certain technical requirements such as lighting and broad spaces to be used. One of the pending tasks of virtual reality tests is to provide parallel versions of the task to avoid the learning effect in reassessments [35].…”

“…The ecological perspective is useful and of great interest in the evaluation of the various cognitive processes when the aim is to determine the causes of limitations in participation in the various activities of daily living that occur naturally in the real world taking multitasking skills into account [33]. In this context, a test is considered to have ecological validity when it is able to predict functional behavior in everyday life [26,34,35]. Parsons [36] suggested four key criteria to ensure that evaluations have ecological validity.…”