Ecological Validity Of Standardised Functional Assessments Of Cognition After Brain Injury In An Acute Setting

Introduction: Cognitive dysfunction is common in older adults after traumatic brain injury. Appropriate assessment of the many complex interrelated cognitive functions is critical, yet age-related cognitive changes in elderly trauma patients present a challenge to traditional pen-and-paper assessments. Ecological validity has become an increasingly important focus in cognitive assessment, in which it is important to assess the person’s cognitive and behavioural capacities with real-world demands and environments. Objectives: To describe the adaptation of two functional assessments of cognition, which were originally developed for administration in the community, into an acute setting. Method: The clinical utility and ecological validity of two standardised functional assessments, The Kettle Test and the Functional Cognitive Assessment Scale (FUCAS), were assessed using specific criteria. The adaptation process, including barriers to administration in an acute hospital setting, was documented and key challenges addressed. Results: With assumptions regarding the familiarity of an environment being central to functional assessments of cognition, ensuring ecological validity in an acute hospital environment is challenging. Both The Kettle Test and FUCAS could be adapted, although hospital protocols and environmental limitations have impacted on the ability to carry out specific subtests of both assessments. Conclusion: Whilst there is evidence to support the use of standardised functional assessments of cognition, it must be acknowledged that the ecological validity of tests may be reduced as a result of adaptation to the acute hospital setting.