Functional Cognition: Moving the Field Forward.

The concept of functional cognition has been variously defined, but at its core relates to how cognitive and performance abilities are integrated and used in everyday life. Functional cognition is a fundamental element of occupational performance, and functional cognitive assessment and intervention are central to how occupational therapy can improve client outcomes. Attendees at a conference convened by the American Occupational Therapy Foundation identified areas where the construct of functional cognition required further clarification.

The Functional Consequences of Long COVID Need to Be Addressed by Occupational Therapists.

Long COVID-persistent health complications after recovery from coronavirus disease 2019 infection-is associated with activity limitations in nearly 48 million U.S. adults, affecting work, leisure, family, and community functioning.

Conventional clock drawing tests have low to moderate reliability and validity for detecting subtle cognitive impairments in community-dwelling older adults.

Background: Early identification of subtle cognitive decline in community-dwelling older adults is critical, as mild cognitive impairment contributes to disability and can be a precursor to dementia. The clock drawing test (CDT) is a widely adopted cognitive screening measure for dementia, however, the reliability and validity of paper-and-pencil CDT scoring scales for mild cognitive impairment in community samples of older adults is less well established. We examined the reliability, sensitivity and specificity, and construct validity of two free-drawn clock drawing test scales-the Rouleau System and the Clock Drawing Interpretation Scale (CDIS)-for subtle cognitive decline in community-dwelling older adults.

Loss-of-Set and Strategy Application on the Menu Task: An Exploratory Study.

The Menu Task (MT) is an occupational therapy screening measure designed to identify people in need of functional cognitive (FC) assessment. To explore whether test-taker strategy selection on the MT is clinically informative. Using a cross-sectional design we administered assessments of FC including the MT and the After MT interview, cognitive screening measures, and self-report instrumental activities of daily living assessment to a convenience sample of 55 community-dwelling adults.

Cognitive Interventions to Improve a Specific Cognitive Impairment for Adults With TBI (June 2013-October 2020).

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on cognitive interventions to improve a specific cognitive impairment for adults with TBI.

Cognitive Interventions With Occupational Performance as a Primary Outcome for Adults With TBI (June 2013-October 2020).

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on cognitive interventions to improve occupational performance for adults with traumatic brain injury.

Methodological Issues in Advancing the Status of Functional Cognitive Assessment.

Many individuals in acute hospital and post-acute care settings experience changes in their capacity to perform complex activities of daily living associated with deficits in functional cognition. Occupational therapists regularly assess and treat these occupational performance deficits. The construct of functional cognition offers oportunities for occupational therapists to define an approach to cognition that is both distinct from that of other disciplines and that supports evidence-based interventions.

Further Validation of the Menu Task: Functional Cognition Screening for Older Adults.

Occupational therapists need a brief tool to identify the potential for functional cognitive deficits leading to impaired occupational performance. The objective is to establish the sensitivity and specificity, concurrent and known-group validity of the Menu Task by comparison with performance on the Weekly Calendar Planning Activity (WCPA). Using a cross-sectional design, we administered the Menu Task and the WCPA to a community-dwelling convenience sample of 287 adults aged from 55 to 93 years.

A Framework for Addressing Clients' Functional Cognitive Deficits After COVID-19.

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.

Screening to Assessment Pathways in Evaluating Functional Cognition in Older Adults.

Identification of functional cognitive deficits can facilitate intervention to improve outcomes among older adults. We aimed to determine if impairments on screening tests of cognition are associated with deficits in performance on a more extensive functional cognitive assessment. Using a cross-sectional study design we administered the Montreal Cognitive Assessment (MoCA), the Mini-Cog, the Menu Task, and Weekly Calendar Planning Activity (WCPA) to a convenience sample of 277 community-dwelling older adults (55-93 years old).

How Well Does the Brief Interview for Mental Status Identify Risk for Cognition Mediated Functional Impairment in a Community Sample?

Objective: To determine the adequacy of the Brief Interview for Mental Status (BIMS) compared with other screening tools in identifying individuals with limitations in functional cognition and instrumental activities of daily living (IADL).

Design: Cross-sectional observational study.

Setting: Midsized midwestern city.

Can service members with mild traumatic brain injury learn to develop implementation intentions for self-identified goals?

Purpose: Goal achievement relies heavily on executive functions, which may be compromised following mild traumatic brain injury (mTBI). Implementation intentions (II) have been found to help people act in accordance with their goals. II are written statements that describe a behavior that a person plans to enact when they encounter some form of anticipated trigger or stimulus.

Can Brief Cognitive or Medication Management Tasks Identify the Potential for Dependence in Instrumental Activities of Daily Living?

The identification of functional performance deficits is critical to the community independence of older adults. We examined whether a combined cognitive and performance-based medication management measure would be able to better classify an individual's functional cognitive status and potential for instrumental activities of daily living (IADL) impairment than either measure alone. Community-dwelling adults age 55 and older ( = 185) were administered the Mini-Cog, the Medication Transfer Screen-Revised (MTS-R), a combination measure the Medi-Cog-Revised (Medi-Cog-R), the Performance Assessment of Self-Care Skills (PASS) Checkbook Balancing and Shopping tasks (PCST), additional cognitive screening measures, and a self-report daily living scale.

Making Functional Cognition a Professional Priority.

Functional cognition is a critical domain of concern for occupational therapy practice. As the health care system moves to assessing value through achievement of quality outcomes, the field of occupational therapy must address the inclusion of functional cognition in evaluation and treatment. Evidence indicates that impaired cognition contributes to risk of hospital readmission and poor overall health outcomes across diagnostic groups.

Reliability and Validity of a Functional Cognition Screening Tool to Identify the Need for Occupational Therapy.

Importance: The Centers for Medicare & Medicaid Services (CMS) has identified the need to assess functional cognition as part of the postacute care planning process.

Objective: We examined the reliability, validity, and clinical utility of the Menu Task (MT) as a screening measure of functional cognition to assess the need for occupational therapy services.

Design: Cross-sectional study testing a convenience sample of community-dwelling older adults (n = 130) and adults hospitalized for elective orthopedic surgery (n = 60).

Neurocognitive Rehabilitation: Skills or Strategies?

The author describes personal and professional milestones in becoming an occupational therapist and his early experience in the first behavior disorder program for neurologically based aggression in the world. A real clinical example is used to bring these early lessons into vivid focus. New evidence underlines occupational therapists' unique role in skill-habit training in clients with severe neurological impairment.

The interrelationship of functional skills in individuals living in the community, following moderate to severe traumatic brain injury.

Objective: The Adaptive Behaviour and Community Competency Scale was used to investigate the interrelationship of 22 basic and instrumental activities of daily living (ADL/IADL) in individuals with moderate to severe traumatic brain injury (TBI). The relationship of self-awareness to task performance was also investigated.

Research Design: Prospective descriptive study.

The construct validity of a new screening measure of functional cognitive ability: The menu task.

This study evaluated the construct validity of the Menu Task (MT): a new performance-based screening measure of functional cognition. We enrolled 114 community dwelling adults (55 years or older) in the study: all participants completed the MT and four other neuropsychological screening measures. Construct validity was evaluated using a three-step hierarchical regression model with the MT as the dependent variable.

Implementation Intentions for Self-Selected Occupational Therapy Goals: Two Case Reports.

Objective: We evaluated the feasibility of an intervention combining metacognitive strategy instruction (MSI) with training in implementation intentions for adults with mild traumatic brain injury (mTBI). Implementation intentions are written premade decision statements specifying when, where, and how goal behaviors are to be enacted.

Method: Two participants with mTBI received a six-session intervention that included setting a daily implementation intention for an occupational therapy goal.

Screening for Functional Cognition in Postacute Care and the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014.

Occupational therapists have a long history of assessing functional cognition, defined as the ability to use and integrate thinking and performance skills to accomplish complex everyday activities. In response to passage of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 (Pub. L.

The relational neurobehavioral approach: can a non-aversive program manage adults with brain injury-related aggression without seclusion/restraint?

Purpose: The Relational Neurobehavioral Approach (RNA) is a set of non-aversive intervention methods to manage individuals with brain injury-related aggression. New data on interventions used in the RNA and on how the RNA interventions can be used with patients with acquired brain injury (ABI) who have differing levels of functional impairment are provided in this paper.

Method: The study was conducted over a 6-week period in a secure 65-bed program for individuals with ABI that is housed in two units of a skilled nursing facility (SNF).

Factors influencing community case management and care hours for clients with traumatic brain injury living in the UK.

Objective: To investigate the relationship between deficits associated with traumatic brain injury (TBI) and case management (CM) and care/support (CS) in two UK community samples.

Research Design: Prospective descriptive study.

Method: Case managers across the UK and from a single UK CM service contributed client profiles to two data sets (Groups 1 and 2, respectively).

Performance-based testing in mild stroke: identification of unmet opportunity for occupational therapy.

Age at first stroke is decreasing, and most strokes are mild to moderate in severity. Executive function (EF) deficits are increasingly recognized in the stroke population, but occupational therapists have not altered their evaluation methods to fully accommodate changing patient needs. We present a hierarchical performance-based testing (PBT) pathway using data to illustrate how PBT could identify patients with mild stroke-related EF deficits in need of occupational therapy intervention.