Scientists test Actual Reality in functional assessment post-TBI

A recent article by Kessler Foundation researchers describes Actual Reality; as a new tool for assessing performance of activities of everyday life (ADL) in people with traumatic brain injury (TBI). The article, "Actual Reality: Using the Internet to assess everyday functioning after traumatic brain injury," was epublished on February 19 in Brain Injury. This is the first study examining the use of Actual Reality in the TBI population. The authors are Yael Goverover, PhD, OT, of New York University and Kessler Foundation, and John DeLuca, PhD, senior VP of Research & Training at Kessler Foundation, and professor at Rutgers New Jersey Medical School.

Despite the scope of functional deficits in the population with TBI, few methods are available to adequately assess functional status during recovery. Current methods of assessing performance-based tasks are impractical, outdated or subjective (self report), and fail to include use of everyday technology. To achieve independence, it is increasingly important to be able to navigate the internet to find and share information, make purchases, and connect with the community. Today's rehabilitative strategies need to objectively address the technological demands of everyday life.

Researchers looked at the feasibility of using everyday technology (computers, handheld devices) to assess how people perform the common technology-based tasks that are essential to everyday function, ie, instrumental ADLs. Actual Reality uses internet-based technology to assess a person's performance on 'instrumental' ADLs (iADLs). In this study, 10 people with TBI were compared with 10 controls. They were assessed for their ability to perform an Actual Reality task comprised of an online purchase of a cookie assortment for a birthday party. Participants were also assessed for prior internet experience, and underwent testing for functional status, affect symptomatology, and quality of life.

The TBI group had greater difficulty performing the internet-based task. "Our findings are consistent with studies that show a positive relationship between cognitive impairment and functional disability," said Dr. Goverover, visiting scientist in Neuropsychology & Neuroscience Research at Kessler Foundation. "To help individuals achieve independence, rehabilitation professionals need the appropriate assessment tools to guide the development of practical interventions. This initial study demonstrates that actual reality is a potential tool for capturing the status of everyday functional activity in individuals with TBI. More studies are needed to support inclusion of internet-based tasks in clinical assessments of iADLs in the rehabilitation of people with TBI."