Feasibility of National Institutes of Health Toolbox Cognition Battery in pediatric brain injury rehabilitation settings.

Abstract

Objective: Cognitive impairments are a devastating consequence of acquired brain injury (ABI) in children. Current pediatric tools for assessing cognitive impairments are generally time intensive and applicable only to a restricted age span. The National Institutes of Health Toolbox–Cognition Battery (NIHTB-CB) is a standardized, tablet-based cognitive assessment that has been normed across the life span in the general population and validated in adults with brain injuries. However, its clinical utility and validity has not yet been demonstrated in pediatric patients with brain injuries. The current study examines the feasibility of NIHTB-CB administration in both a pediatric inpatient and day treatment rehabilitation setting. Design: The NIHTB-CB was attempted in 40 children with ABI aged 4–18 years within 1 year of injury in pediatric rehabilitation settings. Results: Of the 40 participants tested, 38 (95%) were able to complete the full battery and 28 were able to complete it in 1 session. The average time to complete the NIHTB-CB for our sample was 40.2 min. Barriers to completion included both external (scheduling conflicts) and internal (fatigue, attention, and behavioral) limitations. Cohort results are consistent with expected impairments following ABI. Conclusions: This study demonstrates the feasibility of using the NIHTB-CB in postacute pediatric inpatient rehabilitation and day-treatment clinical settings following ABI. The NIHTB-CB has the potential to provide a quick, standardized assessment of cognitive function during the rehabilitation process. Further longitudinal studies of NIHTB-CB using larger samples will be needed to determine its validity, test-retest capabilities, and clinical utility.

Psychometric Properties of the NIH Toolbox Cognition and Emotion Batteries Among Children and Adolescents with Congenital Heart Defects

“…Although the NIHTB-CB has been found to be a useful battery when considering Alzheimer's disease, the tests of memory may be too difficult and insufficiently sensitive for those at the lower end of memory function (Hackett et al, 2018;Ma et al, 2021). It has also been noted that children and adolescents with a high degree agitation (e.g., inhibition, emotional lability, and aggression) may not be able to complete the NIHTB-CB, as noted in a study with pediatric patients with acquired brain injuries (Watson et al, 2020). Such findings across clinical populations point to limitations of the NIHTB-CB that may also be applicable to patients with CHD.…”

Uses of the NIH Toolbox® in Clinical Samples

“…Finally, although we sought to identify records using the NIH Toolbox in clinical research, we identified 6 records reporting applications of NIH Toolbox measures in clinical settings (e.g., inpatient and outpatient medical clinics) for clinical purposes (e.g., to inform clinical practice and/or as part of routine care). These records demonstrated that the NIH Toolbox is feasible for use at rehabilitation settings with a pediatric brain injury population, [11][12][13] is minimally disruptive to the clinical operations of a multidisciplinary outpatient gastroenterology clinic, 16 is valid for use among older adults at different stages of cognitive health at a memory clinic, 15 and can serve as a rapid screening tool in the outpatient setting to identify patients at a high risk for severe encephalopathy. 14 These findings underscore the great potential of the NIH Toolbox for use in routine clinical practice.…”

“…The other category (n = 40, 14.2%) contained a variety of clinical diagnoses, While most records reported applications of the NIH Toolbox in research with clinical samples, 6 reported implementation in clinical settings. [11][12][13][14][15][16] Specifically, applications of NIH Toolbox Cognition Battery measures were reported among pediatric patients with brain tumors in both perioperative and follow-up inpatient and day treatment rehabilitation settings, [11][12][13] patients living with liver cirrhosis in an outpatient transplant clinic, 14 patients with dementia at a memory clinic, 15 and patients with celiac disease at a multidisciplinary outpatient gastroenterology clinic. 16 Study Design An observational study design was used in 39.9% (n = 112) of included records, compared with an experimental study design in 60.1% (n = 169).…”

“…In particular, 3 records assessed the feasibility of administering the NIH Toolbox Cognition Battery to pediatric patients who had sustained acquired brain injuries as primary outcome measures. [11][12][13] These 3 records concluded that the NIH Toolbox Cognition Battery was a practical tool for tracking cognitive function among patients undergoing active treatment and those in rehabilitation because of the low patient burden and easy fit into the standard clinical workflow. [11][12][13] Of these, one record further reported successfully incorporating NIH Toolbox data into individualized clinical treatment plans.…”

“…[11][12][13] These 3 records concluded that the NIH Toolbox Cognition Battery was a practical tool for tracking cognitive function among patients undergoing active treatment and those in rehabilitation because of the low patient burden and easy fit into the standard clinical workflow. [11][12][13] Of these, one record further reported successfully incorporating NIH Toolbox data into individualized clinical treatment plans. 12 The NIH Toolbox Cognition Battery has also been used as a diagnostic tool in a memory clinic to discriminate older adults with varying levels of cognitive impairment 15 and as a rapid cognitive screening tool in routine outpatient care to assess cognitive functioning among ambulatory patients with advanced liver disease.…”