Test accommodations for individuals with neurological conditions completing the NIH Toolbox—Cognition Battery: An evaluation of frequency and appropriateness.

Abstract

Objectives First, to evaluate the frequency with which individuals with neurological conditions require test administration accommodations for the NIH Toolbox – Cognition Battery (NIHTB-CB). Second, to evaluate the appropriateness of accommodations provided by administrators, including adherence to NIHTB-CB Reasonable Accommodations Guidelines. Method Adults with traumatic brain injury, spinal cord injury, or stroke (n=604) completed the NIHTB-CB and other assessments as part of a multi-site study. We provide a descriptive, secondary analysis of test administrator notes to determine use and appropriateness of accommodations. Results Four hundred and fifty participants (75%) completed the NIHTB-CB using standard administration procedures, but 137 (22.6%) encountered accessibility challenges which required accommodations. Participants with motor function impairments were most likely to receive at least one of three kinds of accommodations: (a) non-standard methods of entering responses using standard input devices, (b) use of alternate input devices, or (c) directing the test administrator to enter a response. Fatigue and/or impulsivity led to non-standard administration by 48 (7.9%) individuals. Post hoc audit of test administrator notes revealed that despite careful instructions and supervision, 49 (56.3%) of the accommodated administrations breached standardization and scores could not be interpreted using test norms. Conclusion Although the NIHTB-CB was developed for individuals without neurological impairment, most individuals with neurological conditions completed the standardized administration without accommodations. When accommodations were needed, administrators did not adhere to the official Reasonable Accommodations Guidelines in more than half of the cases.

Using the NIH Toolbox Cognition Battery (NIHTB-CB) in individuals with traumatic brain injury.

“…The types of tests that were missing differed by TBI group:tests requiring rapid responses were most likely to be missing. The impact of missing data in research and clinical settings must be considered when using the NIHTB-CB (Magasi, Harniss, Tulsky, Cohen, & Heaton, Under Review).…”

Cognition among community-dwelling individuals with spinal cord injury.

“…A disproportionate amount of missing data was from individuals with tetraplegia, particularly on speed-based tests. This was mainly because it was not possible to make accommodations or because participants were unable to complete the task even with recommended accommodations (Magasi et al, Submitted). After excluding SCI participants with incomplete data, 156 remained, and were re-matched with 156 control participants from the NIH Toolbox validation sample.…”

“…If an individual was not able to complete a test with reasonable accommodations, the test was not administered. A post-hoc audit of accommodations resulted in some scores being discarded because of questionable fidelity to the NIHTB guidelines (Magasi et al, Submitted). The dependent variable for all tests was a T score (mean = 50, SD = 10 in the normative sample) that was adjusted for age, sex, education, and race/ethnicity (Casaletto et al, 2015).…”

Accessibility Considerations in the National Children's Study

“…Specifically, within the Health Measurements Network, an Accessibility Working Group was created to collaborate with content and measurement experts to evaluate and improve the accessibility of all proposed measurement instruments (18). Harniss and Magasi have experience working in both the Patient Reported Outcomes Measurement Information System (PROMIS R ) and NIH Toolbox R for Assessment of Neurological and Behavioral Function (NIH Toolbox, NIHTB) initiatives to improve measurement accessibility (9,(21)(22)(23)(24). In this paper, we describe the approach and processes we used in the National Children Study's Accessibility Working Group to promote accessible measurement for children with disabilities and special healthcare needs.…”