An occupation-based, metacognitive approach to assessing error performance and online awareness

Area of Science:

• Neuroscience
• Rehabilitation Science
• Cognitive Psychology

Background:

• Online awareness, crucial for self-monitoring and error correction, is typically assessed via standardized tasks.
• Rehabilitation often focuses on individualized, meaningful activities, necessitating tailored assessment methods.
• Current limitations in assessing online awareness during client-specific occupations hinder effective rehabilitation planning.

Purpose of the Study:

• To introduce and evaluate a metacognitive, task-analytic approach for assessing online awareness during meaningful occupations.
• To determine the feasibility and inter-rater reliability of this novel assessment method.
• To explore the validity of the approach by examining error profiles and cognitive impairments in clients with severe traumatic brain injury.

Main Methods:

• An occupation-based assessment involving individualized tasks (e.g., snack preparation, budgeting) was developed.
• Two experienced occupational therapists independently rated audio-visual recordings of clients performing these tasks.
• Inter-rater agreement was calculated for error detection, categorization, and correction.

Main Results:

• Overall agreement on error detection was 76%, with 65% agreement on error categorization.
• 100% agreement was achieved for error correction.
• Fair inter-rater reliability was demonstrated for the occupation-based assessment of online awareness.

Conclusions:

• The described occupation-based approach shows promise for assessing online awareness in meaningful activities.
• This method, especially when combined with standardized neuropsychological assessments, can provide a comprehensive understanding of error behavior.
• The findings support the use of individualized, task-analytic assessments in occupational therapy for clients with brain injuries.