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Accommodations to cognitive assessment for a child with dyskinetic cerebral palsy: case study
Petra Karlsson1, Megan Shepherd2, Ingrid Honan1
1Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia.
Insights
Cognitive assessments for children with cerebral palsy (CP) can be adapted for switch access, improving evaluation for those with motor impairments. While some assessments showed success, others require further development for broader accessibility.
Area of Science:
- Neuroscience
- Developmental Psychology
- Rehabilitation Medicine
Background:
- Formal cognitive assessment is crucial for children with cerebral palsy (CP), yet less than one-third undergo such evaluations.
- This gap can lead to underestimation of cognitive strengths in children with severe CP.
- This case study explores accommodations for cognitive assessment to facilitate switch access.
Observation:
- A 9-year-old boy with dyskinetic CP participated in cognitive assessments adapted for single switch access.
- Assessments included receptive vocabulary, non-verbal reasoning, sustained attention, executive functions, and visual perception.
- User experience, usability, and cognitive load were measured.
Findings:
- Accommodations for switch access were effective for receptive vocabulary, non-verbal reasoning, and sustained attention tasks.
- Assessment completion time increased by 1-2 hours compared to standardized procedures for typically developing children.
- Accessibility challenges remain for executive function and visual perception measures, though user experience was positive.
Implications:
- Switch-accessible cognitive assessments can be successfully implemented for specific domains in children with CP.
- Extended assessment duration necessitates scheduling over multiple sessions.
- Further research is required to refine accommodations for executive function and visual perception, and to validate generalizability for children with motor and speech impairments.
Purpose:
Despite the importance of having knowledge about a child's cognitive functioning, less than one-third of children with cerebral palsy (CP) are formally assessed. Consequently, the cognitive strengths of many children with severe CP may be underestimated or go overlooked. This case study aimed to test accommodations to cognitive assessment administration procedures to enable switch access.
Methods:
A 9-year-old boy with dyskinetic CP tested a suite of cognitive assessments with accommodations for single switch access and measures of user experience. The cognitive assessment included: receptive vocabulary; non-verbal reasoning; sustained attention; executive functions of problem solving and shifting; and visual perception skills.
Results:
The participant's ability to independently undertake assessment on the receptive vocabulary, non-verbal reasoning and the sustained attention measures indicates that accommodations made for single switch access were appropriate. Assessment took 1-2 h longer than expected for a typically developing child via standardised administration procedures, but was considerably faster than expected if undertaken via low-tech partner assisted scanning. Accessibility barriers continued to be present for the executive function and visual perception measures. Overall, the user experience was positive, both in regards to usability and cognitive load.
Conclusions:
This case study provides emerging data for usability and accessibility of accommodations to a battery of cognitive assessment tasks. Further research is needed to devise appropriate accommodations for executive function and visual perception measures and to determine whether the accommodations are accessible more generally for children with motor and/or speech impairments. Implications for rehabilitationAccommodations can be successfully made to receptive vocabulary, non-verbal reasoning and sustained attention assessment administration procedures for switch technologies.Cognitive assessment with switch accommodations takes considerably longer to complete than standardised administration estimates for a typically developing child. Assessment may need to be scheduled over more than one session.User experience, including usability and cognitive load, of accommodations was positive.
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