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A validation and acceptability study of cognitive testing using switch and eye-gaze control technologies for children
Petra Karlsson1, Ingrid Honan1, Seth Warschausky2
1Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia.
Insights
This study validates cognitive assessments for children with cerebral palsy using switch or eye-gaze technology. Accommodated tools improve accessibility and accurately measure cognitive abilities in children with motor and speech impairments.
Area of Science:
- Neurodevelopmental conditions
- Cognitive assessment
- Assistive technology
Background:
- Cerebral palsy (CP) affects cognition in many children, yet standardized assessments are inaccessible due to motor or speech impairments.
- Standardized tools may underestimate abilities in children with CP, highlighting the need for alternative assessment methods.
- Accessible cognitive assessment is crucial for understanding and supporting children with neurodevelopmental conditions.
Purpose of the Study:
- To examine and compare the psychometric properties of cognitive assessment tools adapted for switch or eye-gaze control.
- To evaluate the performance and user experience of children with CP using these accommodated tools.
- To compare accommodated assessments with standardized versions in typically developing children.
Main Methods:
- A mixed-model design study involving 80 typically developing children and 40 children with CP.
- Administration of six cognitive assessments via standardized, switch-controlled, and eye-gaze controlled methods.
- Analysis of psychometric properties, performance, user experience, completion rates, and demographic factors.
Main Results:
- Psychometric properties of accommodated cognitive assessments will be examined for validity and measurement agreement.
- Performance and user experience of children with CP on accommodated assessments will be described and compared.
- Completion rates, time to complete, and influence of condition-specific characteristics on participation will be analyzed.
Conclusions:
- Accommodated cognitive assessments using switch or eye-gaze technology show promise for improving accessibility and accuracy in children with CP.
- This research will provide valuable data on the psychometric properties and usability of these adapted tools.
- Findings will inform the development and implementation of more equitable cognitive assessments for children with diverse needs.
Abstract:
Despite the importance of knowing the cognitive capabilities of children with neurodevelopmental conditions, less than one-third of children with cerebral palsy participate in standardized assessments. Globally, approximately 50% of people with cerebral palsy have an intellectual disability and there is significant risk for domain-specific cognitive impairments for the majority of people with cerebral palsy. However, standardized cognitive assessment tools are not accessible to many children with cerebral palsy, as they require manual manipulation of objects, verbal response and/or speeded response. As such, standardised assessment may result in an underestimation of abilities for children with significant motor and/or speech impairment. The overall aim of the project is to examine and compare the psychometric properties of standardised cognitive assessment tools that have been accommodated for use with either a switch device or eye-gaze control technologies, with the specific aims to: (1) Examine the psychometric properties (measurement agreement and validity) of accommodated assessment tools by comparing the performance of typically developing children on six cognitive assessment tools administered via standardised versus accommodated (switch or eye-gaze control) administration; (2) Describe and compare the performance and user experience of children with cerebral palsy on six accommodated cognitive assessments administered via switch or eye-gaze control technologies. Secondary aims are to: (1) Describe the completion rates and time to complete assessments of participants in each group; (2) Within the group with cerebral palsy, examine the effects of condition-specific characteristics (type of cerebral palsy, functional levels, and pain) and demographics (age, socio-demographic) on participation. This protocol paper describes a two-phase validation and acceptability study that utilizes a mixed-model design. This study will collect concurrent data from 80 typically developing children and 40 children with cerebral palsy, who use switch or eye-gaze control technology as alternate access communication methods. The set of instruments will measure receptive vocabulary, fluid reasoning, sustained attention, vision perception, visuospatial working memory and executive functions. Data analyses will be conducted using SPSS v. 25 and R v 4.1.0. SPSS Sample Power 3 was used for power computation and allows for a 10% drop out rate. Quantitative descriptive statistics, measurement agreement data plotting, bivariate and multiple regressions analysis will be conducted using appropriate methods.
