Challenges to Understanding the Role of Cognition in the Assessment of Activities of Daily Living in Patients with Spinal Cord Injury: A Narrative Literature Review

Research Objectives When working in acute rehabilitation settings with physically compromised populations, including patients with spinal cord injury (SCI), assessing one's ability to manage basic and instrumental activities of daily living (ADLs) is a crucial component of treatment and discharge planning. Neurocognitive diagnoses, in particular, are predicated on the extent to which one's cognitive deficits negatively impact ADLs. However, parsing apart the relative contribution of cognitive versus physical changes on ADLs can be particularly challenging in patients with SCI as decline in ADLs may be attributable to motor limitations, cognitive decline, or both. This narrative review sought to investigate the existing literature regarding cognitive assessment and the role of cognition in functional assessment in SCI Design Narrative literature review. Setting N/A. Participants N/A. Interventions N/A. Main Outcome Measures N/A. Results Robust empirical data suggest substantial cognitive impairment in individuals with SCI. However, there is a lack of standardized cognitive assessments designed for use specifically with this population. Further, few studies have been published assessing the role of cognition in functional assessment of patients post-SCI, and those reviewed suggest that current functional measures with cognitive components have limited ecological validity. This can ultimately result in a lack of convergence among one's cognitive status, motor limitations, and ability to function independently post-discharge. Conclusions While many of the existing measures of functional assessment in SCI speak to the general capacity of physical recovery and level of physical functioning post-injury, few address ability to resume daily activities following discharge from a cognitive perspective. This lack of inclusion of cognition in functional assessment presents challenges for rehabilitation psychologists and neuropsychologists in making accurate diagnoses and treatment plans while working with patients with new onset cognitive difficulties, particularly within the context of physical disability such as SCI. Author(s) Disclosures None. When working in acute rehabilitation settings with physically compromised populations, including patients with spinal cord injury (SCI), assessing one's ability to manage basic and instrumental activities of daily living (ADLs) is a crucial component of treatment and discharge planning. Neurocognitive diagnoses, in particular, are predicated on the extent to which one's cognitive deficits negatively impact ADLs. However, parsing apart the relative contribution of cognitive versus physical changes on ADLs can be particularly challenging in patients with SCI as decline in ADLs may be attributable to motor limitations, cognitive decline, or both. This narrative review sought to investigate the existing literature regarding cognitive assessment and the role of cognition in functional assessment in SCI Narrative literature review. N/A. N/A. N/A. N/A. Robust empirical data suggest substantial cognitive impairment in individuals with SCI. However, there is a lack of standardized cognitive assessments designed for use specifically with this population. Further, few studies have been published assessing the role of cognition in functional assessment of patients post-SCI, and those reviewed suggest that current functional measures with cognitive components have limited ecological validity. This can ultimately result in a lack of convergence among one's cognitive status, motor limitations, and ability to function independently post-discharge. While many of the existing measures of functional assessment in SCI speak to the general capacity of physical recovery and level of physical functioning post-injury, few address ability to resume daily activities following discharge from a cognitive perspective. This lack of inclusion of cognition in functional assessment presents challenges for rehabilitation psychologists and neuropsychologists in making accurate diagnoses and treatment plans while working with patients with new onset cognitive difficulties, particularly within the context of physical disability such as SCI.