Test Accommodations for Individuals with Neurological Conditions Completing the NIH Toolbox – Cognition Battery: An Evaluation of Frequency and Appropriateness

Rehabil Psychol, 2017 · DOI: 10.1037/rep0000191 · Published: November 1, 2017

Simple Explanation

This study looks at how often people with neurological conditions need special help (called accommodations) when taking a cognitive test called the NIH Toolbox Cognition Battery (NIHTB-CB). It also checks if the help given by test administrators follows the guidelines. The study found that most people with these conditions can take the test without needing any help. However, when help was needed, the test administrators didn't always follow the guidelines, which could affect the test results. The researchers suggest that test administrators need better training and that the guidelines should be easier to use during testing to make sure everyone has a fair chance to show their cognitive abilities.

Study Duration

December 2011 and November 2013

Participants

604 adults with traumatic brain injury, spinal cord injury, or stroke

Evidence Level

Not specified

Key Findings

1
75% of participants completed the NIHTB-CB using standard administration procedures.
2
22.6% of participants required accommodations due to accessibility challenges.
3
56.3% of the accommodated administrations breached standardization and scores could not be interpreted using test norms.

Research Summary

The study evaluated the frequency and appropriateness of test accommodations for individuals with neurological conditions completing the NIHTB-CB. Most participants (75%) completed the NIHTB-CB using standard procedures, but 22.6% required accommodations. A significant portion (56.3%) of accommodated administrations breached standardization, potentially invalidating test scores, highlighting the need for better training and accessible guidelines.

Practical Implications

Improve Training for Test Administrators

Test administrators need more rigorous training on how to work with people with functional, physical, cognitive, and sensory impairments.

Integrate Accommodation Guidelines

Consistently integrate the Reasonable Accommodation Guidelines within the NIHTB administration platform for ease of access.

Address Secondary Conditions

Administrators should monitor for signs of fatigue, impulsivity, pain, and spasticity and provide breaks to minimize the impact of secondary impairments on test performance.

Study Limitations

1
Post hoc analysis of examiner notes revealed accommodation procedures that deviated from the Reasonable Accommodations Guidelines, but we are unable to evaluate the effects that these deviations had on test scores and the validity of accommodated administrations.
2
examiners did not use a standardized reporting format, which resulted in richer behavioral descriptions from some examiners than others.
3
Future studies should evaluate the effects of accommodations on test scores and the psychometric properties of tests.

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