Accommodations to cognitive assessment for a child with dyskinetic cerebral palsy: case study

Abstract

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 rehabilitation

• Accommodations 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.

Keywords:

• Case report
• cognitive testing
• assistive technology
• cerebral palsy
• complex communication needs
• severe motor disability

Acknowledgements

We acknowledge and thank Tom, his parents and school staff for supporting Tom to participate in this case study.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This case study was generously supported by the Sydney Medical School Foundation Clinician Researcher Support Scheme, the University of Sydney, the Roger Montgomery Family Fund, and the Neurodisability Assist Trust Grant Program, 2018.