Naturalistic tasks performed in realistic environments: a review with implications for neuropsychological assessment

Abstract

Objective: Understanding functional abilities for those with neurologic disorders is a growing area of investigation. In this paper, performance-based naturalistic tasks used to assess cognitive and functional deficits were reviewed to determine current evidence for effectiveness as valid and reliable assessment measures and to make recommendations for future research.Method: Performance-based naturalistic tasks were defined as observable, rule-based, open-ended tasks completed in an environment that either mimics the real world or is the real world. Thirty-eight studies, discussed by the environment in which the task was performed (i.e. vocational, kitchen, hospital/store, and home), were reviewed.Results: Many studies were found to have significant methodological limitations (e.g. low sample size) and few studies evaluated the relationship between performance on the naturalistic task and everyday functioning. The efficacy of using naturalistic tasks to better understand functional status has yet to be clearly demonstrated across neurologic populations. Numerous factors, including ease of use, limited research on how to best utilize these tasks, and cost impact the use of naturalistic tasks. Nonetheless, given the promising theoretical foundation, opportunities are ripe for further development of assessment strategies that use contextually relevant environments and allow for enhanced safety and controllability of tasks, increased face validity, capitalization on automatic processes, and improved ecological validity.Conclusions: Future research is needed to increase the knowledge base regarding the use of naturalistic tasks, especially as they relate to everyday functioning, because of the potential benefits to advance the standard of care for individuals with neurologic conditions.

Keywords:

• Ecological validity
• milieu-based environments
• real-world assessment
• everyday functioning
• generalizable tasks