A Modified Test of Goal-directed Behaviour: a Feasibility Study

Feasibility Study for Development of a Modified Bedside Test of Goal-directed Behaviour

Cognitive assessment plays an important part in decision making in acute neurological settings, partly because difficulties with cognitive skills such as attention, memory and executive functioning (which includes planning and problem-solving) have direct implications for patents' levels of independence and safety upon discharge.

A bedside cognitive task that could shed light upon a patient's ability to demonstrate effective goal-directed behaviour (potentially along with other aspects of executive functioning such as cognitive flexibility) would be a useful addition to the existing repertoire of bedside cognitive assessments.

One such test could be 'Link's Cube'. The Link's Cube Test is impractical for bedside use in an acute ward setting, as it comprises 27 small blocks. The feasibility study aims to preserve the information that is provided by Link's Cube Test (i.e. an indication of the patient's ability to engage in goal-directed behaviour) whilst altering the testing material such that only nine, slightly larger blocks are used.

The objectives for the feasibility study are:

• To identify any practical difficulties in administration of the tests that may not be apparent without trialling them
• To generate information regarding the timing and sequence of overall administration and in particular the proposed modified Link's Cube test
• To obtain feedback from neuropsychologists about ease of administration of the proposed new test and to obtain their views regarding potential benefits

Inclusion criteria for the main (non-neuropsychologist) element include:

• General population. For convenience at this feasibility study stage this will be largely comprised of colleagues working with GHT, above the age of 18, with no upper age limit.
• Have given informed consent having followed the procedure in the protocol
• Have the physical/sensory abilities to undertake the test procedures (e.g. use of both hands, adequate vision)
• Sufficient English language to be able to follow test instructions

Exclusion criteria for the main (non-neuropsychologist) element include:

• Under the age of 18
• Refusal/inability to give informed consent
• Insufficient English language to be able to follow test instructions
• Using cognitive testing as part of their clinical work, or ongoing familiarity with cognitive tests.
• Working directly with the main investigator.
• Presence of a self-reported cognitive difficulty/neurological condition - not because that in itself would be problematic for test administration or for the information generated, but rather to avoid potential distress to participants were they to find the tests administered challenging.
• Presence of any physical/sensory/cognitive difficulty that would confound administration of the tasks, e.g. being partially sighted or having use of only one upper limb
• There are no exclusion criteria based on gender identity, ethnicity or handedness.
• There are no exclusion criteria relating to medication.

Inclusion criteria for the PPI (neuropsychologist) element include:

• clinical psychologists in GHT who have or have had a role that involves the administration of cognitive tests
• Have given informed consent having followed the procedure in the protocol
• Have the physical/sensory abilities to undertake the test procedures (e.g. use of both hands, adequate vision)
• Sufficient English language to be able to follow test instructions

Exclusion criteria for the PPI (neuropsychologist) element include:

• Under the age of 18
• Refusal/inability to give informed consent
• Insufficient English language to be able to follow test instructions
• Presence of a self-reported cognitive difficulty/neurological condition - not because that in itself would be problematic for test administration or for the information generated, but rather to avoid potential distress to participants were they to find the tests administered challenging.
• Presence of any physical/sensory/cognitive difficulty that would confound administration of the tasks, e.g. being partially sighted or having use of only one upper limb
• There are no exclusion criteria based on gender identity, ethnicity or handedness.
• There are no exclusion criteria relating to medication.