Video Game Improve Cognition in Strokelbrain Injury Survivors? A

NORTHERN ILLINOIS UNIVERSITY

Can an "educational" video game improve cognition in strokelbrain injury survivors?

A Thesis Submitted to the

University Honors Program

In Partial Fulfillment of the

Requirements of the Baccalaureate Degree

With Upper Division Honors

Department Of

Allied Health and Communicative Disorders/Speech Language Pathology

Stacey Behnke

DeKalb, Illinois

May, 2011 University Honors Program

Capstone Approval Page

Capstone Title (print or type)

Can an "educational" video game improve cognition in stroke/brain injury survivors?

Student Name (print or type) _Stacey 8ehnke _

Faculty Supervisor (print or ty e) _Jamie Ma~ r _

Faculty Approval Signature -----:~.....\I-Ih'-l.,,,J.:l-<:....--::::...... --f>-~~-=------~---_---_

Department of (print or ty~e) A\ hu:l t\tol+~b~ Communication Disorders Speech Language Pathology

Date of Approval (print or type) \~---I.J"",-ci.L- _ HONORS THESIS ABSTRACT THESIS SUBMISSION FORM

AUTHOR: Stacey Behnke

THESIS TITLE: Can an "educational" video game improve cognition in stroke/brain injury survivors?

ADVISOR: Jamie Mayer

ADVISOR'S DEPARTMENT: Allied Health and Communicative Disorders

DISCIPLINE: Speech Language Pathology

YEAR: 2011

PAGE LENGTH: 79

BIBLIOGRAPHY: Page 15 and 16

ILLUSTRATED: No

PUBLISHED: No

LIST PUBLICATION:

COPIES AVAILABLE (HARD COPY):

ABSTRACT (100-200 WORDS): Can an "Educational Videogame" Improve the Cognition of Stroke/Brain Injury Survivors?

ABSTRACT

Current healthcare policies limit the time during which intensive rehabilitation is available for stroke and brain injury survivors (AAPM&R, 2009). Yet the timeline for recovery from such insults extends well beyond the typical window of rehabilitation provision, which makes independently administered cognitive stimulation an essential component of the recovery process. Unfortunately, little data exist as to the efficacy of such programs.

Therefore, the purpose of this study was to determine whether a computerized, general cognitive stimulation program (Le., Nintendo OS' "Brain Age 2"), would successfully remediate specific cognitive skills in stroke or brain injury survivors compared to healthy controls. The benefits of this game include, (1) readily available for public use, (2) doesn't require training, (3) self- motivating which is important for successfully completing the program (Cherney et aI., 2008), and (4) automatically tracks the performance and reaction time.

Participants in this study included stroke and brain injury survivors with mild cognitive-linguistic deficits and age- and education-matched healthy controls. All subjects were assessed for memory, attention, reaction time, executive function, and subjective perception of cognition; then played the "Brain-Age" game for 6 weeks, 30-60 min/day. Participants then repeated baseline testing; data analysis included comparing pre- and post- treatment test scores. Can an "Educational Videogame" Improve the Cognition of Stroke/Brain Injury Survivors?

(IGN Entertainment, 2011) Learning Objectives

a. Discuss why an independently administered rehabilitation regimen is needed in the

chronic phase post-stroke or brain injury.

b. Describe the benefits and drawbacks of computerized cognitive stimulation in healthy

controls and stroke/brain injury survivors.

c. Describe the objective evidence for improvement (of lack thereof) of specific cognitive

skills in healthy controls and stroke/brain injury survivors.

Background/Purpose

The leading cause of long term disability in the United States is currently a stroke (American

Heart Association, 2009). A stroke is any disruption in blood flow to the brain and is sometimes referred to as a cerebrovascular accident or CVA (Murray, & Clark, 2006). CVA's can cause damage to the right and left hemispheres of the brain causing cognitive-communication disorders as well as physical motor issues. A Gallup survey was conducted by the NSA (National

Stroke Association) in 1996 and showed that 40% of adults were unaware that a stroke occurs in the brain and also did not know what the symptoms of a stroke were (Murray, & Clark,

2006). This shows that not many people are aware ofthe dangers of a stroke which worsens the chances of getting immediate treatment. Risk factors of a stroke include hypertension (high

blood pressure), heart disease, diabetes, smoking, obesity, substance abuse and high

cholesterol. Signs of a stroke include dizziness, confusion, severe headache, one-sided

numbness or weakness and slurred speech (Murray, & Clark, 2006).

When a person has a stroke, the first thing that needs to happen is the recognition of

symptoms and request help from a medical professional for acute care. For the next few weeks

the stroke survivor will go through what is called spontaneous recovery. This is when the stroke

survivor naturally regains cognitive, sensory and motor skills (AAPM&R, 2009). How severe the

stroke will depend on how much the stroke survivor will spontaneously recover. After the

stroke survivor is medically stable but still in acute care, the initiation of rehabilitative

treatment can begin (US Agency for HealthCare Research and Quality, 1995). It is important to

wait to begin research until at least 6 months post onset because it would be difficult to

attribute it to the treatment or spontaneous recovery (Department of Citizen Services, 2010).

Because rehabilitative therapy is quite expensive, most stroke survivors rely on insurance to

pay for it. But, most current healthcare policies limit the time during which intensive

rehabilitation is available for stroke and brain injury survivors to as little as 2-3 weeks as an

inpatient therapy and 1-2 months of outpatient therapy (AAPM&R, 2009). This is a problem

because the timeline for recovery from such insults extends well beyond this typical window of

rehabilitation provision. It is proven that it is possible for stroke and brain injury survivors to

progress even years after the occurrence ofthe stroke (Bhogal, 2003). Progress can be made

because of the neuroplasticity of the adult brain. Neuroplasticity is the increase of gray matter

in the brain created by changes in the function and organization of the brain. This means that

afferent signals are sent to an undamaged part of the brain that are not normally used for a

. specific task and reorganizes it so it can be used for a different task. Also, increased gray

matter in the hippocampus is very important since this is the part of the brain associated with

memory and learning which is changed during this process. The hippocampus also mediates

the production of neuronal or glial stem cells that go to the damaged part of the brain and help

with the repair process. Repetition is very important for this process because it takes time to

train and reinforce the brain to do something new (Gauthier et aI., 2008). As a result, repetitive and independently administered cognitive stimulation becomes an essential component of the recovery process of a stroke survivor possessing cognitive problems. Because of the growing popularity of video games, it is of interest to explore usage of educational video game for an at home therapy program. Unfortunately, little data exist as to the efficacy of such programs which is why this study is of importance.

This study (part one) supplemented a larger study (part two) currently in progress by Dr. Jamie

Mayer. Part one of the study is to run the testing of healthy control subjects and analyze their data. Healthy control subjects are an important supplement to Dr. Mayer's study because

Nintendo's claims of improved cognition have not to our knowledge been tested on healthy individuals with no history of neurological problems. Such data are crucial prior to exploring the validity of this game to improve cognition in stroke and brain injury survivors. Part two of the study is meant to explore the possibilities of using an "educational" video game to see if it can improve cognition in stroke/brain injury survivors. This topic is pertinent because "There is a growing interest in whether computer and video games may increase IQ. But despite suggestive advertisements, there is no empirical evidence that computer games enhance anything beyond task-specific performance and selective visuospatial attention." (Jaeggi et.a\.

2008). It is of interest to use Nintendo's "Brain Age 2" game because of its many benefits. (1)

The game is readily available for public use. This means it is available for purchase at a local department store. (2) The game doesn't require training. It is geared towards the general public and anyone can learn how to utilize it. (3) Nintendo's "Brain Age 2" game is self- motivating and socially acceptable which is important for successfully completing the program

(Cherney et al., 2008). Self motivation is important because it will keep the stroke survivor interested in the game and they will have a higher chance of completing the therapy program.

Also, since it is socially acceptable, the stroke survivor will feel comfortable playing the game, again, increasing the chance they will finish the therapy program. (4) Lastly, the game automatically tracks the performance, reaction time and how often the stroke survivor plays which is beneficial for collecting data. This way, there is no extra paper work to fill out since the game already does it. Hypothesis

Given the data to date, (e.g., Jaeggi et al., 2008) it is hypothesized that there will be minimal change from pre- to post-testing in the healthy control participants due to ceiling effects. The ceiling effect is where the participant reaches a certain point and can no longer improve. Also, age may have potential to affect the results. It is possible, however, that individuals with a history of stroke/brain injury do have the potential to benefit from this program with respect to specific cognitive functions.

Methods

Participants

Part one of my supplemental study included nine healthy (did not have a stroke or brain

injury) participants all over the age of 45 and all had at least a high school education.

Participants of part two conducted by Dr. Jamie Mayer included stroke and brain injury

survivors with mild cognitive-linguistic deficits and over the age of 45.

Procedures

The first step was to make sure that the participant would fit the criterion of the study

which is described above. Then all participants signed a consent form that explained

the conditions and procedures of the study (See Appendix 1). Next, they signed the loan

agreement for the Nintendo DS and the Brain Age 2 game, unless they already own

both, in order to borrow them to complete the study (See Appendix 1). The participants

also filled out a Subject Information form so we would know some general information

about them (See Appendix 1). Then, all participants took a pre-test to be assessed for (1)

memory defined as cognitive function responsible for storing, retaining, and retrieving

processed information, (Murray, & Clark, 2006), (2) attention defined as a state of

consciousness characterized by such concentration (Merriam-Webster's Medical

Dictionary), (3) reaction time which is defined as the time elapsing between the

beginning ofthe application of a stimulus and the beginning of an organism's reaction to

it (Merriam-Webster's Medical Dictionary), (4) executive function defined as capacities,

under primary control of the prefrontal cortex, that guide complex behavior over time through planning, decision making, and response control, (Webb & Adler, 2008), and (5) subjective perception of cognition or how the participant felt about the process using three different tests and two questionnaires. After initial testing, the participants played Nintendo's "Brain-Age 2" game for 6 weeks, 30-60 minutes a day. Participants then repeated the same baseline testing at the conclusion of the study. These tests served as pre- and post- tests used to assess the progress of the participant. The data was analyzed at the end to compare the pre- and post- test scores.

Measures

The measures that were used in this study included the following tests:

(1) TONI-III (Test of nonverbal Intelligence Third Edition) which is a test

developed in 1982 to assess the aptitude of individuals that may not be

physically or cognitively able to respond to the test questions. This also included

participants that cannot read, hear, speak or have neurological impairment

such as head injury, stroke, aphasia, cerebral palsy, learning disability and

Alzheimer's disease. The directions ofthe test are pantomimed which forced the

participant to pick up what they needed to do without any verbal instruction.

The task the participant was to perform was to pick the next figure that would go

in the sequence. It is normed on a population aging from 6-90 and is not

timed. There is a form A and B of this test to prevent the participant

from learning the test. (Brown, Sherbenou, & Johnsen, 1997). (See Appendix 2

for Sample Test Items).

(2) RBMT-3 (Rivermead Behavioral Memory Test Third Edition) which is a test

that is used to predict (a) everyday memory problems in people with acquired,

non progressive brain injury; and (b) monitor change over time. Tasks that were

performed included things such as name recognition immediate and delayed,

remembering where an object was hidden at the beginning of the test and

recalling it at the end, reciting a story immediate and delayed, picture

recognition immediate and delayed, face recognition immediate and delayed, remembering a route immediate and delayed, answering date and orientation

questions and a novel task immediate and delayed. All of these tasks are

something that people that have memory problems will have trouble with. ,

There is an alternate form of this test to combat the participant from learning

the test and it is normed on ages 5-96 (Wilson el at., 2008). (See Appendix 2 for

Score Sheet).

(3) D-KEFS (Delis-Kaplan Executive Function System) which is a test of executive

functions that assesses the participants' attention, language, and perception, in

order to see if they have a higher level of abstract thought. There were nine

components to this test but only four were used in this study due to the

complexity of the test and the limited abilities of some participants. The four

components that were used were (a) Trail Making which included visual

scanning, number sequencing, letter sequencing, number-letter switching and

motor speed; (b) Verbal Fluency which included letter fluency, category fluency

and category switching; (c) Design Fluency which included connecting filled dots,

connecting empty dots and switching while connecting dots; (d) Color-Word

Interference which included color naming, word reading, inhibition,

inhibition/switching. This test was normed on ages 8-89 and alternate forms are

provided for some components of the test. Also, these tasks were timed so the

participant had to perform them as fast as they could optimally without error

(Delis, Kaplan, & Kramer, 2001). (See Appendix 2 for Score Sheet).

After part one of the study was finished, it was concluded that the results of this study may be more subjective, therefore a questionnaire should be used to collect subjective data. As a result, a questionnaire was created specifically for this study in order to see if the participate felt like there were changes even though the quantitative data doesn't show it (See Appendix 3). Another questionnaire used was called the APT-II Attention

Questionnaire (Sohlberg et aI., 2001). In order to make the APT-II better fit our needs for this study, two questions were added regarding memory and problem solving (See

Appendix 3).

Examples of the types of games that were featured in the "Brain Age 2/1 game are below.

In this game, the participant was to hit the correct notes on the keyboard with the stylus as they pass by on the screen accurately as fast as he/she could.

E E

~ o BG G .&

(IGN Entertainment, 2011)

In this game, the participant was to listen carefully to what words were produced by the game and write them down. The catch was that two or more words were said at once.

They also had to do this task accurately as fast as he/she could.

Write tileVVOrd-;--1 ~ hear. . - •.!l~-~-~"""""'·.

[RESPO o~t ( PE' Cl L ~t L

(IGN Entertainment, 2011) This game was to simulate working as a cashier. The total amount spent by the customer was presented and the bill used to pay. The participant was to use the right side of the screen and point tothe correct amount of change the customer should receive with the stylist accurately as fast as he/she could.

(IGN Entertainment, 2011)

In this game, the participant was to unscramble the letters as they spun in a circle to create a word. Then write the letters in the correct order with the stylist as fast as he/she could.

(IGN Entertainment, 2011) In this game, the participant was presented with a variety of number in different sizes and had to correctly point to the highest number with the stylist accurately as fast as

he/she could.

Touch the highest number. 16 14 1 10 0 9 3 8 7 P'.I ••••.•. :"" <';,(:'.,

(lGN Entertainment, 2011)

The goal of this game was for the participant to keep track of the runner as he

repeatedly passes and got behind other runners. At the end of the race the participant

had to correctly say what place the runner finished in.

Keep track of the runner.

(IGN Entertainment, 2011) In this game, the participant had to write on the right side of the screen with the stylus what time it is while reading the clock upside down as accurately and as fast as he/she could.

What time is it?

(lGN Entertainment, 2011)

The object of this game was to look at the number presented and write the corresponding symbol from the key with the stylus accurately and as fast as he/she could.

o···@, 1···% I 7... 2··· $ 3···? 4··· = 5···# I 6···+ 7···& 8···< 1 6... 9···! !

(IGN Entertainment, 2011) This game was similar to rock, paper scissors in the sense that the participant would use

the same rules. The participant was to correctly follow the directions on the top of the

screen and say word aloud that was picked up by a microphone that would satisfy the

statement and fast as he/she could.

(IGN Entertainment, 2011)

Results

For this study a Repeated Measures ANOVA was conducted to compare our variables for pre- and post-tests with age as a covariate. This measure is used for comparing three or more groups measuring the same characteristics under different conditions (Choudhury, 2009). It was found that none of the scores across participants from pre to post session not change significantly but age appeared to mediate performance on the TONI III with a P-value of .017 (p is significant if :5.05). (Refer to figure 3) Subjective data appeared to match the quantitative scores. This means that the initial inspection of questionnaire results were consistent with little change following regular playing of the "Brain Age 2" game. (Refer to Figure 1 and 2 for selected test results). Discussion

Perhaps Brain Age 2 does not change anything in healthy adults without neurological problems, but perhaps it can affect adults who have had a stroke/brain injury. Since there was no change in the control group, it will be easier to attribute any change found in adults who have had a stroke/brain injury because we can attribute the change to the treatment and not any other factors. Furthermore, there were only 9 control subjects used and there needs to be more to ensure adequate statistical power to detect changes in scores. It could also be that the "Brain

Age 2" game is simply not challenging enough for healthy controls subjects. Although some of the mini games on "Brain Age 2" are replicated after real life scenarios, not all of them are which makes the game hard to generalize to anything else other than the game itself. In a study done by Gauthier et al. 2008, if was found that more improvements were made if the rehabilitation therapy was modeled around real world function. Also, since all of the participants grew up in a time where video games of this kind of advanced technology were not common; maybe they are at a disadvantage. This is because they have no prior knowledge of how to run the Nintendo DS and it may be hard to learn how and advance in the game at the same time. Therefore, participants of the current generation may do better because they are more likely to have prior knowledge to run the game system. This may be shown by the change in pre- to post- testing of the TONI-III where age made a difference. Playing educational videos game could be used to strengthen social ties between the older and younger generation. This

is because the two generations would have something in common to talk about bringing them closer together, improving moral, and broadening the social circle (Goldstein et aI., 1997).

Since there is little change in the objective data, there may be change in the subjective data.

This is something that will be looked at in the future when the use of the APT-II questionnaire

and another questionnaire made specifically for this study will be implemented. These

questionnaires will target changes in attention, reaction time, problem solving, memory and overall satisfaction with the study. It would also be interesting to see if other video games such

as "X-Box Live" would work as a rehabilitation method since the participant would be able

practice verbal communication using a headset. Since many stroke survivors live alone or have transportation issues, this would help them practice their communication skills and at the same time help with networking. References

Adler, R.K., & Webb, W.G. {2008} Neurology for the Speech Language Pathologist. Canada: Sabre Foundation.

American Academy of Physical Medicine and Rehabilitation. {2009}. Therapy helps in regaining coordination, full speech, and other abilities. Retrieved from http://www.aapmr.org/condtreat/rehab/recover.htm attention. {n.d.}. Dictionary.com Unabridged. Retrieved March 14,2011, from Dictionary.com website: http://dictionary.reference.com/browse/attention

Bhogal, 5., Teasell, R., & Speech ley, M. {2003}. Intensity of aphasia therapy, impact on recovery. Stroke, 34, 987-993.

Brown, L., Sherbenou, R.L, & Johnsen, S.K. {1997}. Examiner's manual: test of nonverbal intelligence third edition. Austin, Texas: ProEd.

Cherney, L., Halper, A., Holland, A., Cole, R. {2008}. Computerized script training for aphasia: preliminary results. American Journal of Speech Language Pathology, 17,19-34

Choudhury, Amit {2009}. Repeated Measures ANOVA. Retrieved 3/28/2011 from Experiment Resources: http:Llwww.experiment-resources.com/repeated-measures-anova.html

Delis, D.C., Kaplan, E., & Kramer, J.H. {2001}. Delis kaplan executive function system examiners' manual. San Antonio, Texas: The Psychological Corporation.

Department of Citizen Services Staff. {2010, January}. Stroke survivors may benefit from research study. The Senior Connection, 16{1}, Retrieved from http://www.co.ho.md.us/OA/OADocs/january10web.pdf

Gauthier, L.V., Taub, E., Perkins, c., Ortmann, M., Mark, V.W., & Uswatte, G. {2008}. Remodeling the brain plastic structural brain changes produced by different motor therapies after stroke. National Institute of Health, 39{5}, Retrieved from http://www.ncbLnlm.nih.gov/pmc/articies/PMC2574634/pdf/nihms43851.pdf doi: 10.1161/STROKEAHA.107 .502229.

Goldstein, J., Cajko, L., Oosterbroek, M., Michielsen, M., Van Houten, 0., & Salverda, F. {1997}. Video games and the elderly. Social Behavior and Personality, 2S{4}, 345-352.

IGN Entertainment. {2011}. Brain age 2: more training in minutes a day. Retrieved from http://ds.ign.com/objects/774/774696.html Jaeggi, S.M., Buschkuehl, M., Jonides, J., & Perrig, W.J. (2008). Improving fluid intelligence with training on working memory. PNAS, 105(19), Retrieved from www.pnas.orgjcgljdoi/l0.l073jpnas.0801268105 doi: 10.1073

Murray, L.L., & Clark, H.M. (2006). Neurogenic disorders of language: theory driven clinical practice. Clifton Park, NY: Thomson Delmar Learning.

reaction time. (n.d.). Merriam-Webster's Medical Dictionary. Retrieved March 31, 2011, from Dictionary.com website: http://dictionary.reference.com/browse/reaction time

Sohlber, M.M., Johnson, L. Paule, L,. Raskin, S.A., & Mater, CA. (2001). Attention process training-II: A program to address attentional deficits for persons with mild cognitive dysfunction (2nd ed.) Wake Forest, NC: Lash & Associates.

US Agency for HealthCare Research and Quality. (1995, May). Recovering after a stroke: a patient and family guide. Retrieved from http://www.strokecenter.org/patients/rasOl.htm#Purpose%2Oof%20This%20Booklet

Wilson, B.A., Greenfield, E., Clare, L., Baddeley, A., Cockburn, J., Watson, P., Tate, R., Sopena, S., Nannery, R., & Crawford, J.R. (2008). The rivermead behaviorural memory test - third edition administration and scoring manual. London, England: Pearson Education Ltd. Figures

Average Baseline Test Results for Control Subjects

Average Scores form Selected DEKEFSSubtests

Tests of Between Subjects Effects for TONI-III I I I i I I ....,U) U) RBMT Pre

~ (IJ RBMT Post --c -(IJ TONI-III Pre nsU) a:l TON I-III Post

98 100 102 104 106 108 110 112 114 116 118 120 Mean Scores Inhibition/Switching VS. Inhibition Scaled Score pre

Inhibition/Switching VS. Inhibition Scaled Score post

Switching VS. combined filled dots+ Empty dots scaled score pre

Switching VS. combined filled dots+ \I) 1;; Empty dots scaled score post QI .Jl•.. ~ category switching VS. category fluency VI ~ scaled pre =:.i:: U.I CCategory switching vs. category fluency scaled post

Combo#+letter sequencing composite pre

Combo#+letter sequencing composite post

o 2 4 6 8 10 12 14 16 Mean Scores Figure 3: Tests of Between-Subjects Effectsfor TONI-III (pS .05)

Source T~pe III Sum Degrees Mean F-test Significant of Sguares of Sguare Value Freedom Age 1288.42 1 1288.042 10.705 .017 Appendix 1

Consent Form

loan Agreement Form

Subject Information Form "Brain-Age": Can an "educational" video game improve cognition in stroke survivors?

I agree to participate in the research project named above, being conducted by Jamie Mayer, Ph.D., a faculty member at Northern Illinois University. I have been informed that the purpose of the study is to explore whether using an

N()Rftll·.RN educational video game regularly might improve my thinking skills. This project may help healthcare professionals plan treatment programs for adults with brain lLL.!NCIIS damage following a stroke. U;-;I,'ERSITY I understand that if I agree to participate in this study, I will be asked to do the following: 1) Complete three tests of thinking. These tests will involve remembering, problem-solving, and following directions. The tests will take about 1 and 112 hours to complete. 2) Play the Nintendo DS "BrainAge2" video game at home every day for 30- 60 minutes, for a period of 6 weeks. 3) After 6 weeks of playing the video game, re-do portions of the thinking tests that I completed in the beginning of the study.

I am aware that my participation is voluntary. This means that I can stop at any time and there is no penalty or cost for doing that.

If I have any additional questions about this study, I may contact Jamie Mayer at (815) 753-9166 and [email protected]. I understand that if I wish further information about my rights as a research subject, I may contact the Office of Research Compliance at Northern Illinois University at (815) 753-8524.

I understand that the intended benefits of this study include: 1) Receiving free of charge (for a period of 6 weeks), an educational video game and gaming system that might help improve my ability to pay attention and remember information 2) Helping researchers to plan cognitive treatment programs for other stroke survivors.

I have been informed that the main potential risk of being in this study is that I might get frustrated during the initial assessment or while playing the game. This is just like in regular rehabilitation sessions or electronic games. The researcher will do her best to make sure this happens as little as possible.

I understand that all information gathered during this experiment will be kept confidential. The records of this research will be kept private in a locked office. Only the researcher will have access to these records. Participants in this study will not be identified in any reports.

I have read this form and received a copy of it. I understand that my consent to participate in this project does not constitute a waiver of any legal rights, and will not affect my medical care or other therapy.

Signature of Subject Date

School of Allied Health and Communicative Disorders -- DeKalb, Illinois 60115-2899 -- (815) 753-1484 Accreditedby the Councilon AcademicAccreditationof the AmericanSpeech-language-HearingAssociation Brain-Age 2: Can an 'educational' video game improve cognition in stroke survivors?

I, (name), have received a Nintendo OS NORTHERN system and Brain-Age2 game for participation in the study, "Brain-Age: Can an ILLINOIS 'educational' video game improve cognition in stroke survivors?", conducted by Jamie tJNIV.ERSirY Mayer, Ph.D., in the School of Allied Health and Communicative Disorders at Northern Illinois University.

I understand that I may use this device for a period of 6 weeks, after which I will return the device and game to Jamie Mayer.

I will return the Nintendo OSand BrainAge2 game to Jamie Mayer on ______(date)

Signature: (subject)

Signature of Investigator: _

School of Allied Health and Communicative Disorders -- OeKalb, Illinois 60115-2899 -- (815) 753-1484 Accredited by the Council on Academic Accreditation of the American Speech-language-Hearing Association Northern Illinois University

Adult Cognition and Language Laboratory

Subject Information

Name: _

Address: _

Pho ne (with area code): Home Work _

Contact Person: Relatio nsh ip: _

Ad dre ss (if d iffere nt): _

Phone (if different): _

Birthdate: Age : Sex: Race: _

Handedness (Before stroke or disease onset): Right Left Ambidextrous _

Primary language spoken now: First language learned: _

Languages spoken other tha n English: _

Highest grade co m pleted: __ -'-- Degree( s): _

Primary Occupation (if retired, please list former occupation): _

Spouse's occupation (if retired, please list former occupation): _

Do you wear glasses? Can you see well enough to read? _

Do you have any other visual problems, such as right or left visual field cut? _

Do you have a hea ring loss? _

Do you wea r a hea ring aid in you r R or L ea r? _

How would you describe your general health? _

Current medications and dosages (if known): _ Do you have a history of any of the following?

Onset Date and Current Status

Stroke Yes No

Aphasia Yes No

Other Communication Yes No Disorder

Right or Left-sided Weakness Yes No

Dementia (e.g., Alzheimer's Yes No Disease)

Memory Impairment Yes No

~------. Other Neurological Disease Yes No

Head Injury Yes No

Seizure Disorder Yes No

Clinical Depression Yes No

Psychiatric Problems Yes No

Alcohol or Substance Yes No Problems/ Abuse , Other Major Illness Yes No

Would you like to be contacted to participate in other research projects conducted by our lab in the future?

This form was completed by: Date: _ Appendix 2

TONI-III Sample Test Items

RBMT Score Sheet

DKEFS Score Sheet ~ 0 0 al Q) be 0 (I) c •••• Q) =8 0) ::l --- ••• -Q) =8 +- ::J C 0 0 (l) "0•.... T- .- C c c c U'J or--. e, - 0 3 (l) C ><>- - += 0.0£ vj ~~ L.. L.. 0 0 TI CD or--. .0 LU a:l(l)-, • ..::.::co ~ r~~r;:; « TI oc55~ e =- Q) L.. TI ·c ~o~ ~ C-, > I-s: • ..c0 "_c: --.J.- 0 U'J0 .O~(/')1;; E C ••• ±:: ::J 0«O:J 0 ~Cf) r--. ~ 0 Z co U. "I-- ~ 0 +- ':; ~ en I ~ ~ Z- :e f-0 a

~ 3

~ I!I

, I~

i~ :!t -~ ~ - :9

~ =- =-

Rivermead Behavioural Memory Test Third Edition (RBMT-3)

Record Form

Name: Examiner:

Date of Birth: Date of Assessment:

Gender: Male Female Version: 1 2 (First assessment) (Retest) Summary of Scores Subtest Raw Score Scaled Score (55) Index Score First and Second Names - Delayed Recall (N) Sum of Scaled Scores Belongings - Delayed Recall (B) General Memory Index Appointments - Delayed Recall (A) Picture Recognition ~ Delayed Recognition (PR) Percentile Rank Story - Immediate Recall (51) Confidence Interval

Story - Delayed Recall (SD) 95% 90% FaceRecognition - Delayed Recognition (FR) Route -:-Immediate Recall (Rl) Route - Delayed Recall (RD) Messages-Immediate Recall (MI) Messages- Delayed Recall (MD) Orientation and Date (0) Novel Task-Immediate Recall (N!) Novel Task.....Delayed Recall (ND) Sum of Scaled Scores

Subtest Scaled Score Profile Plot the examinee's score on each subtest from the Summary of Scores table by placing an X'in the Scaled Score (SS) box that corresponds to their subtest score.

11 11

10 10

9 9

8 8 7 7

6 6

4 4

3 3

N 51 so PR FR RI RO B A MI MO o NI NO Visual Mf'morv Soatial Mf'morv Prosoective Memorv Orien/Date Nf'W learnlnn 1. First and Second Names - Presentation Action: Present two photographic portraits and the first and second names of the people portrayed as described in the test materials.

2. Belongings - Presentation Action: Hide two belongings as described in the test materials. Write the belongings and hiding places below.

Belonging 1: -- Location 1: _

Belonging 2: Location 2: _

3. Appointments - Presentation Action: Demonstrate and set the alarm for 25 minutes as described in the test materials, and state questions to be asked.

4. Picture Recognition - Presentation Action: Present the pictures as described in the test materials.

5. Story - Immediate Recall Action: Read the story as described in the test materials and then ask the examinee to recall it.

Record: Tick each of the 21 'ideas' correctly or partially recalled. Version 1 I Version 2 I Response I Correct = 1 I Partial = V2 After 20 years, William identical twins Carter Jenny was rescued and Diane Tuesdayevening Black after his boat capsized. have been reunited. Two fishermen They had both discovered the wreck been adopted at birth and notified the coast guard. by different families. A patrol boat Jenny discovered found him shortly after that she had a twin and brought him when she requested to the local hospital a copy of her birth certificate. where he was met She then began by his wife to search for her, and two children. a task that took Doctors report that he spent two years. four hours in the cold water The sisters said and is being treated 'it was like looking for exposure. into a mirror He is expected when we met'. to make a full recovery.

Tick box if participant required prompt Raw score Total for 'ideas' recalled word perfect or using a close synonym Total for 'ideas' partially recalled or recalled with an approximate synonym - Deduct one point if participant required prompt* Total raw score (max = 21) Rivermead Behavioural Memory Test - Third Edition (RBMT- 3) 6. Picture Recognition - Delayed Recognition

Action: Present pictures as described in the test materials.

Record: Tick the correct identifications and the number of false positives.

Version 1 I Version 2 I Response Butterfly House Scarf Shark Paperclip Snail Cloud Book Lion Rabbit Chicken Pig Mushroom Doll Banana Star Foot Mouse Piano Mask Clock Fork Dog Comb Spoon Hand Sofa Chair Crown Guitar

Record number of false positives here

Raw score

Total number of pictures correctly identified - Minus the number of false positives Total raw score (max = 15)

7. Face Recognition - Presentation

Action: Present faces as described in the test materials. 8. Route & 9. Messages - Immediate Recall

Action: Demonstrate the route, leaving message envelope and book at appropriate locations, as described in the test materials. (Adapt the instructions to suit the room if appropriate, and note your route in the column headed 'Your own version' below.)

Record: Tick the boxes as appropriate to record the route taken by the examinee. Also tick the message/book boxes as appropriate.

=:".PickedUP . Book picked up ======...

Version 1 I Version 2 I Your own version I Examinee's route Radiator Window

Door Chair 1

Chair 1 Table Message left at correct location Message left at correct location D D Chair 2 Door

Table Chair 2 Book left at correct location Book left at correct location D D Window Radiator

Scoring for Route

Raw score

If the route is completed correctly = 13

If the route is not completed correctly calculate the raw score:

Score 1 for each correct location visited regardless of order (max = 6) Score 1 if the starting place was correct and score 1 if the finishing point was correct (max = 2) Consider each location in turn together with the location following it, and score 1 if that particular pair order appears somewhere in the correct route list (max = 5) Note: the last location in the sequence is not counted since there is no location following it. Note also: If the same correct pair order occurs twice (or more) it should only be counted once. Deduct 1 point for every incorrect or repeated stage (i.e. a totally different location. or the same - location visited more than once) Total raw score (max = 13)

Scoring for Messages

Raw score

Message picked up spontaneously = 2lwith prompt = 1 Book picked up spontaneously = 2/with prompt = 1 Message left in correct location = 1 Book left in correct location = 1 Total raw score (max= 6) Rivermead Behavioural Memory Test -Third Edition (RBMT-3) 10. Face Recognition - Delayed Recognition

Action: Present the faces as described in the test materials.

Record: Tick the correct identifications (shown by page number in the stimulus book) and false positives.

Version 1 I Version 2 I Response p.145 p.145 p.149 p.149 p.155 p.155 p.157 p.157 p.159 p.163 p.165 p.167 p.167 p.173 p.175 p.175 p.l77 p.l77 p.183 p.183 p.187 p.185 p.189 p.193 p.195 p.195 p.20l p.20l p.203 p.203

Record number of false positives here

Raw score

Total number of pictures correctly identified - Minus the number of false positives Total raw score (max = 15) 11. Orientation & Date

Action: Ask the 13 questions as described in the test materials.

Record: Write the examinee's responses below.

I Response I Raw score 1.Year(1 point if correct)

2. Month (1 point if correct)

3. Day (1 point if correct)

4. Time (1 point if correct or within half an hour)

5. Date (2 points if correct, 1 point if one day out)

6. Place (1 point if correct)

7. CityITown (1 point if correct)

8. Age (1 point if correct)

9. Birth year (1 point if correct)

10. Prime Minister (1 point if first and second names correct, 'l2point for correct surname only)

11. Previous Prime Minister (1 point if first and second names correct, '/2 point for correct surname only)

12. President (1 point if first and second names correct, '12 point for correct surname only)

13. Previous President (1 point if first and second names correct, '/2 point for correct surname only) Total raw score (max = 14)

12. Novel Task - Immediate Recall

Action: Show the examinee how to put pieces of the design into the template. Then ask them to place the pieces in the same place and order that you did. Get them to repeat this twice more.

Record: Write down the order in which the pieces are laid and where they are positioned. Tick whether they are placed in the correct order and position.

First trial

Version 1 Star I Version 2 Square I Examinee's order by colour I Correct order I Correct position Red Purple Purple Blue Blue Red White Yellow

,- Black White Yellow Black Rivermead Behavioural Memory Test - Third Edition (RBMT-3) Raw score

Calculate score as follows:

If the task is completed correctly = 17

If the task is not completed correctly: Score 1 for each piece laid in the right order (max = 6) Score 1 for each piece in the right position (max = 6) Consider each piece in turn, together with the location following it, and score 1 ifthat particular pair order appears somewhere in the correct list (max = 5) Note: the last piece in the sequence is not counted since there is no piece following it. Raw score trial 1 (max = 17)

Second trial Square I Examinee's order by colour Correct order Correct position Version 1 Star I Version 2 I I I Red Purple Purple Blue Blue Red White Yellow Black White Yellow Black

Raw score

Calculate score as follows:

If the task is completed correctly = 17

If the task is not completed correctly:

Score 1 for each piece laid in the right order (max = 6) Score 1 for each piece in the right position (max = 6) Consider each piece in turn, together with the location following it, and score 1 if that particular pair order appears somewhere in the correct list (max = 5) Note: the last piece in the sequence is not counted since there is no piece following it. Raw score trial 2 (max = 17)

Third trial

Version 1 Star I Version 2 Square I Examinee's order by colour I Correct order I Correct position Red Purple Purple Blue Blue Red White Yellow Black White Yellow Black Raw score

Calculate score as follows:

If the task is completed correctly= 17

If the task is not completed correctly:

Score 1 for each piece laid in the right order (max = 6) Score 1 for each piece in the right position (max::: 6) Consider each piece in turn, together with the location following it, and score 1 if that particular pair order appears somewhere in the correct list (max::: 5) Note: the last piece in the sequence is not counted since there is no piece following it. Raw score trial 3 (max = 17)

Total Raw score for subtest

Trial 1 +Trial 2 +Trial 3 (max = 51) ------I 13. Appointments - Delayed Recall

Action: Engage the subject in conversation until the alarm sounds. Prompt the subject for the two questions if not asked spontaneously.

Record: Write down the examinee's response and tick the box to indicate whether this was given spontaneously or after a prompt.

i Version 1 I Version 2 I Response II Sponta- I After :! neously prompt Question 1 When do I have to When willi know the see you again? results ofthe test? When does this What time do we Question 2 session end? finish today?

Raw score Question 1 asked spontaneously = 2/with a prompt =1 Question 2 asked spontaneously = 2/with a prompt = 1 Examinee remembers two things had to be done but not what they were = 2 Examinee remembers one thing had to be done but not what it was = 1 Total raw score (max = 4) Rivermead Behavioural Memory Test - Third Edition (RBMT-3) 14. Story - Delayed Recall

Action: After a delay the examinee tries to remember the story they heard earlier.

Record: Tick each of the 21 'ideas' correctly or partially recalled.

Version 1 I Version 2 I Response I Correct = 1 I Partial = V2 After 20 years, William identical twins Carter Jenny was rescued and Diane Tuesday evening Black after his boat capsized. have been reunited. Twofishermen Theyhad both discovered the wreck been adopted atbirth and notified the coast guard. by differentfamiHes. A patrol boat Jenny discovered found him shortly after that she had a twin and brought him when she requested to the local hospital a copy of her birth certificate. where he was met She then began by his wife to search for her, and two chi.ldren. a task that took Doctors report that he spent two years. four hours in the cold water The sisters said and is being treated 'it was likelooking for exposure. into a mirror He is expected when we met'. to make a full recovery.

Tick box if participant required prompt

Raw score

Totalfor 'ideas' recalled word perfect or using a close synonym Totalfor 'ideas' partially recalled or recalled with an approximate synonym - Deduct one point if participant required prompt"

Total raw score (max = 21) ' ..

*nb: if you used a prompt do not give credit for the first two ideas of the story 15. Route & 16. Messages - Delayed Recall

Action: Ask the examinee to retrace the route they did earlier.

Record: Tick the boxes as appropriate to record the route taken by the examinee. Also tick the message/book boxes as appropriate.

I Spontaneously I After prompt Message picked up

Book picked up

Version 1 I Version 2 I Your own version I Examinee's route Radiator Window

Door Chair 1

Chair 1 Table Message left at correct location Message left at correct location D D Chair 2 Door

Table Chair 2 Book left at correct location Book left at correct location D 0 Window Radiator

Scoring for Route

Raw score

If the route is completed correctly = 13

If the route is not completed correctly calculate the raw score:

Score 1 for each correct location visited regardless of order (max = 6) Score 1 if the starting place was correct and score 1 if the finishing point was correct (max = 2) Consider each location in turn together with the location following it. and score 1 if that particular pair order appears somewhere in the correct route list (max = 5) Note: the last location in the sequence is not counted since there is no location following it. Note also: If the same correct pair order occurs twice (or more) it should only be counted once.

, Deduct 1 point for every incorrect or repeated stage (Le. a totally different location, or the same - location visited more than once) Total raw score (max = 13)

Scoring for Messages

Raw score / Message picked up spontaneously = 2/with prompt = 1 Book picked up spontaneously = 2lwith prompt = 1 Message left in correct location = 1 Book left in correct location = 1 Total raw score (max = 6) Rivermead Behavioural Memory Test - Third Edition (RBMT-3) 17. Novel Task - Delayed Recall Action: The examinee is asked to remember the order, this time without any demonstration. Record: Write down the order in which the pieces are laid and where they are positioned,

First trial

Version 1 Star I Version 2 Square i Examinee's order by colour I Correct order I Correct position Red Purple Purple Blue Blue Red White Yellow Black White Yellow Black

Raw score Calculate score as follows: If the task is completed correctly = 17 If the task is not completed correctly:

18. First and Second Names - Delayed Recall Action: Re-present the photographic portraits and ask for the names of the people portrayed as described in the test materials, Record

I Version 1 I Version 2 ! Spontaneously I After prompt Portrait 1 - First name Catherine Andrew Portrait 1 - Second Name Taylor Harris Portrait 2 - First Name Henry Sarah Portrait 2 - Second Name Fisher Roberts

Scoring for First and Second Names Raw score

Portrait 1 First name remembered spontaneously = 2/with prompt = 1 Portrait 1 Second name remembered spontaneously = 2/with prompt = 1 Portrait 2 First name remembered spontaneously = 2/with prompt = 1 Portrait 2 Second name remembered spontaneously = 2/with prompt = 1 I Total raw score (max ="8) Rivermead Behavioural Memory Test - ThirdEdition (RBMT-3) 19. Belongings - Delayed Recall

Action: Pause/prompt the examinee for the hidden belongings as described in the test materials.

Record

I Spontaneously I After prompt Belonging 1 recalled Belonging 2recalled Location 1 recalled Location 2 recalled

Raw score

Belonging 1 recalled spontaneously = 2/with prompt = 1 Belonging 2 recalled spontaneously = 2/with prompt = 1 Location 1 recalled spontaneously = 2lwith prompt =1

Location 2 recalled spontaneously = 2/with prompt =1

Total raw score (max = 8)

08 09 10 11 12 ABC D E Delis-Kaplan E.xecutive Function System Dean C. Delis Edith Kaplan Joel H. Kramer Standard Record Form ExeCutive Function Syste1'li'"

Name: ID: Examiner: _

Sex: 0 F 0 M Handedness: f..J R :I L :I Ambidextrous Highest Level of Education (years): _ Current Grade (if applicable): _ SchOOl(if applicable): _

Referral Source/Reason for ReferraVPresenting Complaints: _

Attitude Toward Testing: __ _,...------

Affea and Mood: _

Unusual Behaviors and Comments: _

Physical Appearance: _

VisuaVAuditory/Motor Problems: _

Language Background: _

Diagnostic History: _

Current Medications: _

THE PSYCHOLOGICAL Copyright C 2001 by The Psychological Corporation. a Harcourt Assessment Company. OCORPORATION" All rights reserved. A Harcourt Assessment Company Printed in the UnitedStates ofAmerica

,Trails Verbal D$sign Color Sorting Twenty Word Tower, Prove~b D-KEFS Trail Making Test:. Summary of Scores

Condition 1: Condition 2: Condition 3: Condition 4: Condition 5: Vlaual Scanning Number Sequencing Letter Sequencing Number-Letter Switching Motor Speed []---- []---- []---- -~--.~ ri- ri- L Raw Score Scaled Score Raw Score Scaled Score Raw Score Scaled Score Raw Score Scaled Score Raw Score Sc.-cl Score

Number Letter Composite Sequencing Sequencing Scaledr~'-lScore Combined Number Sequencing + Letter Sequencing o + D :: o .~.~. Scaled Scaled - Score Score

SwItching: Scaled Scaled Score Contrast Scaled Score Score DIfference Scaled Score" Visual Scanning Number-Letter Switching va. :: r'-"-l Visual Scanning· D D D l__ ...i Number Sequencing - ,--, Number-Lelter Switching vs. ,L__I Number Sequencing" D D = D Letter Sequencing - Number-Letter Switching va. I------j Letter Sequencing· D D = D· L._.--4 Number Sequencing + Letter Sequencing - Number-Letter SwItching vs. Combined Number Sequencing + D D = D Letter Sequencing" Composlle - Motor Speed Number-Letter Switching vs. ~ Motor Speed* = i , D D D- -' ---' • A low or high contrast scaled score may reflect different cognitive problems; see examiner's manual-

Condition 1: Condition 2: Condition 3: Condition 4: Condition 5: Visual Scanning Number Letter Number-Letter Motor $peed Sequencing Sequencing SwItching

Omission 00 Sequencing 0 0 0 0 0 0 Errors Raw Cumullolive Errors Raw CumuIattve Raw Cumulative Raw CumuIaIIYe Score PercentIle Score PercentIle Score Pen:entlie Score Pen:enIIkt Rank Rank Rank R-* +

Commission 001 Set-Loss 0 0 0 0 0 0 Errors Raw CumuIlIIive i Errors Raw ~Iva Raw Cumulellve Raw Cumulllliva Score Petcenlile I Score PereenIIIe Score Petcenlile Score Pen:enllie R-* i Rank Rank R-* + TIme- 00 100 0 0 0 0' Discontinue Raw Cumulative i Raw Cumulative Raw Cumulath/j> Raw Cumullllive I Errors Score Petcen111e I Score Pen:enllie Score PercentIle Score Pen:enIiIe I Rtlnk Rink Rank Rank I t Condition 4: All 0 0 Note: CumulatiVe percentile ranks fOr\he D-KEFS were scaled 10,eftect t!Ie peteentage 0/ t!Ie Error TOlai Scaled nonnative sample thai obtained raw _ equal 10or WOISII1I1an \he raw score obtained by Typos Raw Score 2 t!leaxamlnee. Score Trails Name Age _ 10 Date _ Examiner _ Notes _

Trait Making Test

Condition 1 Visual SCannll1g

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Trail Making Test

Condition 2 Number Sequencing

Practice

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Notes Trail Making Test ===--====

Condition 3 letter Sequencing

Practice

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Conditio!' 4 Number- Letter Switching

Practice

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Trail Making Test

Condition 5 Motor Speed

Practice

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F A s

1'-15' F+A+S Correct First Responses 1'-15' 1'-15' 1'-15' Interval: 1-15 Seconds o o

16'-30' F+A+S Correct Second Responses Interval: 16'-30" 16'-30' 16'-3()' 16-30 Seconds o ~------i 0 ______Q_ 0

31'-45' F+A+S Correct Third Responses Interval: 31'-45' 31'-45' 31'-45' 31-45 Seconds o o ______. . .Q_ 0

46'~' F+A+S Correct Responses Fourth 46'~O' 46'~' 46'~' Interval: 46-60 0 S~nds L- ~ o '-----__ 0--' 0

T!al 0 T!. 0 Total Correct Responses Correct Responses SO Correct Responses Letter Total 0 Total 0 Total 0 Fluency: Set-Loss Errors set-toss Errors set-toss Errors Total Correct Total 0 Total 0 Total Raw Score Repetition Errors Repetition Errors Repetition Errors o

3 D-KEFS Verbal Fluency Test (continued}

Animals Boys' Names

".•....1'-15' ..,+ .. •••••••• First Correct 1'-15' Interval: 1'-15' Responses 1-15 Seconds o ------00.

16'-30" An••••••• ..,..+ •••••• Second Correct 16'-30' 16'-30' Responses Interval: 16-30 Seconds ------o ______Q_ D

31'-45' animals + Boys'

Third "_Correct 31'-45' 31'-45' Responses Interval: 31-45 Seconds o ______Q_ D

46'~' animals + Boys'

••••••••Correct Fourth 46'-60' 46'~' Responses

S~~1=: ~ 0~ L--- O---'C

Boys' •••••••• ""-:::1. D Total Correct Responses Correct Responses D categcllY Total Fluency: set_L:a~rrors D Set-Loss Errors D TOIIII Correct Total D Total Rawscc.. Repetition Errors Repetition Errors D

4 ' Hots: Somll repetition errors life coded also as seI-IoIIs errors; eacll double-cOded error COUI'iISas only one response for lila total respQnsas rneasu", . ...,...~"., D-KEFS Verbal Fluency Test (continued}

Fruits I Furniture

1'-15' Fruits + FurnIture First Correct Interval; Responses' 1-15 Seconds D

16'-30" Fruits + Fumlture Second Correct Interval: Responses' 16-30 Seconds D

31'-45' FruIts + Fumlture Third Correct Interval: Responses' 31-45 Seconds D

46"~O' FruIts + Fumlture Fourth Correct Interval: Responses' 46-60 Seconds L- ~ _J D

Category Switching: D D + D = Total Correct Responses' Category Switching: Fruits Furniture Raw Total Switching Total Correct Total Correct Score Accuracy Responses' Responses' , Com!ct re$POI'ISeSat$ S\lmmeQ independent of swIk:hing accuracy. D Total Set-Loss Errors

D Total Repetition Errors

•• Note: Some ~ errors are coded also as set·1oss errors; each doubIe-coded error COunlsas only one response Iorlhe totaJ responses measure. 5 r D-KEFS Verbal Fluency Test: Summary of Scores

Condition 1: Condition 2: Condition 3: Condition 3: Letter Fluency CatBgory Fluency Category Switching Category Switching Total Correct Total Correct Total Correct Responses Total SwHchlng Accuracy

r---l i--.-~j D-L I D-L__J D-L_i ...... J• D-I l Raw Score Scaled Sc:ore Raw Score Scaled Sc:ore Raw Score Scaled $Coni Raw Score Scaled Sc:ore

Letter Fluency va. Category Fluency· category Switching va. category Fluency* Category Switching: I.eItar Fluency: Catagory Fluency: Total Comet Catagory Fluency: Scaled-Score Contrast TocalCorrect Total Comet R"JIOMd Total C«rect om..- Scaled $COnI' o D= o 0 = 0--...0 Scaled Scaled Scaled SCOre $COnI Score • A low or high contrast scaled score may reflect dilIerent cognitive problems; see examiner's manual.

Condition 1: CondHion2: Condition 3: Letter Category Category Fluency Fluency SWItching Total Raw Score Raw Score Raw Score Raw Score Scaled Score First Interval (1"-15"): Total Correct D + D + D = D D Second Interval (16"-00"): Total Correct D + D .+ D = D

Third Interval (31"-45"): Total Correct ! .~ D + D + D = D L---.-J Fourth Interval (46"-«)"): Total Correct D + D + D = D I _..__] Set-Loss Errors D + D + D = D ,.-.---, Repetition Errors D + D + D = D L___...J Total Responses (Correct + Incorrect)" D + D + D = D • Nottr. Some repetitionertors are coded also as se1-1ossemlfS; each doubfe.<:oded error counts as onlyone response lor the lOla! responses measure.

Percent Set-Loss Errors Percent Repetition Errors Total Tolal Set-L_ Total PIIrcent Scaled RlII*ttIon Total Pen:ent Scaled Errors FIMponMs' Raw$COnl ,---,Score Error1I FIeepOnMS' Raw $COnI SCOre O X 100 D --... L..J Dx 1oo=D--'" Raw Score Raw Score Raw Score Raw SCore

TotaIRes~ Scaled Category Switching: CondItIon 3 Only' $COnI Percent Switching Accuracy !I :.: 1J X 100 = { i (Condition 3 Only) 0+ +0 L....---.: [ Raw Score Raw Score

• Nottr. Some repetiIIonerrors are coded also as set-loss errors; eachcfoubJe.<:oded errorc:ouotsas onlyone response for the IotaIresponses measure. 6 -- D-KEFS Design Fluency Test: Summary of Scores

ConditIon 1 Condilion2 Condition 3 FUted Dots: Empty Dots Only: Switching: Design Fluency Total Correct Total Correct Total Correct Total Correct

D + D + D = Design Fluency: Total Conecl . Raw Score Raw Score Raw Score Raw Score Sum of Scaled Scores ;--i+ + + t.... + [J + Scaled Seen Scaled Seen Scaled Seen

Condition 1 Condition 2 Sum of Composite Ailed Dots Empty Dots Only Scaled Scores Scaled Score Combined Filled Dots + Empty Dots: D + D = D~L Total Correct Scaled Seen Scaled Score

Condition 3 Scaled Contrast Switching: Conditions 1 + 2 SCOre Scaled Total Correct Combined Difference Score' SWItching vs. Combined Filled Dots + Empty Dots" D = D~·D Scaled Score Composite Scaled ScOre

• A low or h1gh contrast scaled score may reflect different cognitive problems; see examiner's manual.

Condition 1 Condition 2 Condition 3 Filled Dots Empty Dots Only Switching

Set-Loss Set-Loss Set-Loss Total Set·Loss Total Set·Loss Designs Designs Designs Designs Designs r----, j ! Total Set-Loss DesIgns + + = , I D D D D I-----~ Raw Score Raw Score Raw Score Raw Score - Scaled Score

Repeated Repeated Repeated Total Repeated Total Repeated Designs Designs Designs Designs Designs Total Repeated DesIgns !l D + D + D = D L-_.J Raw Score Raw Score Raw Score Raw Score - Scaled Seen

Attempted Attempled Attempted Total Attempted Total Attempted Designs Designs Designs Designs Designs' Total Attempted Designs- D + D + D = D ~ r-l Raw Score Raw Score Raw Score RawSoore Scaled Score • Note: Some repetition errors are coded also 11$ set-loss errors: each doubIe-coded error counts 11$ only one response for !he total attempled designs measure.

AH.nptedTotal ] Pen:ent Scaled Designs' Raw Score Score Percent Design Accuracy + D X 100 = D~D R_Score

7 r •• Name _--..,. Age _ 10 Date _ Examiner _ N~$ _

Design Fluency Test

Condition 1 Filled Dots

• • • Practice • • • • • • • • • • • • • • • .- _ .._------• • •• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • . • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Condition 2 Empty Dots Only

Practice

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• 0 • • 0 • • 0 • • 0 • • 0 • 0 0 0 0 0 0 0 0 • • • 0 0 • • • • • • • 0 0 0 0 • 0 • 0 • 0 0 • 0 • 0 • 0 • • 0 • • 0 • • 0 • • 0 • 0 0 0 0 0 0 0 0 0 0 • • • • • • • • • • 0 0 0 0 0 • 0 • 0 • 0 • 0 • 0

• 0 • • 0 • • 0 • • 0 • 0 • 0 0 0 0 0 0 0 0 •0 0 • • • • • • • • • • 0 0 0 • 0 • 0 • 0 0 • 0 0 • 0 Cononic,;>.: Switchit;g

Practice • • 0 • • 0 • • 0 • • 0 0 0 0 • 0 0 0 • 0 • 0 • • 0 • 0 • 0 0 • • 0 • • 0 • • 0 • • 0 • • 0 0 0 0 0 0 0 0 0 0 • • • • • 0 • 0 • 0 • 0 • 0 • • 0 • 0 • 0 • 0 • 0 0 • • 0 • • 0 • • 0 • • 0 • • 0 0 0 0 0 0 0 0 0 0 • • • • • 0 • 0 • 0 • 0 • 0 • • 0 • 0 • 0 • 0 • 0 0 • • 0 • • 0 • • 0 • • 0 • • 0 0 0 0 0 0 0 0 0 0 • • • • • 0 • 0 • 0 • 0 • 0 • • 0 • 0 • 0 • 0 • 0 0 • • 0 • • 0 • • 0 • • 0 • • 0 0 0 0 0 0 0 0 0 • • 0 • • • 0 • 0 • 0 • 0 • 0 • • 0 • 0 • 0 • 0 • 0 0 • • 0 • • 0 • • 0 • • 0 • • 0 0 0 0 0 0 0 0 0 0 • • • • • 0 • 0 • 0 • 0 • 0 • • 0 • 0 • 0 • 0 • 0 0 • • 0 • • 0 • • 0 • • 0 • • 0 0 0 0 0 0 0 0 0 0 • • • • • 0 • 0 • 0 • 0 • 0 • • 0 • 0 • 0 • 0 • 0 0 • • 0 • • 0 • • 0 • • 0 • • 0 0 0 0 0 0 0 0 0 0 • • • • • 0 • 0 • 0 • 0 • 0 • • 0 • 0 • 0 • 0 • 0 D-KEFS Color-Word Interference Test Age$H9 Materials: Record Form. Stimulus Booklet (Flat Position). Stopwatch

Discontinue O.iscontlnuelf the examinee has marked difficulty or makes four uncorrected errors on the practice lines. Otherwise, discontinue .the scored task after 90 seconds. Adminl8tration lind Recording Place the stimulus booklet flat on the table in a horizontal (landscape) position directly in front of the examinee so thai the two practice lines of Condition 1 are positioned at the top of the page from the examinee's perspective. Say,

This page has patches of color on it. I'd like you to say the colors as quickly as you can without skipping any or making mistakes. W~n you finish this lill(! (sweep across the first practice line of five squares with your finger), go on to this one (point to the first square of the second row). Now try these first two lines for practice.

If the examinee is able to complete the two practice lines, say, Good. Now, when I say begin, I want you to say the rest of the colors. Begin here (point to the first square on the first line of 10 squares below the practice fines) and say each color. one after the other, without skipping any. When you finish this line (sweep across the first row with your finger). go on to this one (point to the first square of the second row). Keep saying the colors until you reach the end of the last line (point). Say the colors as quickly as you can without making mistakes. Ready? Begin. Start timing. Follow the examinee's progress item by item. Record errors by writing the first letter. of the Incorrect color name beneath the correct response and record any nonsense words (e.g.• "b.leen") verbatim. Indicate self-corrections by drawing a slash mark through the letter or word. Record total completion time in seconds.

Allow the examinee to use a finger to maintain his or her place on the stimulus page. If the examinee skips a line accidentally, point out the error immediately and redirect the examinee to the correct line. Keep the stopwatch running while pointing out line-skipping errors. If the examinee does not complete the task at the end of 90 seconds, say, Stop. Indicate the last item attempted and record 90 seconds as the total completion time. Iterns to which the examinee did not respond because the time limit was reached are not counted as errors. Tum the page in the stimulus booklet to Condition 2: Word Reading. '

green red blue green blue

red blue green blue green

red blue red green red blue green blue red green

blue green red green red green blue red blue green

red green blue red green red green blue green red

blue red green blue red green blue red blue green

red blue red green blue green blue red blue green

D D D Total Total Total Uncorrected Self-Corrected nmeTo Enors Errors Complete 8 •• D-KEFSColor-Word Interference Test {continued]

Discontinue Discontinue If the examinee has marked difficulty or makes four uncorrected errors on the two practice lines. Otherwise, discontinue the scored task after 90 seconds. Administration and Recording Place the stimulus bookiet flat on the table in a horizontal (landscepe) position directly in front of the examinee, with the rows of words printed in black ink facing the examinee. Say, Now look at this page with words printed on it. I'd like you to read the words aloud as quickly as you can without skipping any or making mistakes. When you finish this line (sweep across the first practice line of five words with your finger). go on to this one (point to the first word of the second row). Now try reeding these first two lines for practice. If the examinee Is able to complete the two practice lines, say, Good. Now, when I say begin, I want you to read the rest of the words. Begin here (point to the first word on the first line of 10 words below the practice lines) and read each word, one after the other, without skipping any. Keep reading the words until you reach the end (point to the last word on the last line). Read the words as quickly as you can without making mistakes. Ready? Begin. Start timing. Follow the examinee's progress item by item. Record errors by writing the first letter of the incorrect word beneath the correct response and record any nonsense words (e.g., "bIeenj verbatim. Indicate self-corrections by drawing a slash mark through the letter or word. Record total completion time in seconds.

Allow the examinee to use a finger to maintain his or her place on the stimulus page. If the examinee skips a line accidentally, point out the error immediately and redirect the examinee to the correct line. Keep the stopwatch running while pointing out line-skipping errors. 11 the examinee doeS not complete the task at the end of 90 seconds, say, Stop. Indicate the last item attempted and record 90 seconds as the total completion time. Iterns to which the examinee did nol respond because the time limit was re~d are not counted as errors. Tum the page in the stimulus bookiet to Condition 3: Inhibition. red blue green red blue

green blue green red green

green red blue green blue red blue green blue green

red green blue green blue green red blue red green

red green blue green red blue green red blUe red

blue green red blue green red blue green blue red

green red blue red blue green red blue red green

D D D Total Total Total Uncorrected SeIf-corr.cted TlmeTo EITOnI Errora C

D-KEFS Color-Word Interference Test (continuedl

Discontinue Discontinue if the examinee has marked difficulty or requires four corrections on the two practice lines. Otherwise, discontinue the scored task after 180 seconds.

Administration and Recording Place the stimulus booklet flat on the table in a horizontal (landscape) position directly in front of the examinee, with the rOWSof words printed in dissonant ink colors facing the examinee. Say,

Now look at this page. It's going to. be a little harder than the other pages because the color names are printed in a different-colored ink. For example (point to the first word on the first practice line of five words), do you see how the word red Is printed in grtHm ink here? This time, you are to name the color 01 the ink that the letteraare printed in and not read the lNord. So, what would you say for this one? (Point again to the first word on the first practice line and allow the examinee to respond. Correct any errors.) Good. And this one? (Point to the next two practice items. Correct any errors.) Good. Now try these first two lines for practice. Hthe. examinee has difficulty understanding the task, you may demonstrate it by naming the ink colors on the first practice line, then inviting the examinee to respond to the second line. If the examinee requires four corrections on the two practice lines, discontinue this condition and do not administer Condition 4: InhibitionlSwitching. If the examinee is able to complete the two practice lines, say, Good. NOW, when I say begin, I want you to do the same thing for the rest of them. Say the color of the ink the letters are printed in; do not read the words. Begin here (point to the first word on the first line of 10 wordS below the practice lines) and say each ink color, one after the other, without skipping any. Keep saying the ink colors until you reach the end (point to the last word of the last line). Say the ink colors as quickly as you can without making mistakes. Ready? Begin. Start timing. Follow the examinee's progress item by item. The single letter (r for red. b for blue, g for green) printed in parentheses next to each correct response represents the error response if the examinee reads the word rather than naming,the ink color. Record errors by circling the letter or by writing the initial letter of other incorrect colors beneath the correct response. Also record any nonsense words (e.g., "bleen") verbatim. Indicate self-corrections by drawing a slash through the letter or word. Record total completion time in seconds.

Allow the examinee to use a finger to maintain his or her place on the stimulus page. If the examinee Skips a line accidentally, point out the error immediately and redirect the examinee to the correct line, Keep the stopwatch running while pointing out line-skipping errors.

If the examinee makes three consecutive errors of reading the words, prompt him or her to narne the ink color. Provide this prompt only once during this condition and keep the stopwatch running.

If the examinee does not complete the task at the end of 180 seconds, say, Stop. Indicate the last item attempted and record 180. seconds as the total completion time. Items to which the examinee did not respond because the time limit was reached are not counted as errors. Tum the page in the stimulus booklet to Condition 4: Inhibition/Switching.

green(r) red(b) blue(g) green(b) red(g)

blue(r) red(b) greener) red(g) greener) red(b) blue(g) red(b) greener) red(b) blue(r) green(b) blue(r) red(b) greener)

red(b) blue(g) green(b) blue(g) greener) blue(g) red(b) greener) red(b) blue(g)

greener) blue(g) greener) red(b) blue(g) greener) red(g) blue(r) green(b) red(g)

green(b) blue(g) red(b) greener) blue(g) red(b) greener) blue(g) greener) red(g)

blue(g) green(b) blue(r) red(b) blue(g) greener) red(b) blue(g) greener) red(b)

D D D Total Total Total Uncorrected Setf..conected TIme To EI'I'OI'II Errors Complete 10 •••• D-KEFS Color-Word Interference Test {continued}

DI$Continue Do not administer Condition 4 If the examinee had marked difficulty or did not finish before the time limit was reached on Condition 3: Inhibition. Discontinue if the examinee has marked difficulty or requires four corrections on the practice lines of Condiditon 4. Otherwise, discontinue the scored task after 180 seconds.

Administration and Recording Place the stimulus booklet flat on the table in a horizontal (landscape) position directly in front of the examinee, with the rows of words printed in dissonant ink colors, half of which are contained in rectangles, facing the examinee. Say, This Is the fourth and last page. This time. for many of the WOrds, you are to do the same thing you just did: Name the color of the ink and do not read the words. But if a word is inside a little box, you should read the word and not name the ink color. (Point to the first three items in the first practice line of five words.) For example, what would you say for these first three words? (AlloW the examinee to respond and provide corrections if necessary.) Good. Now try these first two lines for practice. If the examinee has difficulty understanding the task, you may demonstrate it by responding to the items on the first practice line, then inviting the examinee to respond to the second line. If the examinee requires four corrections on the two practice fines, discontinue this condition. If the examinee is able to complete the practice lines, say, Very good. Now, when Is

If the examinee does not complete the taSk at the end of 180 Seconds, say, Stop. Indicate the last item attempted and record 180 seconds as the total completion time. Items to which the examinee did not respond because the lime limit was reached are not counted as errors.

red(b) blue(r) Igreener) I blue(r) green(b) blue(g) red(g) I blue(g) greener) I blue(T) I red(g) I blue(g) I red(g) green(b) I red(b) Ii greener)I blue(r) I greener)I greener) I blue(r) I red(b) II blue(r) I greener) red(g) I blue(g) I red(g) green(b) red(b) greener) I blue(r) I green(b) blue(r) Igreener) II red(g) I blue(r) Igreener)I green(b) red(b) green(b) I red(b) I red(b) Igreen(b) I red{b) Igreen(b) II red(g) I blue(r) Igreener) I blue(r) I blue(g) I red(g) /greener) II red(g) I blue(r) red(b) Igreen(b) I red(b) bhJe(r) Igreen(r) I blue(g) I red(g)

D D D Total Total Total Uncorracted SeH-corrected nmeTo Errors Errors Complete •.. -- 11 D-KEFS Color-Word Interference Test: Summary of Scores

Condition 1: Condition 2: Condition 3: Condition 4: Color Naming Word Reading Inhibition InhlbltionlSwltching [J--...L.,] [J--... [J--...C=l [J--...I] Raw SCaI'" Raw SCaled Raw Sealed Raw SCaled Score Score Score Score Score Score Score Score

'(t/< Condition 1: ConcIitIon 2: Sum or CompoeIte ColorNaming WcInJReading SCaledSconM SCaledScore Combined Naming + Reading 0+ 0=0-

Scaled Scaled ScaMd-Score Contrast Score Score Difference Scaled Score" Inhibition Color Naming 1----, Inhibition vs. Color Naming' D D = D L-J Inhibition/SwItChing Combined Naming + Reading - InhlbitlonlSwltching va. Combined Naming + Reading" D D = D I I Composite - InhibitionlSwitching Inhibition InhlbltlonlSwltchlng va. Inhibition' D 0 = D D • A .Iowor high contrast scaJedscore may reIkIc:tdiIIetent cognitiveptOblems; _examloer'smanual. - ~ ~

Scaled Scaled-Score Contrast InhlbltlonlSwltching: Score Difference Scaled Score" Scaled Score Color Naming InhlbltlonlSwitchlng va. i'i Color Naming" D D = D ,...... _..._j Word Reading - InhibHionlSwitching va. ;~ Word Reading" D D '" D - 1----J • A low or high contrast scaJedIICOt8 may reftact dlfferentcognitive ptQb!erll$; see ~iner's manual.

.'4IIIIi~_~~:,<{:~"<~~<~7:ffi;'~:~~;~dfiAt~J~:~:_,_~'~~1'llm,I.. I.;~I__;1.:;ili",li,·,.~I, wlt!r.Cumu~ per<;entierlI!1l<$ 'or~ D-i

Nintendo OS "Brain Age 2" Questionnaire

APT-II Questionnaire Nintendo OS"Brain Age 2" Questionnaire

Client's Name. _ Rater's Name and Relationship to Client (if applicable) _ Date Age. _ Stroke Survivor Control Subject. (mark one)

Pleaserate the extent to which you agree with the following statements by ticking the box which offers the best description.

DescriRtion Definitel)£ NO Occasionall)£ Sometimes Freguentl)£ Definitel)£Yes 1. I had problems • with memory before the study. 2. I had problems with attention before the study. 3. I had problems reacting quickly to situations before the study. 4. I had trouble problem solving before the study. 5. I have problems with memory now. 6. I have problems with attention now. 7. I have problems reacting to situations quickly now.

8. I have trouble problem solving now. 9. I feel this study was worth my time. Oescri~tion Oefinitel~ No Occasionall~ Sometimes Freguentl~ Oefinitel~ Yes

10. I emotionally feel BETTERabout myself after completing this study. 11. I feel emotionally WORSE about myself after completing this study. 12. I WAS motivated to play the OS. 13. I was NOT motivated to play the OS. 14. I WAS frustrated while playing the OS. 15. I was NOT frustrated while playing the OS. 16. I thought the games were too HARD. 17. I thought the games were too EASY. 18. On a scale of 1 1 2 3 4 5 6 7 8 9 10 to 10, I feel my skills improved •••• (circle one)

An~ Comments? APT-II ATTENTION QUESTIONNAIRE

Client Name _ Rater's Name and Relationshi p to Client (if applicable) _ Therapist Date. _

I. RATING SCALE*: Please answer the followirig questions about your ( or __ 's) attention as it applies to daily functioning by ticking the box which offers the best description.

Only gets in Sometimes Frequently Is a problem Not a problem the way on gets in the gets in the all the time DESCRIPTION or no change occasion way (about 1- way (is a (affects most from before (less than 3 times per problem most activities) once a week) week) days) 1. Seem to lack mental energy to do activities

2. Am slow to respond when asked a question or when participating in conversations 3. Can't keep mind on activity or thought because mind keeps wandering 4. Can't keep mind on activity or thought because mind feels "spacy" or "blank" 5. Can only concentrate for very short periods of time

6. Miss details or make mistakes because level of concentration decreased 7. Easily get off track if other people milling about nearby

8. Easily distracted by surrounding noise

9. Trouble paying attention to conversation, if more than one other person 10. Easily lose place if task or thinking interrupted

11. Easily overwhelmed if task has several components

12. Difficult to pay attention to more than one thing at a time

13. Trouble remembering where you put everyday items such as your keys or glasses 14. Trouble solving daily daily obstacles Scoring: a) total number of items ticked in second column multiplied by (1) _ b) total number of items ticked in third column multiplied by (2) _ c) total number of items ticked in fourth column multiplied by (3) _ d) total number of items ticked in fifth column multiplied by (4) _

Total Score: add a) through d) _

II. INDIVIDUALIZED ATTENTIONAL PROBLEM LIST: In the space provided below describe the five most frequent and frustrating breakdowns in your attention ability. The first line has been filled out with an example description.

Describe Attention Breakdown (include setting and What do you do when it occurs? approx. frequencv.) Example: I cannot concentrate when I am preparing dinner I often yell or blow up at the children or cry because the noise from the children playing around my feet and while I am cooking. Sometimes I just give up even in the next room distracts me. I forget ingredients or parts and make something simple like sandwiches. of the meal and usually feel totally frustrated during this time. This happens for every dinner.

*Scale adapted from Ponsford, J. & Kinsella, G. (1991) Rating Scale of Attentional Behavior.Neuropsycho/ogical Rehabilitation, I (4) 241-257.