Alex W.K. Wong

Theoretical Foundations for the Measurement of Environmental Factors and Their Impact on Participation Among People With Disabilities

The ascendance of the World Health Organizations International Classification of Functioning, Disability and Heath (ICF) as the global standard for describing and characterizing aspects of disability has refocused attention on the role that environmental factors (EFs) have on the health and participation of people with disabilities, both as individuals and as a group. There has been a rise in the development of instruments designed to measure EFs alone and in relation to participation. Some instrument developers have used the ICF as a theoretical base for instrument development and to substantiate content validity claims. We contend that this is a misapplication of the ICF. There is a need to step back and reexamine the role that environmental theories can play in developing a conceptually driven approach to measuring the interaction between EFs and participation. For this review, we draw on the fields of social, community, and developmental psychology; disability studies; gerontology; public health; and rehabilitation. We discuss different approaches to the measurement of EFs. We suggest that given the complex nature of EFs and their influence on participation, there is a need for a fresh approach to EF measurement. The thoughtful application of theories and the use of advanced psychometric, measurement, and e-technologies and data visualization methods may enable researchers and clinicians to better quantify, document, and communicate the dynamic interrelationship between EFs and participation and health outcomes for people with disabilities at the individual, group, and population levels.

Five-Factor Model of Personality, Work Behavior Self-Efficacy, and Length of Prior Employment for Individuals with Disabilities: An Exploratory Analysis.

With the continued lower employment rate for persons with disabilities, researchers are focusing more on barriers to employment that reach beyond functional impairment. Personality and self-efficacy have consistently been important factors when considering employment outcomes for persons without disability; less is known about these factors as they relate to job tenure in samples of people with disabilities. A sample of 56 individuals eligible for vocational rehabilitation services was used to investigate the relationship among personality, work behavior efficacy, and length of prior employment. Results of this study revealed that work behavior efficacy and personality are related to length of prior employment. Personality was found to account for a significant amount of variance in work behavior efficacy, and personality was a stronger predictor of length of prior employment over work behavior efficacy. Specifically, the personality trait openness significantly contributed to length of prior employment, and openness and neuroticism significantly contributed to length of prior employment among persons with low education. A discussion of the dynamic nature of personality as it relates to persons with disabilities and employment is included.

Career readiness, developmental work personality and age of onset in young adult central nervous system survivors

Purpose: The primary purpose of this paper is to undertake foundational research in the area of career readiness, work personality and age of onset with young adult central nervous system (CNS) survivors. Method: Participants for this study consisted of 43 individuals whose age range from 18 to 30 (M = 21.64, SD = 3.46), an average age of brain tumor onset of 9.50 years (SD = 4.73) and average years off of treatment of 7.25 years (SD = 5.80). Packets were distributed to survivors who were participating in a psychosocial cancer treatment program. Participants completed multiple career instruments and a demographic form. Differences between groups and among the variables were examined and size effect sizes were analyzed. Results: Young adult CNS survivors had significantly lower levels of work personality and career readiness when compared to young adult non-cancer survivors with CNS cancer with those between the ages of 6 and 12 reported significantly lower levels when compared to individuals diagnosed before age 6 and after the age of 13. Conclusions: Young adult CNS survivors at an increased risk for having lower levels of work personality and career readiness then a norm group comparison. Age of onset (between 6 and 12) may be at significant risk factor for developing poor or dysfunctional work and career behaviors. Implications for Rehabilitation Young adults with central nervous system (CNS) cancer are at particular risk for experiencing difficulties related to career and employment. Work personality and career readiness are two constructs that have been found to be related to one’s ability to meet the demands of work. Young adult CNS cancer survivors have lower levels of work personality and career readiness. Individuals diagnosed between the ages of 6 and 12 may be at particular risk and may need specific vocational rehabilitation interventions. The results of this study point to the need for comprehensive career and vocational services for young adult CNS cancer survivors.

Using the NIH toolbox cognition battery (NIHTB-CB) in individuals with traumatic brain injury

Purpose/Objective: The NIH Toolbox for the Assessment of Neurological Behavior and Function Cognition Battery (NIHTB-CB) is a common data element for use in individuals with traumatic brain injury (TBI). This study evaluates its sensitivity and specificity in distinguishing individuals with complicated mild, moderate, or severe TBI, and provides support for the construct validity of the NIHTB-CB in individuals with TBI. Research Method: One hundred eighty-two individuals with TBI (n = 83 complicated mild/moderate; n = 99 severe) completed the NIHTB-CB and neuropsychological criterion measures. Complete data were obtained on 158 participants. A control sample of 158 individuals without known neurological impairment was extracted from the NIHTB-CB normative sample. Multivariate analyses of variance determined the sensitivity of the NIHTB-CB measures to TBI and injury severity (complicated mild/moderate TBI, severe TBI, and controls) on the demographically corrected NIHTB-CB composite scores and seven subtests. A descriptive analysis of the sensitivity of each subtest was conducted. Finally, correlations between NIHTB-CB measures and criterion tests assessed convergent and discriminant validity. Results: Multivariate analyses indicated that there was a main effect for group (complicated mild/moderate vs. severe vs. controls) for fluid scores in the NIHTB-CB as opposed to only marginally significant results for the verbal scores. Moderate to strong relationships were found between the NIHTB-CB measures and their corresponding neuropsychological measures (convergent validity), whereas much smaller correlations were found between measures of different cognitive domains (discriminant validity). Conclusions: Findings provide evidence of construct validity and the clinical utility of the NIHTB-CB in individuals with TBI.

The relationship between contextual work behaviours self-efficacy and work personality: an exploratory analysis

Background. Work personality and contextual work behaviours have been identified as constructs that play critical roles in developing the foundation for effective vocational and career behaviour for persons with disabilities. Method. For this study, we used a sample of 84 individuals with disabilities who were eligible to receive vocational rehabilitation services. Demographic variables and questions concerning work personality, contextual work behaviours self-efficacy, employment status and longest time employed were obtained and analysed to determine the relationship between contextual work behaviours self-efficacy, work personality and employment outcomes. Results. The results indicate that work personality explained 24% (F = 2.73; p = 0.013) of the variance of contextual work behaviours self-efficacy with the subscale of Personal Presentation (β = 0.466) making a significant and unique contribution to CWB total score. Results of a correlation between the work personality profile scale and the contextual work behaviours self-efficacy scale revealed a significant and positive relationship. Levels of work personality and contextual work behaviours self-efficacy were unable to discriminate between employed and unemployed individuals. However, a post-hoc regression analysis did find that work personality and contextual work behaviours self-efficacy accounted for approximately 24% of the variance of longest time employed. Conclusions. The results of this study provide initial support for the relationship between work personality and contextual work behaviours self-efficacy. Overall, work personality appears to be an important construct related to individuals confidence to meet the contextual demand of the work environment and length of employment tenure.

Validation and clinical utility of the executive function performance test in persons with traumatic brain injury.

ABSTRACT This study examined the relationships between the Executive Function Performance Test (EFPT), the NIH Toolbox Cognitive Function tests, and neuropsychological executive function measures in 182 persons with traumatic brain injury (TBI) and 46 controls to evaluate construct, discriminant, and predictive validity. Construct validity: There were moderate correlations between the EFPT and the NIH Toolbox Crystallized (r = −.479), Fluid Tests (r = −.420), and Total Composite Scores (r = −.496). Discriminant validity: Significant differences were found in the EFPT total and sequence scores across control, complicated mild/moderate, and severe TBI groups. We found differences in the organisation score between control and severe, and between mild and severe TBI groups. Both TBI groups had significantly lower scores in safety and judgement than controls. Compared to the controls, the severe TBI group demonstrated significantly lower performance on all instrumental activities of daily living (IADL) tasks. Compared to the mild TBI group, the controls performed better on the medication task, the severe TBI group performed worse in the cooking and telephone tasks. Predictive validity: The EFPT predicted the self-perception of independence measured by the TBI-QOL (beta = −0.49, p < .001) for the severe TBI group. Overall, these data support the validity of the EFPT for use in individuals with TBI.

A Multi-level Funneling Approach to Data Provenance Reconstruction

When data are retrieved from a file storage system or the Internet, is there information about their provenance (i.e., their origin or history)? It is possible that data could have been copied from another source and then transformed. Often, provenance is not readily available for data sets created in the past. Solving such a problem is the motivation behind the 2014 Provenance Reconstruction Challenge. This challenge is aimed at recovering lost provenance for two data sets: one data set (WikiNews articles) in which a list of possible sources has been provided, and another data set (files from GitHub repositories) in which the file sources are not provided. To address this challenge, we present a multi-level funneling approach to provenance reconstruction, a technique that incorporates text processing techniques from different disciplines to approximate the provenance of a given data set. We built three prototypes using this technique and evaluated them using precision and recall metrics. Our preliminary results indicate that our technique is capable of reconstructing some of the lost provenance.

Construct validity of the NIH toolbox cognition battery in individuals with stroke

Objective: The National Institutes of Health (NIH) Toolbox (NIHTB) for the Assessment of Behavior and Neurological Function Cognition Battery (NIHTB-CB) provides a brief assessment (approximately 30 min) of key components of cognition. This article examines construct validity to support the clinical utility of the NIHTB-CB in individuals with stroke. Research Method: A total of 131 individuals with stroke (n = 71 mild stroke; n = 60 moderate/severe stroke) completed the NIHTB-CB. Univariate analyses were conducted to examine the cognitive profiles of the two different stroke groups (mild vs. moderate/severe stroke) on NIHTB-CB measures and composite scores. Pearson correlations were conducted between NIHTB-CB and established measures to examine convergent and discriminant validity. Effect sizes and clinical impairment rates for the different NIHTB-CB measures and composite scores were also examined. Results: Participants experiencing moderate to severe stroke had poorer performance than did individuals with mild stroke on several of the NIHTB cognition measures. Evidence of convergent validity was provided by moderate to strong correlations between the NIHTB measures and the corresponding standard neuropsychological test (Pearson rs ranged from 0.31 to 0.88; median = .60). Evidence of discriminant validity was provided by smaller correlations between different cognitive domains than correlations of measures within the same domain. Effect sizes for composite and subtest scores regarding stroke severity were generally moderate-to-large. In addition, 42% of the sample were exhibiting mild cognitive impairment (i.e., ≥2 low scores on fluid tests). Conclusions: Findings provide support for the construct validity of the NIHTB-CB in individuals with stroke.

Racial differences in neurocognitive outcomes post-stroke: The impact of healthcare variables

OBJECTIVES The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors using the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke. METHODS One-hundred seventy adults (91 Black; 79 White), who participated in a multisite study were included (age: M=56.4; SD=12.6; education: M=13.7; SD=2.5; 50% male; years post-stroke: 1-18; stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the Modified Rankin Scale. RESULTS An independent samples t test indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score: M=37.63; SD=11.67) than Whites (Fluid T-score: M=42.59, SD=11.54; p=.006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (p<.001 and p=.02, respectively) and significantly mediated racial differences on neurocognitive impairment. CONCLUSIONS We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences. (JINS, 2017, 23, 640-652).

Validation of the NIH Toolbox in Individuals with Neurologic Disorders

Objective Individuals with spinal cord injury (SCI), traumatic brain injury (TBI), and stroke experience a variety of neurologically related deficits across multiple domains of function. The NIH Toolbox for the Assessment of Neurological and Behavioral Function (NIHTB) examines motor, sensation, cognition, and emotional functioning. The purpose of this paper is to establish the validity of the NIHTB in individuals with neurologic conditions. Methods Community-dwelling individuals with SCI (n = 209), TBI (n = 184), or stroke (n = 211) completed the NIHTB. Relative risks for impaired performance were examined relative to a matched control groups. Results The largest group differences were observed on the Motor domain and for the Fluid Cognition measures. All groups were at increased risk for motor impairment relative to normative standards and matched controls. Fluid cognitive abilities varied across groups such that individuals with stroke and TBI performed more poorly than individuals with SCI; increased relative risks for impaired fluid cognition were seen for individuals in the stroke and TBI groups, but not for those in the SCI group. All three neurologic groups performed normally on most measures in the Sensation Battery, although TBI participants evidenced increased risk for impaired odor identification and the stroke group showed more vision difficulties. On the Emotion Battery, participants in all three groups showed comparably poor psychological well-being, social satisfaction, and self-efficacy, whereas the TBI group also evidenced slightly increased negative affect. Conclusions Data provide support for the validity of the NIHTB in individuals with neurologic conditions.