Feasibility of National Institutes of Health Toolbox Cognition Battery in Pediatric Brain Injury Rehabilitation Settings

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Objective: Cognitive impairments are a devastating consequence of acquired brain injury (ABI) in children. Current pediatric tools for assessing cognitive impairments are generally time intensive and applicable only to a restricted age span. The National Institutes of Health Toolbox–Cognition Battery (NIHTB-CB) is a standardized, tablet-based cognitive assessment that has been normed across the life span in the general population and validated in adults with brain injuries. However, its clinical utility and validity has not yet been demonstrated in pediatric patients with brain injuries. The current study examines the feasibility of NIHTB-CB administration in both a pediatric inpatient and day treatment rehabilitation setting. Design: The NIHTB-CB was attempted in 40 children with ABI aged 4–18 years within 1 year of injury in pediatric rehabilitation settings. Results: Of the 40 participants tested, 38 (95%) were able to complete the full battery and 28 were able to complete it in 1 session. The average time to complete the NIHTB-CB for our sample was 40.2 min. Barriers to completion included both external (scheduling conflicts) and internal (fatigue, attention, and behavioral) limitations. Cohort results are consistent with expected impairments following ABI. Conclusions: This study demonstrates the feasibility of using the NIHTB-CB in postacute pediatric inpatient rehabilitation and day-treatment clinical settings following ABI. The NIHTB-CB has the potential to provide a quick, standardized assessment of cognitive function during the rehabilitation process. Further longitudinal studies of NIHTB-CB using larger samples will be needed to determine its validity, test-retest capabilities, and clinical utility.

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