http://informahealthcare.com/bij ISSN: 0269-9052 (print), 1362-301X (electronic) Brain Inj, Early Online: 1–7 ! 2015 Informa UK Ltd. DOI: 10.3109/02699052.2015.1004744 ORIGINAL ARTICLE Actual reality: Using the Internet to assess everyday functioning after traumatic brain injury Yael Goverover 1,2 & John DeLuca 2,3 1 Department of Occupational Therapy, New York University, New York, NY, USA, 2 Kessler Foundation, West Orange, NJ, USA, and 3 Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ, USA Abstract Objectives: The aim of this pilot study was to examine and compare the performance of everyday life activities in persons with traumatic brain injury (TBI) and healthy controls (HC) using a new assessment tool called ‘actual reality’ (AR). Method: A between-subjects design was utilized to compare 10 individuals with TBI and 10 healthy controls (HC) performing an AR task. Participants were asked to access the Internet to purchase a decorative arrangement of cookies and were administered a battery of neuropsychological tests and questionnaires to assess quality-of-life, functional status, affect symptomatology and prior Internet experience. Results: Participants with TBI had significantly more difficulties than HC participants in accurately and independently completing the AR task—primarily due to cognitive impairment. In addition, self-reports of quality-of-life and everyday functional abilities were not correlated with AR performance. Conclusions: The results provide initial evidence supporting the use of the AR approach in assessing persons with TBI performing everyday life activities. The utilization and interpretation of the AR approach is a significant step forward in increasing the sensitivity, accessibility and relevancy of functional assessments in people with cognitive impairments. Actual reality will be discussed in terms of accessibility and directions for assessment and treatment. Keywords Activities of daily living, cognition, outcome, rehabilitation, traumatic brain injury History Received 29 April 2014 Revised 13 October 2014 Accepted 3 January 2015 Published online 16 February 2015 Introduction Traumatic brain injury (TBI) may result in various cognitive, motor, sensory, social and emotional deficits, which adversely impact independent functioning. There are ample reports of disability after TBI based on subjective ratings by health personnel or relatives [1]. However, to date, there are only a few assessment tools specifically designed for persons with TBI that systematically assess instrumental activities of daily living (IADLs) through performance-based tasks [2, 3]. Some reasons for the lack of use of performance-based assessments of everyday functioning are related to space requirements for performance (i.e. kitchen or bathroom), physical or medical conditions that can pose constraints on certain tasks, safety issues associated with various tasks (e.g. using a stove or iron) and excessive time commitment. Therefore, the assessment of functional status post-TBI is frequently based on self-or proxy reports. Self-report, however, is not ideal due to impaired self-awareness [4], high rates of depressive symp- tomatology [1] and/or the presence of cognitive impairment of the informant [5]. Thus, the current standard-of-practice methods for evaluating the everyday functioning impact of TBI are generally insensitive (e.g. self-report [6]), outdated and/or highly impractical for routine use in the clinic [7]. In fact, research frequently shows low rates of agreement between self-reported and actual performance of activities of daily living [8–10]. To assist in the assessment and treatment of IADLs, researchers have suggested that using computers or electronic devices (referred to as everyday technology) could be useful [11–13]. Everyday technology can be classified as IADLs, because IADLs are tasks that contribute to an individual’s functional independency and are thought to include a greater cognitive component than more basic self- care tasks [14]. Advances in Internet technology provide an especially germane, naturalistic, user-friendly and contemporary plat- form upon which to develop the next generation of everyday functioning assessments for persons with cognitive impair- ments. Using electronic devices to access the Internet has the potential to facilitate independence in everyday activities for people with disabilities, such as TBI [15]. However, recent studies have found that individuals with cognitive deficits experience difficulties using various technology methods [11]. Some difficulties that were identified include finding the correct technological functions, accurately following the Correspondence: Yael Goverover, PhD, OT, Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, 82 Washington Square East, 6th floor, New York, NY 10003, USA. Tel: 212-998-5854. Fax: 212-998-4044. E-mail: yg243@nyu.edu Brain Inj Downloaded from informahealthcare.com by Nyu Medical Center on 02/23/15 For personal use only.