The Quick Measure of Cognitive Status - Monitoring Neurocognitive Recovery in Children

Scientific Paper

Pediatric TBI

Wed, 6/15, 10:30 AM
International West

• Barbara Ladenheim, PhD
  Blythedale Children's Hospital
  barbaral@blythedale.org
• Joelle Mast, MD, PhD
  Blythedale Children's Hospital
  JoelleM@Blythedale.org

• To understand some of the issues involved in the repeated assessment of cognitive function in pediatric patients.
• The presentation of a new tool, the Quick Measure of Cognitive Status (QMOCS), for the assessment of cognitive function in pediatric TBI patients during their course of treatment.

Neurocognitive sequelae of TBI include impairments in many modalities. These impairments can have devastating impacts on neurodevelopment when TBI occurs in children. Measures currently available to assess cognitive function are either validated for adults, become invalid when administered too frequently, or are too cumbersome to administer to children. The Quick Measure of Cognitive Status (QMOCS) was developed as a tool to monitor neurocognitive recovery in pediatric patients.

The Level of Cognitive Functioning Scale (LCFS) is commonly used to monitor recovery, yielding a score based on observations of behaviors. These behaviors can be grouped into cognitive domains (eg. response to stimuli, orientation, processing, memory, attention/concentration, language, mood). LCFS is reliable and valid, but does not give information about specific domains – information is collapsed to generate the score. Like LCFS, QMOCS's intent is to generate a profile of a patient through repeated measurements over the course of treatment. QMOCS uses observations of behaviors in specific domains; a score is generated for each so that each can be tracked independently. This presentation will describe the QMOCS, some of its psychometric properties and pilot data examining its underlying component structure.

The QMOCS was administered at least once to 63 TBI patients between the ages of 3 months and 19 years. Principal component analysis identified a cognitive subscale with four stable component loadings ranging from .77-.91: attention and concentration, language, memory, and processing. Significant cognitive improvement was shown (p<.0005) with test-restest correlation=.543 (p<.004) (N=26). Analyses showed good internal consistency (Cronbach alpha: test=.91, retest=.85) and test-retest reliability (intraclass correlation coefficient=.41, p=.002).

The findings support further testing with a larger sample, multiple administrations, and comparisons to other, standardized, measures of cognitive function, which might lead to the refinement of a tool that will serve as a valuable measure in monitoring recovery in pediatric cases with TBI.