About the ADAMS Profile System
The ADAMS Profile system raises awareness of cognitive deficits, resulting in more effective treatment programs and more successful rehabilitation outcomes.
Science Behind ADAMS
Cognitive Symptoms Evaluated
Treatment Planning
Analyzing Cognitive Symptoms
After Traumatic Brain Injury
Using the Delphi Method
Rick Parenté, Ph.D.
Towson University
The Delphi Method is a forecasting technique that involves the amalgamation of expert judgment.
Three experiments were designed to evaluate the use of the Delphi Method for analyzing neurocognitive functioning after traumatic brain injury.
Traditional Approach
Usually, analysis of symptoms resulting from brain injury involves neuropsychological evaluation.
However, neuropsychological evaluation is not only expensive and time consuming, it may be impractical for analyzing large groups such as sports teams or with military populations. Moreover, the ecological validity of neuropsychological evaluation is questionable. In order to improve this situation, three experiments using the Delphi Method were conducted using a protocol known as the Cognitive Complaint Survey (CCS).
The Cognitive Complaint Survey was designed to supplement the results of neuropsychological testing. The items on the survey were obtained over a 25-year period from the report of persons who had been diagnosed with, and subsequently treated for, Traumatic Brain Injury (TBI).
New Approach Studied
These items were grouped into nine categories of behavior: executive functioning, memory, learning, attention, processing, hyperactivity, vigilance, social skills and expression.
Two versions of the survey were created, one that measured the patient’s self-report and another that assessed an observer’s observations of the patient. The final analysis included an amalgamation of these two versions of the survey.
The hypothesis tested in this long-term study was that the combination of the two versions of the survey would provide a more accurate understanding of the patient’s neuropsychological functioning relative to either version used alone. Differences between the patient and observer’s responses also provide a measure of the patient’s level of deficit awareness.
• Experiment 1 established the content validity and internal consistency of the items and categories that compose the instrument.
• Experiment 2 examined the validity of the categories identified in Experiment 1 for discriminating persons with brain injury from other populations such as persons with learning disability.
• Experiment 3 evaluated whether the amalgamated CCS scores predicted performance on neuropsychological evaluations of persons with brain injury.
Results from Study
Preliminary results of these experiments indicate that the CCS is a valid and reliable instrument that can discriminate persons with brain injury from other patient groups. Accuracy of prediction is directly related to the number of patient observers included in an amalgamated summary for any given patient.
Practical Application
This ability to discriminate persons with brain injury from other patient groups, i.e. the CCS, has been incorporated into the Acquired Deficit and Awareness Management System (ADAMS) as the ADAMS Profile, and has been designed to assist in the process of cognitive rehabilitation both inside and outside of the clinic.
The ADAMS "Profile"
The "Profile" itself refers to the graphic view of the survey data generated by the ADAMS system. This graphical system shows, in one image, both the type and level of deficit and the level of awareness for the 36 most common complaints across nine cognitive domains.
The ADAMS Profile uses the Cognitive Complaint Survey to evaluate nine categories of behavior: Executive Functioning, Memory, Learning, Attention, Processing, Hyperactivity, Vigilance, Social Skills and Expression.
These categories of behavior—collected over a 25-year research period from people diagnosed and treated with traumatic brain injury—represent the most common deficits, or complaints, associated with many types of brain injury.
Items within these categories represent behaviorally identifiable deficits of persons diagnosed with ABI and TBI—as reported by the patients themselves...and independently by the people who knew them the best (family, friends, co-workers, etc.).
In addition, the 36 complaints that comprise the Cognitive Complaint Survey of cognitive symptoms were written using the actual words or phrases used by patients with TBI, significantly increasing the validity of survey responses.
Below is a listing of the nine cognitive categories covered by the Cognitive Complaint Survey used by the ADAMS Profile system, along with a more detailed explanation of the behaviors and deficits (expressed as less threatening "symptoms") evaluated.
Executive Function:
• Ability to plan, think ahead and regularly manage tasks.
- These items require skills in foresight, insight, anticipation, and self-monitoring.
Memory:
• Ability to capture, retain and retrieve new information for later use.
- These items involve retention of new or novel information.
Learning:
• Ability to acquire new skills or knowledge through conscious effort.
• Ability to gain new knowledge or skills, or improve old skills with training.
- These items describe the ability to improve with practice.
Attention:
• Ability to sustain focus and concentrate on current activities.
• The ability to stay focused on the task currently being done.
- These items measure focus, concentration, and immediate processing.
Processing:
• Ability to understand and effectively use information in everyday life.
- These items describe problems with reasoning and manipulation of information.
Hyperactivity:
• Ability to sit still and stay on task without moving or fidgeting.
- These items measure the ability to sit still or to maintain vigilance.
Vigilance:
• Ability to stick to finishing the task at hand.
- These items describe problems with staying on task.
Social Skills:
• Ability to interact with other people in everyday life.
- These items index (list) the skills of social interaction (interacting with other people).
Expression:
• Ability to make yourself understood when speaking to other people.
- These items measure the ability to decode thoughts into spoken language.
The ADAMS Profile is designed to aid in both deficit analysis and treatment planning.
The analysis profile identifies which of the nine cognitive categories best characterizes the client’s cognitive status. The client and observer responses to the Cognitive Complaint Survey provide unique perspectives regarding a client’s functional capacities and limitations.
The more observers that participate in the rating process, the more accurate will be the analysis profile that emerges from the amalgamation of the different ratings.
The differences between the client’s and the observers' consensus are a measure of deficit awareness. The entire profile provides a clinician or therapist with a clear idea of deficit areas and an assessment of areas of cognitive strength and weakness of which the client may not be aware.
Sample: Graphic View of Survey Results
These treatment options can be incorporated immediately by the clinical provider as a part of a long-term treatment plan.
An added benefit of the ADAMS Profile system is that it produces a set of potential treatment options that are uniquely matched to the client’s strengths and weaknesses.
Every item on the Cognitive Complaint Survey is paired with therapy suggestions that have been successfully used in clinical settings. These treatment options are matched to the consensus of the client and observer ratings. The treatment options may be incorporated into the clinician’s treatment plan and can be implemented by a therapist, by family members, and in some cases, by the client.
Sample: Treatment Options by
Client Complaint
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