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Lian Todd, Sara Muller and Emily HamesThe Executive Function Performance Test (EFPT): The EFPT is a performance-based standardized assessment of cognitive function that specifically examines executive functioning through mediated goal-directed activities. This assessment measures executive functioning through four basic tasks that are essential for self- maintenance and independence. The executive function for each task is measured by:Initiation of a task: the advent of motor activity that commences a task Execution of a task: the proper completion of each step without incident. Execution requires:organization: the physical arrangement of the environment, tools, and materials to facilitate efficient and effective performance of steps Sequencing: the coordination and proper ordering of the steps that comprise the task, requiring a proper allotment of attention to each step Judgment: the employment of reason and decision-making capabilities to intentionally avoid physically, emotionally, or financially dangerous situations. Completion of a task: the inhibition of motor performance driven by the knowledge that the task is finished This is an occupation-based assessment because it observes clients performing IADL tasks Target Population: The target population is not stated. The EFTP was designed to accommodate all levels of functioning. The assessment is often used for clients who have experienced stroke and an mental health disordersThe client must have pre-requisite skills: vision, fine motor skills, sensation, process skills, attention and memory would be useful. Contraindication: People who do no have appropriate judgment and safety awareness required to use a stove. Also those that have sensory issues, such as being unable to distinguish hot and cold temperatures. Administration: it takes about 30-45 minutes to administer. The EFPT is a standardized test and there must be no modifications to the directions in the tests protocol, regardless of the participant’s preferences or experiences. At the beginning of the test, the administrator will place a box of items in front of the participant. (see attached page)1. Begin the EFPT with the script and the pre-task questions. 2. Leave all of the items necessary for all of the tasks in the box The tasks will be carried out in this order: Hand Washing (Score Sheet A) This task is a screening tool, only use this task if the person has severe cognitive impairment and you want to see if they can follow directions. If they cannot complete the task of washing their hands do not proceed with administration. The hand washing task is not scored in the final analysis. Oatmeal Preparation (Score Sheet B) Telephone (Score Sheet C) Taking Medication (Score Sheet D) Paying Bills (Score Sheet E)3. Ask the person to begin the task by stating what is written on the script. 4. Offer assistance only after the participant has made a good attempt to process the actions necessary to carry out the step. The cueing guidelines should be used. -The therapist will try to not intervene while the client is performing the task, unless the participant is in danger, such as touching the burner when making oatmeal5. Complete the cueing chart and behavior assessment chart for each task. Scoring procedures: Each 4 tasks measures 5 executive functions: initiation, organization, sequencing, safety and judgment and completion. For each exec functions, the test administrator rates them on standardized scale 0-5. The levels of cueing are: independent (0), verbal guidance (1), gestural guidance (2), verbal direct instruction (3), physical assistance (4) and do for participant (5). Each score ranges 0–25, the total test score for all range 0-100. Lower score represent higher exec functioning abilities and greater independenceUtility: This assessment is easy to use and has an easy script to follow. The test is also free to download online. Strengths: This assessment is free and there is no training required to administer it to a client. The test offers an occupational-based real-life situation to evaluate a person’s executive functioning. The test is also easy to score, and allows the administrator to cater the test toward the participant’s level of functioning by being able to grade up or down through using different levels of cueing. Limitations: This test needs to be done in an environment where the tasks can be executed. This test also takes a considerable amount of preparation and needs there are a lot of supplies needed to administer it. This assessment is also a bit length, which might be difficult for some participants that might have trouble paying attention for long periods of time, it also might pose a lot of frustration for those that have high cognitive deficits. References:Baum, C.M., Connor L.T., Morrison, T., Hahn, M., Dromerick A.W., Edwards D.F (2008). Reliability, validity, and clinical utility of the Executive Function Performance Test: a measure of executive function in a sample of people with stroke. American Journal of Occupational Therapy.62,4, 446-455.Baum, C., Morrison, Hahn, M., & Edwards, D. (2007). "Executive Function Performance Test: Test protocol booklet." Unpublished program in Occupational Therapy Washington University School of Medicine, St. Louis, MO.The following items will be placed in a box and presented to the client:Hand soap in dispenser (as one would find in a home) and Towel Pan (with handle that gets hot and requires a pot holder) Pot holder, measuring cups, spoon for stirring, spoon for eating, rubber spatulaOld-fashioned-oatsenlarged copy of instructions for stovetop version onlyBowlsalt shakertimer, phone bookmagnify glassMedicine bottle with instructions and person’s name on it (filled with sugar-free candy), medicine bottle as distracter (another person’s name on it, filled with sugar free candy), Claritin bottle (non prescription) as a distracter ( filled with sugar-free candy) Drinking cupTwo bills (cable and phone bill with pre-addressed envelopes) mixed with 5 other pieces of mail (letter from credit card company, postcard, flier, letter in a plain white envelope, mail order catalog.) in a Ziploc bag. The dates due on the bills should differ, one due upon receipt and one due 30 days from receipt. Checks in a check register (obtained from a bank), Balance sheet (i.e., account book) with a balance $5.00 less than the bills total Pen, paper, Calculator Other distracter items: Tongs, Pepper shaker, Restaurant / apartment guide ................
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