Development and standardization of an ecological complex organizational and problem solving test in vocational rehabilitation: Multiple Errands Test in Vocational Rehabilitation, MET-PRO

Abstract

Objective.- An executive dysfunction is one of the most frequent and disabling long-term sequelae after severe traumatic brain injury (TBI). The executive impairments, often minimized by classic structured neuropsychological testing, are likely to hinder an adequate professionnal reintegration. The objective is to develop a standardized and ecological test (MET-PRO) in the context of vocational rehabilitation, sensitive to executive difficulties of patients who sustained severe TBI. Materials/patients and methods.- MET-PRO, initiated by the Department of Neurological Rehabilitation, results from a collaboration between the Vocational Training Service and the Neuropsychology Unit. It is based on the model of Multiple Errands Test originally created by Shallice and Burgess (1991), translated into French and validated in our clinic. A first adaptation applied to vocational rehabilitation has been drafted and then revised with the introduction of new tasks, aspects of prospective memory and new distractors in a standardized format. The subject must perform four ecological activities of varying complexity, search for information and record them, while respecting given rules. The realization of this test highlights especially planning abilities, prospective memory, selective and sustained attention, organization and problem solving as well as the adaptation of behavior over an extended period. Patients hospitalized in the context of rehabilitation of the musculoskeletal system (ie without neurological or psychiatric history) participate as controls. Results.- Preliminary results show a good sensitivity of MET-PRO with no ceiling effect (ie no patient made no mistake). The MET-PRO is achievable between 3 and 6 hours. It allows a differentiated quantifiable assessment, the classification of different types of errors (errors of interpretation, judgment failures, rule breaks, task failures and inefficiencies) and a qualitative analysis of the behavior. Discussion.- The Multiple Errands Test in vocational rehabilitation (TEM-PRO) is an original, ecologically valid and sensitive test. This first stage of standardization allows a differentiated assessment of cognitive functioning, and especially of executive aspects, which can be applied to a vocational evaluation setting.