Actual reality: Using the Internet to assess everyday functioning after traumatic brain injury

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.