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Kessler Foundation scientists test Actual Reality in functional assessment post-TBI

Results of first study in TBI support the use of Actual Reality for assessing performance of everyday activities in this population

Kessler Foundation


IMAGE: Dr. Goverover is a visiting scientist at Kessler Foundation. A former fellow at the Foundation, Dr. Goverover is an associate professor at NYU. Her expertise is cognitive rehabilitation research. view more

Credit: Kessler Foundation

West Orange, NJ. March 18, 2015. A recent article by Kessler Foundation researchers describes Actual Reality; as a new tool for assessing performance of activities of everyday life (ADL) in people with traumatic brain injury (TBI). The article, "Actual Reality: Using the Internet to assess everyday functioning after traumatic brain injury," was epublished on February 19 in Brain Injury (doi:10.3109/02699052.2015.1004744). This is the first study examining the use of Actual Reality in the TBI population. The authors are Yael Goverover, PhD, OT, of New York University and Kessler Foundation, and John DeLuca, PhD, senior VP of Research & Training at Kessler Foundation, and professor at Rutgers New Jersey Medical School.

Despite the scope of functional deficits in the population with TBI, few methods are available to adequately assess functional status during recovery. Current methods of assessing performance-based tasks are impractical, outdated or subjective (self report), and fail to include use of everyday technology. To achieve independence, it is increasingly important to be able to navigate the internet to find and share information, make purchases, and connect with the community. Today's rehabilitative strategies need to objectively address the technological demands of everyday life.

Researchers looked at the feasibility of using everyday technology (computers, handheld devices) to assess how people perform the common technology-based tasks that are essential to everyday function, ie, instrumental ADLs. Actual Reality uses internet-based technology to assess a person's performance on 'instrumental' ADLs (iADLs). In this study, 10 people with TBI were compared with 10 controls. They were assessed for their ability to perform an Actual Reality task comprised of an online purchase of a cookie assortment for a birthday party. Participants were also assessed for prior internet experience, and underwent testing for functional status, affect symptomatology, and quality of life.

The TBI group had greater difficulty performing the internet-based task. "Our findings are consistent with studies that show a positive relationship between cognitive impairment and functional disability," said Dr. Goverover, visiting scientist in Neuropsychology & Neuroscience Research at Kessler Foundation. "To help individuals achieve independence, rehabilitation professionals need the appropriate assessment tools to guide the development of practical interventions. This initial study demonstrates that actual reality is a potential tool for capturing the status of everyday functional activity in individuals with TBI. More studies are needed to support inclusion of internet-based tasks in clinical assessments of iADLs in the rehabilitation of people with TBI."


This study was funded by Kessler Foundation.

About TBI Research at Kessler Foundation

Nancy Chiaravalloti, PhD, is director of TBI Research and Neuropsychology & Neuroscience Research. Dr. Chiaravalloti is project director of the Northern New Jersey TBI System (NNJTBIS), a collaborative effort of Kessler Foundation, Kessler Institute for Rehabilitation, and local hospitals. John DeLuca, PhD is co-project director. NNJTBIS is one of 16 federally funded model systems that form a national comprehensive system of care, research, education and dissemination aimed at improving quality of life for people with TBI. NNJTBIS is supported by grant #H133A120030 from the National Institute on Disability & Rehabilitation Research (NIDRR). In addition to NIDRR and the Department of Defense, TBI research is funded by the New Jersey Commission on Brain Injury Research, the Department of Veterans Affairs, the Department of Defense, and Children's Specialized Hospital. Kessler researchers and clinicians have faculty appointments in the department of Physical Medicine and Rehabilitation at Rutgers New Jersey Medical School.

About Kessler Foundation

Kessler Foundation, a major nonprofit organization in the field of disability, is a global leader in rehabilitation research that seeks to improve cognition, mobility and long-term outcomes, including employment, for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord. Kessler Foundation leads the nation in funding innovative programs that expand opportunities for employment for people with disabilities. For more information, visit

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