Realistic Assessment Strategies
As noted previously, EMA allows for the momentary assessment of functional activities. However, in cases where an individual is not spontaneously performing these activities, a functional capacity assessment in the real-world may be an important assessment strategy. Several such strategies have been developed in the past, targeting both aging and neuropsychiatrically impaired samples.
As noted earlier, realistic Virtual Reality (VR) variants of functional tasks have been developed. These tasks examine a variety of everyday functional skills, including shopping, banking, bill paying, using the Internet for health information, and other health management activities (e.g., prescription refill, doctor’s visit). These assessment strategies have several advantages over paper-and-pencil functional capacity assessments. First, a structured simulation of an everyday task already performed on the computer, such as bill paying or ATM interaction, does not have to be examined for criterion-referenced validity, as the task is identical. Second, there is no need to infer from cognitive limitations that there would be a functional skills deficit, as the functional skills are assessed directly. Third, these realistic assessments are more amenable to targeted intervention than more general skills deficits. One does not need to determine which cognitive abilities underlie the skills deficits and then train them; the training can be directed at the functional skills alone. Thus, in a way, these outcome measures can “bootstrap back” to intervention development because they are directly related to critical daily activities and poor performance directly results in functional deficits.