Ecological validity in NeuronUP: Examples

This article explains how NeuronUP approaches ecological validity and gives examples of some exercises with ecological validity on our platform.

What is ecological validity in neuropsychology?

Ecological validity in neuropsychology refers to the correspondence between the improvement of skills trained in therapy and better performance in everyday activities.

Ecological values in rehabilitation

We don’t intend to provide an exhaustive review of the concept of ecological validity, but rather to highlight a couple of important ideas. Some people may think it’s sad to have brain impairment or to grow old and be put in front of a computer screen. It can be frustrating and can even affect motivation, which is a key factor in functional recovery. At NeuronUP, we think exactly the same way.

We don’t believe in computerized rehabilitation when it can do more harm than good. We don’t believe in video games if they don’t have a positive effect.

We always say that the goals of a rehabilitation program must fit our patient’s cognitive profile, but also their preferences and motivations. The same goes for the format. We can’t expect a computer to be motivating for someone who has never found it so, although we can carry out a motivational program beforehand to help them get used to this format.

It’s somewhat ironic that the concept of “ecological” applied to validity comes from the experimental world. Brunswik (1956) was the first to use the term to describe the degree of relationship between a proximal cue and a distal variable in perception experiments. The capacity for generalization was opposed to the representativeness of the task. Today, these concepts have changed.

Functionality

We say that goals must fit the cognitive profile. True. But the main goal is functionality, not numerical recovery in constructs. 

Functionality and constructs are two common concepts in neuropsychological rehabilitation. According to Burgess et al. (2006), a third concept could be added, that of operations, giving us the triad of levels of analysis in neuropsychology.

So, there are:

• Constructs: theoretical and inferred, such as working memory;
• operations: established from correlations between variables manipulated in a task and the level of BOLD activity (oxygen consumed by the brain);
• functions: directly observable, they are the result of the interaction between a cognitive system and a goal that may be internal or externally elicited, such as social behavior.

What do these three concepts have to do with the idea of ecological validity?

Each of them is a level of analysis we start from to build activities, and each of those activities has a different scope.

Kvavilashvili and Ellis (2004) describe three ecological levels in activities.

1. Level one corresponds to the generalization between two identical tasks.
2. Level two corresponds to the generalization between a rehabilitation task and tasks that require similar processes.
3. Level three refers to the generalization of what has been learned to untrained activities and functions.

This means two things:

1. Rehabilitation activities must be representative and predictive. Representative means that the task we use in rehabilitation is related to (or operationally overlaps with) a real-life task.
2. Predictive means that performance on that “lab” task generalizes to other tasks of daily living.

Ecological validity in assessment

When we assess, we use abstractions (tests), simplified representations of the outside world. We (intuitively?) think that an “ecological” assessment task can’t meet the necessary psychometric standards. But several studies (for example, with the Zoo Map Test or the Multiple Errands Test) show more satisfactory values than the most established assessment tests.

Let’s ask two questions:

1. Why do many executive function tests fail to detect executive symptoms? Possibly because they are multifactorial (such as the WCST), because they were designed for purposes other than the original one (as with the Stroop Test), or because they are more complex than we think (such as the Tower of London). But above all, because the reality of a theory behind a task goes beyond the data.
2. Should we do the same in rehabilitation? Should we work at a theoretical, construct level to design neuropsychological rehabilitation activities? Not if what we want are ecological tasks. We know that not all rehabilitation tasks need to be ecological, because many help people improve specific operations. But if the ultimate goal is functionality, we must do our part to design tasks connected to real activity.

Ecological validity: the patient at the center

We can’t force people in rehabilitation to adapt to the format we give them. That’s why computerized rehabilitation may not always be appropriate. When we talk about ecological, the patient is part of the concept. To paraphrase a well-known credit card brand: “For everything else, NeuronUP.”

Exercises with ecological validity

Below are some NeuronUP exercises with ecological validity:

1. Task Sequencing (Picture-Only)

What does it involve?

In this activity, the user has to put in order the different steps needed to carry out an activity.

In the image, for example, the idea is to number all the steps needed to go shopping in the order in which they naturally happen.

What does this activity work on?

Its main function is planning, and its secondary function is reasoning.

Play by levels

It is organized into five difficulty levels: basic, easy, medium, hard, and advanced.

Children’s version

This activity also has a children’s version called Step by Step.

Format

It’s also available in text format, and it can be done in both digital and paper format.

2. What’s Making Noise in the Kitchen?

What does it involve?

This exercise with ecological validity involves identifying sounds heard in a kitchen setting. First, the user has to listen carefully to the sounds; then, they have to tap the object that makes each sound. Here’s an example in the following video:

What does this exercise work on?

This game works on auditory gnosis. It also works on cooking and cleaning.

Play by levels

This game has 9 difficulty phases.

Customizing the activity

You can customize this activity to fit each person’s individual needs and abilities by configuring the general settings and the parameters:

Parameters

On the one hand, there are the parameters, where you can select:

• Recognition difficulty,
• number of items,
• number of audio clips,
• response time,
• the maximum number of errors.

General settings

On the other hand, you can adjust general settings such as the number of exercises, the maximum time, whether or not to show a visible timer for the activity, and an inactivity alert, or you can edit the instructions if you wish.

3. Recycle your trash

What does it consist of?

The user has to put different types of trash in the right bin.

What does this activity work on?

This activity works on:

• Reasoning,
• sustained attention,
• semantic memory,
• episodic memory,
• cooking and cleaning.

Play by levels

This game has 9 difficulty phases.

Customizing the activity

You can customize this activity to fit each person’s individual needs and abilities by configuring the general settings and the parameters:

Parameters

On the one hand, there are the parameters, where you can select:

• Setting,
• number of items,
• maximum number of errors,
• help: object labels, bin labels, list, and placed object.

General settings

On the other hand, you can adjust general settings such as the number of exercises, the maximum time, whether or not to show a visible timer for the activity, and an inactivity alert, or you can edit the instructions if you wish.

4. Correct Image Name

What does it consist of?

It involves choosing the word that matches the image shown.

Play by levels

The activity Correct Image Name is organized into five difficulty levels: basic, easy, medium, hard, and advanced.

Format

This worksheet is available in both digital and paper format.

5. Get dressed (woman)

What does it consist of?

This activity involves dressing the silhouette appropriately, taking into account both where and in what order each garment goes and the type of situation.

There is a male silhouette version and a female silhouette version.

What does this activity work on?

This cognitive stimulation exercise works on the following cognitive functions:

• Decision-making,
• body schema,
• planning,
• dressing.

Play by levels

There are 6 phases. At the easier levels, there are fewer commands and more prompts from the program to complete the activity correctly, while at the harder levels there are fewer prompts and the clothing requirements are more complex.

Customizing the activity

You can also customize the activity to suit each user’s abilities.

Parameters

On the other hand, there are the parameters, where you can select the number of garments, the setting, whether to add any kind of distractor, the errors that can be made, how the garments are presented, and more.

General settings

On the one hand, you can adjust the general settings, such as the number of exercises, the maximum time, whether or not to show a visible timer for the activity, editing the instructions, and more.

Adaptability

Finally, you can choose whether the garments are moved by dragging or simply by tapping on the garment to select it. You can choose one option or the other depending on the user’s functional abilities.

6. Straighten Up the Kitchen

What does it consist of?

In this exercise, users have to put the kitchen items where they belong.

What does this activity work on?

It works on:

• Reasoning,
• cooking and cleaning,
• sustained attention,
• semantic memory,
• episodic memory.

Play by levels

There are six phases. At the easier levels, the program gives more prompts to complete the activity correctly, while at the harder levels there are fewer prompts.

Customizing the activity

You can also customize the activity to suit each user’s abilities.

Parameters

On the other hand, there are the parameters, where you can select the number of items, the type and amount of help you want the user to receive, and the errors that can be made.

General settings

On the one hand, you can adjust the general settings, such as the number of exercises, the maximum time, whether or not to show a visible timer for the activity, editing the instructions, and more.

7. Counting

What does it consist of?

Counting is a game in which children have to listen carefully and count the number of stimuli presented.

What does this activity work on?

This children’s activity with ecological validity works on sustained attention and processing speed.

Play by levels

There are six phases. At the easier levels, the program gives more prompts to complete the activity correctly, while at the harder levels there are fewer prompts.

Customizing the activity

You can customize this activity to fit each child’s individual needs and abilities by configuring the general settings and the parameters:

Parameters

On the one hand, there are the parameters, where you can select:

• Number of target stimuli,
• time interval,
• the maximum number of errors.

General settings

On the one hand, you can adjust the general settings, such as the number of exercises, the maximum time, whether or not to show a visible timer for the activity, editing the instructions, and more.

8. Pick Up your Baggage

What does it consist of?

In this game, you have to select only the suitcases that match the model from a set of moving luggage. Depending on the phase, more suitcases will appear to recognize.

What does this activity do?

This exercise for adults works on:

• Selective attention, 
• sustained attention,
• working memory,
• processing speed,
• leisure.

Play by levels

There are 12 phases.

Customizing the activity

You can customize this activity to fit each person’s individual needs and abilities by configuring the general settings and the parameters:

Parameters

On the one hand, there are the parameters, where you can select:

• Similarity between items,
• frequency of stimuli,
• number of stimuli to find,
• how long the stimuli stay on screen,
• number of stimuli,
• total duration,
• number of target stimuli,
• correction criteria,
• the maximum number of errors.

General settings

On the one hand, you can adjust the general settings, such as the number of exercises, the maximum time, whether or not to show a visible timer for the activity, editing the instructions, and more.

9. Differentiate numbers

What does it involve?

It involves choosing the number dictated from several options. 

Play by levels

The activity Differentiate numbers is organized into five difficulty levels: basic, easy, medium, hard, and advanced.

Format

This worksheet is available in both digital and paper format.

10. Pack your Backpack

What does it involve?

It’s a game in which children have to pack their backpack for school, selecting only the items they need that day.

The goal of this activity of daily living is for children not to forget anything. It also aims to keep them from packing materials they don’t need, which would make their backpack too heavy. The challenge is on!

What does this activity work on?

It’s a children’s activity for working on planning: the child works out what to take based on the subjects they have each day. It also stimulates selective attention.

Play by levels

It is also divided into six difficulty levels.

Customizing the activity

You can also customize this ADL game.

Parameters

• Number and type of subjects,
• hints: visible, hidden, or none,
• distractors: related, unrelated, all, or none,
• the maximum number of errors.

General settings

You can choose general settings such as the number of exercises, the maximum time, whether or not to show a visible timer for the activity, and an inactivity alert. You can also edit the instructions.

These are just 10 NeuronUP exercises with ecological validity. You can find many more on the platform. Request a free trial and try them with your patients:

References

• Kvavilashvili, L., & Ellis, J. (2004). Ecological validity and twenty years of real-life/ laboratory controversy in memory research: A critical (and historical) review. History and Philosophy of Psychology , vol 6 , pp. 59-80.
• Tirapu Ustárroz, J., García Molina, A. & Roig Rovira, T. (2007). Validez ecológica en la exploración de las funciones ejecutivas. Anales de Psicología, 23(2) 289-299.
• Yantz, C. L., Johnson-Greene, D., Higginson, C., & Emmerson, L. (2010). Functional cooking skills and neuropsychological functioning in patients with stroke: an ecological validity study. Neuropsychological rehabilitation, 20(5), 725-738. doi:10.1080/09602011003765690

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Validez ecológica en NeuronUP: ejemplos