RIPA 2: A Review

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RIPA 2 A Review
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What is RIPA-2?

• RIPA-2 stands for Ross Information Processing
  Assessment (Second Edition)
• The first RIPA was published in 1986
• The second edition was published in 1996

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Who is it used on?

• Individuals who experience cognitive-linguistic
  deficits following traumatic brain injury (TBI)
• 16-90 years of age

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Who is it used by?

• Primarily used by speech-language pathologists
• Psychologists
• Neuropsychologists
• Physiatrists
• Used all over the United States and Canada

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Some facts about TBI

• Each year over 1 million cases of head injury
  require hospitalization (Berrol Rosenthal,
  1986)
• The most frequently injured group includes males
  between the ages 15 to 24 years, who constitute
  50 of all head injury cases (Fisher, 1985)
• 10 of individuals who survive a significant head
  injury are likely to have permanent residual
  deficits (Kingston, 1985)
• The cost of rehabilitation of patients with TBI
  is between 5-10 billion annually (Anderson
  McLaurin, 1980)

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What is the purpose of the test?

• To identify and quantify information processing
  deficits
• Assist in establishing treatment goals
• Measure and document progress
• Note It is not intended to replace
  traditional neuropsychological batteries but to
  supplement and complement information about
  individuals cognitive status.

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What is the assessment made up of?

• 10 subtests hierarchically from simple to
  complex, which provide quantitative and
  qualitative data in cognitive-linguistic areas
  of
• Immediate Memory i.e. repeat numbers, words etc.
  
• Recent Memory i.e. recall info about environment
• Temporal Orientation i.e. questions related to
  time-based information
• Temporal Orientation i.e. remote memory
• Spatial Orientation i.e. categorization
  sequencing
• Orientation to Environment i.e. receive and
  respond to stimuli within his/her environment
• Recall General Information
• Recall general information in remote memory
• Organization
• Auditory processing i.e. answer yes/no questions
  about temporal, spatial and comparative stimuli

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The Basis of the RIPA 2

• The development of the RIPA 2 is based on 2
  processing theories
• The interdependent relationship between cognition
  and information processing
• Language provides the basis to understanding and
  identifying disordered and disorganized
  communication (both verbal and nonverbal
  following TBI)

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The Theoretical Framework

• Lurias (1973) theory integrates neuroanatomical
  and processing theory working together.
• Nebes (1974) stated that there are 2 types of
  processing mediated in the right and left
  hemispheres The left hemisphere is responsible
  for the analysis and synthesis of serial,
  sequential, and detailed information, while the
  right hemisphere produces and organizes the
  information
• Atkinson and Shiffrin (1968) proposes that
  information is processed sequentially, involving
  sensory perception and short and long term
  storage.

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The Results

• Examiner obtains raw scores, percentiles and
  standard scores for each of the 10 subtests
• It enables the examiner to compare the scores of
  the different subtests and possibly compare
  subtest scores with scores from other tests
• The standard score has a mean of 10 and standard
  deviation of 3
• The Severity Rating Profile plots percentiles of
  each subtest
• Score gives examiner a visual representation of
  the test-takers cognitive functioning (mild,
  moderate, severe, profound)
• Diacritical scores Each question on the test
  allows the examiner to give a diacritical score
  in addition to a score for the correctness of the
  response
• This enables the examiner to see patterns of
  responses (i.e. perseveration, delayed response)
• Provides the clearest information about the
  test-takers information processing and
  cognitive-linguistic skills

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Criticisms Standardization Sample and Normative
Procedures

• The RIPA-2 was standardized on 126 individuals
  with TBI who lived in nine states
• Is it sufficient to include individuals from only
  9 states?
• Which states were included? Were they in
  different regions of the country?
• Participants in the standardization sample were
  between the ages of 15-77
• The test is intended for people between the ages
  of 16-90.
• The author of the study reported that The
  samplewas representative of TBI cases relative
  to gender, area of residence (city/rural),
  geographic area, and ethnic background as
  described in TBI literature relative to
  demographic information.
• This does not provide the reader of the test
  manual with specific information about the
  standardization
• This makes it difficult for a potential test
  administrator to determine whether the sample
  truly was representative of TBI cases

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Criticisms Standardization Sample and Normative
Procedures

• Participants were included in the sample if they
  had a diffuse bilateral brain lesion or if they
  had damage to the right hemisphere and were
  right-handed (with no evidence of left hemisphere
  damage or aphasia)
• What about individuals who have damage to the
  left hemisphere? Most people are left hemisphere
  dominant for language
• The standardization sample is geared toward
  people who speak English as a primary language
• Information is not provided about the languages
  spoken by the individuals in the standardization
  sample
• Were any multilingual individuals in the sample?

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Criticisms Construct Validity

• Construct Validity can be defined as the degree
  to which a test measures the theoretical
  construct it is intended to measure (Anastasi, as
  cited in McCauley Swisher, 1984).
• RIPA 2 assessed construct validity by using
  subtests interrelationships,
• Subtest Interrelationships
• Relationship of RIPA-2 to other cognitive
  measures
• Woodcock Johnson Tests of Cognitive Ability
• Factorial Analysis
• For something to be a factor, it must have an
  Eigen value of greater than 1.00, but only one
  factor was yielded
• Item Validity
• refer to tables 6.2 and 6.3
• Anastasi (as cited in Ross-Swain, 1996) says .2
  or .3 is acceptable item validity looks
  acceptable
• Severity Differentiation- none
• there are no significant differences between the
  test results of severe TBI patients and mild TBI
  patients
• Summary
• Construct validity is poorly demonstrated because
  the test it is compared to is the Woodcock
  Johnson, which is not directly intended for
  individuals with TBI. The Woodcock Johnson may
  have flaws in its validity as well. There is no
  severity differentiation. Item validity does
  look sufficient, however.

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Criticisms Content Validity

• Content Validity refers to the examination of
  test items and tasks to determine appropriateness
  of what is being tested (Hutchinson, as cited in
  Paul, 2000????). To demonstrate content validity
  designers of the RIPA-2 provided a rationale for
  subtest format and selection, judgments of three
  professionals with expertise in the field of TBI
  and statistical item analysis procedures.
• Inclusion of subtest VI is a result of
  observations made by Deborah Ross-Swain, the
  author of this manual. Perhaps she should have
  included additional research to support her claim
  that these subtests are in fact appropriate for
  TBI patients in assessment
• The professional review was done by three highly
  qualified people, but is three people enough?
• Item Analysis the literature provides little
  guidance regarding the magnitude of acceptable
  discriminating powers. (Erica, where did you get
  this quote so we can cite it) Anatasi (as cited
  in Ross-Swain, 1996) suggests that coefficients
  of .2 or .3 can be considered acceptable if they
  are statistically significant. On the average,
  the test items satisfy the requirements and
  provide evidence of item validity.
• The questions included in subtest VII Recall of
  General Information seem biased. First, this
  information may not be general to someone who
  was not born in the United States. Second,
  someone who is uneducated may not have known the
  answers to some of these questions even before
  their traumatic brain injury

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Criticisms Criterion Validity

• Criterion Related Validity involves the
  collection of empirical evidence that scores on
  the test are related to some other measure of the
  behavior being assessed (McCauley Swisher,
  1994, p. 35). There are two types of criterion
  related validity concurrent and predictive.
• Concurrent Validity is examined by how closely an
  individuals test score is related to his/her
  scores on a variable (i.e. another validated
  language test) measured at the same time
  (McCauley and Swisher, 1984)
• To test concurrent validity, RIPA-2 was compared
  to the Woodcock Johnson Tests of Cognitive
  Ability
• Refer to table 6.4 mild to moderate correlation
• Predictive Validity is measured by the degree to
  which a test predicts future performance
  (McCauley Swisher, 1984)
• McCauley and Swisher (1984) state that both types
  of criterion related validity, concurrent and
  predictive, are usually considered important
• Predictive Validity was not tested on the RIPA-2
• Summary
• Criterion related validity is poor. Predictive
  validity is not addressed at all, and concurrent
  validity is based on a comparison with the
  Woodcock Johnson, which may have validity issues
  of its own and is not necessarily directed toward
  TBI patients.

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CriticismsReliability

• Reliability
• According to McCauley Swisher (1984),
  reliability is the consistency with which a test
  measures a given attribute or behavior (p. 35).
  There are two types of reliability test-retest
  reliability and inter-examiner reliability.
• Test-retest reliability is a measure of the
  stability of test scores over time. A
  correlation coefficient of .90 (Salvia
  Ysseldyke, as cited in McCauley Swisher, 1984)
  with a statistical significance of .05 or better
  (Anastasi, as cited in McCauley Swisher, 1984)
  is considered to be evidence of acceptable
  test-retest reliability (McCauley Swisher,
  1984)
• The RIPA-2 does not indicate any evidence of
  test-retest reliabilitya necessary psychometric
  criterion according to McCauley Swisher (1984).
• Inter-examiner reliability refers to the degree
  to which different test scorers or test
  administrators might influence test results
  (McCauley Swisher, p. 36). The correlation
  coefficient should be at least .90 (Salvia
  Ysseldyke, as cited in McCauley Swisher, 1984)
  with a statistical significance of .05 or better
  (Anastasi, as cited in McCauley Swisher, 1984)
• The RIPA-2 manual indicates that three clinicians
  independently scores a videotape recording of the
  administration of the original RIPA and obtained
  results that were 99.5 reliable
• How can they get results for the RIPA-2 from the
  administration of the original RIPA? Were any
  changes or improvements made for the RIPA-2?
• The test manual does not provide any correlation
  coefficients
• The use of three clinicians and one
  administration of the test may not be sufficient
• The RIPA-2 manual does provide information about
  internal consistency reliability
• The median coefficient alpha was .85, which
  suggests strong reliability, according to the
  test manual
• Subtest X (Auditory Processing and Retention) was
  insufficient, as it had a coefficient alpha of
  .67
• The coefficient alpha for the other nine subtests
  ranged from .83 to .91, which indicates
  acceptable reliability, according to the test
  manual
• Summary
• The manual does not provide sufficient evidence
  that the test has strong reliability.
  Test-retest reliability was not addressed in the
  test manual, and many questions remain unanswered
  regarding the tests inter-examiner reliability.
  While nine of the ten subtests may have
  sufficient internal consistency reliability, one
  subtest does not appear to have acceptable
  internal consistency reliability.

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Strengths and weaknesses according to the Academy
of Neurologic Communication Disorders Sciences

• Fairly quick
• Gives good memory info, processing and verbal
  problem solving
• Has standard scores with age equivalents
• Is specific and structured to determine therapy
  strategies
• - Questions are redundant
• - Does not give high level executive functioning
  testing
• - Dont have to know much to get a fair score

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How useful are the results?

• The results may serve as a good baseline
  measurement. However, the tests
  standardization, validity, and reliability appear
  to have some flaws. We would not use this as a
  basis for diagnosis or severity indication
  because the validity tests did not find any
  significant differences between the test results
  of severe TBI patients and mild TBI patients
• The results can be useful depending on who is
  given the test. One must be careful that the
  patient fits the requirements as indicated in the
  standardization procedures, which are pretty
  specific
• Even if the scores are not totally useful, the
  test itself and its subtests with generate good
  clinical observations and an indication of
  general functioning

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References

• Anderson, D. W., McLaurin, R. L. (1980). The
  national head and spinal cord injury
• survey. Journal of Neurosurgery, 52, s1-s43
• Berrol, S., Rosenthal, M. (1986). From the
  editors. The Journal of Head Trauma
• Rehabilitation, 1, viii.
• Fisher, J. M. (1985). Cognitive and behavioral
  consequences of closed head inujury.
• Seminars in Neurology, 5, 197-204.
• Kingston, W. J. (1985). Head injury. Seminars in
  Neurology, 5, 197-270.
• Ross-Swain, Deborah (1996).Ross Information
  Processing Assessment Examiners
• Manual (Second Edition), Pro-ed.