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Administrator`s Manual

1. ecce eee eene eese eene nennen nenne nnne nnne 195 Appendix 3 Pausing Stopping Resuming Rules eeeeeee eese eene eene nee nenne 196 COGQIUUION mc EE 196 Idee p E 200 IV OL OM oe E 201 ero p P adaa 203 Appendix 4 NIH Toolbox Equipment and Materials eee esce eese eene ee eene 207 Appendix 5 Key to Instrument Name Abbreviations eeee eee ee eee eren nennen 211 Appendix 6 NIH Toolbox 4 Meter Walk Gait Speed Test and 2 Minute Walk Endurance Test Walking COUESB coti b e ex Edidi a rav ML EDM on 215 Appendix 7 NIH Toolbox Regional Taste Test Materials and Taste Solutions Mixing Lord dU Pep rfo RPPERDTURGTTITITODTI OD TTDTD a a a a ee ea 217 A Introduction to the NIH Toolbox App A 1 What is the NIH Toolbox App The NIH Toolbox app provides access to the NIH Toolbox for Assessment of Neurological and Behavioral Function a standard set of valid reliable and royalty free tools for assessing cognitive emotional motor and sensory function Designed to benefit all scientists interested in investigating behavioral and neurological function the NIH Toolbox App is also relevant for students and clinicians across a broad spectrum of health research It is particularly well suited for measuring outcomes in longitudinal epide
2. 3B Screen 8 Here s a pink one Where does it go E reads screen C touches a Live trial 3 box 3B Screen 9 If it s a pink one then it goes in the pink box If it s E reads screen After 3 Rule reminder 4 a yellow one then it goes in the yellow box Text appears above relevant boxes seconds Touch and Hold Here to Continue button appears E touches and holds button to continue 3B Screen 10 Live Trial 4 Here s a yellow one Where does it go E reads screen C touches a box 3B Screen 11 Rule reminder 5 If it s a pink one then it goes in the pink box If it s a yellow one then it goes in the yellow box Text appears above relevant boxes E reads screen After 5 seconds Touch and Hold Here to Continue button appears E touches and holds button to continue 3B Screen 12 Live Trial 5 Here s a yellow one Where does it go E reads screen C touches a box If less than 4 of 5 correct DEXT Phase 3 is discontinued If DEXT started at Phase 3 DEXT Phase 2A items are presented depending on performance on Phase 2A items Phase 2B or Phase 1A is presented When either or both depending on performance Phase 2A and 2B are administered the test ends or when either or both depending on performance Phase 1A and 1B items are No Phase is administered more than once If 4 or more correct test continues to DEXT Phase 4 administered the test ends
3. Acuity Test 3 7 NIH Toolbox Dynamic Visual Acuity Test 8 NIH Toolbox Dynamic Visual Acuity Test Age 8 v2 0 Return to TOC 214 Appendix 6 NIH Toolbox 4 Meter Walk Gait Speed Test and 2 Minute Walk Endurance Test Walking Course The NIH Toolbox Four Meter Walk Gait Speed Test and Two Minute Walk Endurance Test each use walking courses The walking courses differ from each other but if both measures are being administered the courses can be laid out at the same time Equipment and materials needed e Tape measure with both feet and meter measurements e Colored masking tape e Two cones e Chair If administering the Two minute Walk Endurance Test you need an open space of at least 60 feet in length Following the schematic diagram attached at 5 feet from the start put a piece of tape 2 to 3 long across the hallway Put shorter pieces of tape at four 10 foot intervals from that piece of tape At the fifth 10 foot interval put another piece of tape 2 to 3 long across the hallway If administering the Four Meter Walk Gait Speed Test you can superimpose the course on the course above or make another course Following the schematic diagram attached at 5 feet from the start put a piece of tape 2 to 3 long across the hallway Measure 4 meters from the piece of tape and put another piece of tape 2 to 3 long across the hallway Lastly measure 1 meter from that piece of tape and put anoth
4. If less than 4 of 5 correct DEXT Phase 2 is discontinued If DEXT started at Phase 2 Phase 1A items are presented depending on performance on Phase 1A items Phase 1B items may be presented as well Then the test is discontinued No Phase is administered more than once If 4 or more correct the test continues to DEXT Phase 3 Return to TOC 82 3A Screen 1 Instructions Now we re going to play another game Here is a flower and here is a heart This is the shape game In the shape game all the flowers go in the flower box And all the hearts go in the heart box E reads screen and points out the relevant aspects After 10 seconds Touch and Hold Here to Continue button appears E touches and holds button to continue 3A Screen 2 Instruction See here is a heart It goes in the heart box E reads screen and touches the heart box which makes a clicking sound Touch and Hold Here to Continue button appears E touches and holds the button to continue 3A Screen 3 Instruction And here is a flower It goes in the flower box E reads screen and touches the flower box which makes a clicking sound Touch and Hold Here to Continue button appears E touches and holds the button to continue 3A Screen 4 Rule check Can you show me where the hearts go in the shape game E reads screen C touches a box 3A Screens 5a amp b Feedback 5a If correct Ver
5. Return to TOC 86 4A Screen 1 Instructions Now we re going to play the color game with different pictures In this color game all the red ones go in the red box And all the blue ones go in the blue box E reads screen and points out the relevant aspects After 8 seconds Touch and Hold Here to Continue button appears E touches and holds the button to continue 4A Screen 2 Demonstration Here is a red one It goes in the red box E reads screen and touches the red box which makes a clicking sound Touch and Hold Here to Continue button appears E touches and holds the button to continue 4A Screen 3 Demonstration Here is a blue one It goes in the blue box E reads screen and touches the blue box which makes a clicking sound Touch and Hold Here to Continue button appears E touches and holds the button to continue 4A Screen 4 Rule check Can you show me where the blue ones go in the color game E reads screen C touches a box 4A Screens 5a amp b Feedback 5a If correct Very good that s right E reads screen Touch and Hold Here to Continue button appears E touches and holds button to advance to next Screen 5b If incorrect Uh oh Remember in the color game if it s a blue one then put it in the blue box but if it s a red one put it in the red box Touch and Hold Here to Continue button appears after E touches and holds
6. EE N 27 B 4 4 Export Data ie terree nere ea Yea e aA en Ee ER eae evang ene EX ERRER EVER Re E EVER ee E VERRE e ES VERR 30 B 4 5 NIH Toolbox App Settings eese eene tinin eTR EEE senta sessi ntes sies atn s sse tans nenne 36 C Administering NIH TOOIDONX iiid uei su kcvpDd Dou tooi DURe pL eiu E VeuP Id EE pouoto yeu E rED KP PXUDMU Yeas Ta SOR ERU 38 C 1 NIA Toolbox Touch Sereen Tutorial oiii iiie ota rio e REEL EE PHI ERES HIE ERR EI eve REEE Re ele ER e pde 39 C2 Cosenitiomibotiiallizs no iseaccci mn eed Eme ps esum vest aa susGaged oean Sse eee ees seasnses ana aces e TENE RU fetis E 40 C 2 1 NIH Toolbox Picture Vocabulary Test cccccesssececssssscecssssecesssaecessessecessessecesssaaecesseaaeeesseaseeeeeees 43 C 2 2 NIH Toolbox Flanker Inhibitory Control and Attention Test esses 46 C 2 3 NIH Toolbox List Sorting Working Memory Test esses seen 58 C 2 4 NIH Toolbox Dimensional Change Card Sort Test DCCS esses enne 67 C 2 5 NIH Toolbox Pattern Comparison Processing Speed Test 96 C 2 6 NIH Toolbox Picture Sequence Memory Test eene ener nnne 105 C 2 7 NIH Toolbox Oral Reading Recognition Test esses ener nnne 124 C3 IEMOTON M DIT RE ETOILE SOLL M 127 C 3 1 Emotion CODSTEUCLUS a iret itte den a e ORE ae dE o e deua se Dau a Oeo ase ORE ero deuote sa MER EENS 128 C32 General Instr ctiOns i d a ees Seeds FOIE VE e DN reve ERI ee ep ue eins 130 C 3 3 NI
7. Test Bluetooth Wireless Keyboard Apple Store 69 00 NIH Toolbox Oral Extra AA batteries for Any Varies A R the keyboard Reading Recognition T NIH Toolbox Oral est bs Reading Recognition Contact Fre Test Training and cognition nihtoolbox org Certification Materials NIH Toolbox Emotion instruments additional equipment and materials None 208 Return to TOC NIH Toolbox Motor instruments additional equipment and materials Instrument Equipment Materials Vendor Approximate NIH Toolbox 9 hole Pegboard Dexterity Test NIH Toolbox Grip Strength Test NIH Toolbox Standing Balance Test NIH Toolbox 4 Meter Walk Gait Speed Test and 2 Minute Walk Endurance Test Suggestion Cost Jamar 9 Hole Peg Test Kit item number A8515 Patterson Medical 80 75 also known as Rolyan 9 hole Peg Test Kit Jamar 9 Hole Peg Test Kit Replacement Patterson Medical 11 65 Pegs item number A8516 Jamar Plus Digital Hand Dynamometer Patterson Medical 363 55 item number 563213 iPod touch 5 generation or later Appie Siara 199 00 Griffin Survivor protective case part CDW Varies 3611154 or similar AIREX Balance Pad mee Elite item number Medex Supply m A 69 00 ARX 23431 as Scott Gait Belt w Velcro item number 177 0089 various Promedxpress 14 99 19 99 sizes Sanitary booties Any Varies Any Sufficient to Measuring tape with set up a 50 Varies
8. C 5 4 NIH Toolbox Words in Noise Test This measure quantifies a participant s ability to hear words in a noisy environment Equipment and materials needed e iPad e Sennheiser HD201 headphones or similar Detailed information on equipment and materials needed for all tests can be found in Appendix 4 A female speaker instructs the participant to a say a one syllable word while in the background there is the noise of multiple people speaking at the same time At the beginning of the test the speaker s voice is much louder than the background noise as the test progresses the speaker s voice gradually becomes softer and eventually is the same level as the background noise There are seven levels of word noise ratios and five words at each level Each ear is tested separately and the test is concluded when a participant cannot repeat any of the five words at a given level in each ear separately Each screen represents a different background noise level and on each the examiner touches the word s that the participant correctly identifies If the participant correctly repeats at least one word at a level the audio files will continue to present words to that ear If all five words at a given level are incorrect the iPad will begin testing the second ear For the second ear a series of five words will appear on the iPad screen as before and the associated audio files will play in the participant s earphones If all five words at a g
9. Determining Handedness If a participant does not know or cannot tell the examiner his her handedness the following questions should be used to determine it a Which foot do you use to kick a ball Left Right b Which hand do you use to pick up and throw a ball Left Right C Which hand do you use to write or draw Left Right Whichever is selected at least two times from the above three questions right or left is determined to be the dominant hand Return to TOC 195 Appendix 3 Pausing Stopping Resuming Rules Different instruments may behave differently if Resume Instrument is selected In most cases users will be taken back to where they were before pausing the assessment In some cases e g timed tests users will be taken back to the beginning of the instrument In select cases an instrument may not be restarted once paused Detailed rules for skipping pausing or stopping each test are provided below Cognition NIH Toolbox Picture Vocabulary Test e Skip o Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted e Pause perform admin gesture and return to instrument without selecting stop or skip o During Instructions Return to active screen pause not recorded in data o During Practice Return to active screen pause not recorded in data o During Live Items Return to active screen pause not recorded in data e Stop exit
10. NIH Toolbox Odor Identification Test 10 NIH Toolbox Odor Identification Test Age 10 v2 0 NIH Toolbox Odor Identification Test 3 9 NIH Toolbox Odor Identification Test Ages 3 9 v2 0 NIH Toolbox Words In Noise Test 64 NIH Toolbox Words In Noise Test Age 6 v2 1 NIH Toolbox Regional Taste Test 124 NIH Toolbox Regional Taste Intensity Test Age 12 v2 0 NIH Toolbox Visual Acuity Test 3 7 NIH Toolbox Visual Acuity Test Ages 3 7 v2 0 NIH Toolbox Visual Acuity Test 8 NIH Toolbox Visual Acuity Test Age 8 v2 0 NIH Toolbox Dynamic Visual Acuity Test 3 7 NIH Toolbox Dynamic Visual Acuity Test Ages 3 7 v2 0 NIH Toolbox Dynamic Visual Acuity Test 8 NIH Toolbox Dynamic Visual Acuity Test Age 8 v2 0 NIH Toolbox Pain Intensity FF Age 18 NIH Toolbox Pain Intensity FF Age 18 v2 0 NIH Toolbox Pain Interference CAT Age 18 NIH Toolbox Pain Interference CAT Age 18 v2 0 NIH Toolbox Touch Screen Tutorial 3 NIH Toolbox PVT 3 NIH Toolbox Picture Vocabulary Test Age 3 v2 0 NIH Toolbox OR 3 NIH Toolbox LS 7 NIH Toolbox PC 7 NIH Toolbox PSM 3 4 Form A NIH Toolbox PSM 3 4 Form B NIH Toolbox Touch Screen Tutorial Age 3 NIH Toolbox Oral Reading Recognition Test Age 3 v2 0 NIH Toolbox List Sorting Working Memory Test Age 7 v2 0 NIH Toolbox Pattern Comparison Processing Speed Test Age 7 v2 0 NIH Toolbox Picture Sequence Memory Test Ages 3 4 Form A
11. The Left arrow takes the participant back to the previous item Ctrl 4 Shift on the Keyboard is equivalent to the gesture used to STOP an administration on the iPad Like the iPad when Ctrl Shift is entered on the keyboard a login screen will pop up and ask for the password of the user who started the assessment As described earlier three options will appear resume skip and stop In this task the participant is asked to read and pronounce letters and words as accurately as possible For the youngest children the initial items may require them to identify the letters in an array with three symbols or to identify a specific letter in an array of four letters In such cases an audio file will play instructing the participant to point out the answer on the iPad screen the examiner will score the item accordingly using the keyboard as with all other items The administration is individualized using a computerized adaptive CAT format This task is intended for participants 7 years and older although it can be administered to children as young as age 3 as appropriate The test uses age for participants younger than 18 and education for participants age 18 and older to determine which items it initially presents There is an override in the participant information screen If an examiner feels that a participant should begin the test at a level higher or lower than that determined by his her education and age the examiner should use t
12. 2 If child fails all 4 trials test will discontinue Test Sequences Children age 7 will be presented with two test trials one with a 15 step sequence and the other with an 18 step sequence Read the screen Now we are going to play the game with more pictures This time you will see how to Play in the Park Form A Go to the Fair Form B Work on the Farm Form C When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue Test Item Trial As the pictures are presented an audio recording will say appropriate labels Form A Play in the park Form B Go to the fair Form C Work on the farm e Flyakite e Geta hot dog e Put the cow in the barn e Play in the sand e Go for a pony ride e Drive the tractor e Go down the slide e Pet the sheep e Feed the pig e Pull the wagon e Win a dog show e Load the cart e Swing on the monkey e Watch the rodeo e Put the carrots in the bars e Catch a pig basket e Lay out the blanket e Judge the cake e Pick the fruit e Play catch e See a puppet theater e Fix the fence e Catch a butterfly e Take a picture of a e Cut the sheep s wool e Kick the ball clown e Collect the honey e Take the baby for a walk e Look at the babies e Shovel out the barn e Draw on the sidewalk e Goonaride e Peel the corn e Pet the dog e Get some tickets e Chop some wood e Feed the ducks e Get some ice cream e Collect the eggs e Push the swing e Playagame e Put the blanke
13. Airplanes go here Stars go here Text appears above relevant boxes E reads screen After 3 seconds Touch and Hold Here to Continue button appears E touches and holds button to continue 4B Screen 6 Here is astar Where does it go E reads screen C touches a box Live trial 2 4B Screen 7 If i s an airplane then it goes in the E reads screen After 5 seconds Touch Rule reminder 3 airplane box If it s a star then it goes in the star box Text appears above relevant boxes and Hold Here to Continue button appears E touches and holds button to continue 4B Screen 8 Here is an airplane Where does it go E reads screen C touches a box Live trial 3 4B Screen 9 Airplanes go here Stars go here text E reads screen After 3 seconds Touch Rule reminder 4 above boxes and Hold Here to Continue button appears E touches and holds button to continue 4B Screen 10 Live Trial 4 Here is an airplane Where does it go E reads screen C touches a box 4B Screen 11 Rule reminder 5 If its an airplane then it goes in the airplane box If it s a star then it goes in the star box Text appears above relevant boxes E reads screen After 5 seconds Touch and Hold Here to Continue button appears E touches and holds button to continue 4B Screen 12 Live Trial 5 Here is a star Where does it go E reads screen C touches a box DEXT Phase
14. Battery Information Battery Name Custom2 v Selected Instruments E NIH Toolbox 2 Minute Walk Endurance Test Age 3 v2 0 Drag to reorder NIH Toolbox Odor Identification Test Ages 3 9 v2 0 v Available Instruments Sensation w AllAges All Types amp 63 E NIH Toolbox Odor Identification Test Age 10 v2 0 Sen Select Tap Done in the upper right corner of the screen or the arrow in the upper left corner to save the selection and return to the previous screen Return to TOC 2d B 4 4 Export Data The Export Data button allows the user to export data collected on a given iPad At any point when export is selected it will contain all the data cumulatively collected on that iPad There are three options to transfer data files from the iPad to another device i e computer connected to a backup server e mail iCloud drive and file sharing via iTunes hard wired Only file sharing via iTunes is activated by default To activate the ability to email files and upload them to iCloud please update Data Security in the NIH Toolbox app Settings Data security settings can be updated at any time before or after data files were generated There are three steps to exporting data Step 1 Tap the Export Data button on the app s home screen The next screen File List will be either blank if no files were previously created or contain the list of previously generated files e File List Return to TOC il Step 2 T
15. NIH Toolbox Participant Instructions for Self Report Measures Children and Adults On the next screens we will ask you questions about your thoughts feelings and behaviors Read each question carefully and answer as well as you can There is no right or wrong answer only what is true for you and describes your thoughts feelings and behaviors Select an answer by touching your answer choice on the screen After you make your choice the computer will automatically go on to the next question If you want to change your answer touch the GO BACK button to return to the question then touch a different answer choice A button at the bottom of the screen says Touch and Hold Here to Continue The content and order of measures within the self report batteries are shown in the following tables C 3 3 1 NIH Toolbox Emotion Battery age 18 Instrument name NIH Toolbox Emotion Instructions Adult Child CAT or of Items in Fixed Form NIH Toolbox Positive Affect CAT Age 18 v2 0 CAT NIH Toolbox General Life Satisfaction CAT Age 18 v2 0 CAT NIH Toolbox Meaning and Purpose CAT Age 18 v2 0 CAT NIH Toolbox Emotional Support FF Age 8 v2 0 8 NIH Toolbox Instrumental Support FF Age 18 v2 0 8 NIH Toolbox Friendship FF Age 8 v2 0 8 NIH Toolbox Loneliness FF Age 8 v2 0 5 NIH Toolbox Perceived Rejection FF Age 8 v2 0 8 NIH Toolbox Perceived Hostility FF Age 8
16. STRESS amp SELF NIH Toolbox Fear Affect CAT Age 18 v2 0 CAT Sadness NIH Toolbox Sadness CAT Age 18 v2 0 CAT NIH Toolbox Anger FF Ages 8 17 v2 0 6 Fear NIH Toolbox Fear FF Ages 8 17 v2 0 8 Sadness NIH Toolbox Sadness FF Ages 8 17 v2 0 8 NIH Toolbox Anger Parent Report CAT Ages 8 12 v2 0 CAT NIH Toolbox Fear Parent Report CAT Ages 8 12 v2 0 CAT Sadness NIH Toolbox Sadness ParentReport CAT Ages 8 12 v2 0 CAT NIH Toolbox Anger Parent Report FF Ages 3 7 v2 0 9 NIH Toolbox Fear Over Anxious Parent Report FF Ages 3 7 v2 0 6 NIH Toolbox Fear Separation Anxiety Parent Report FF Ages 3 7 v2 0 7 Sadness NIH Toolbox Sadness Parent Report FF Ages 3 7 v2 0 CATs are typically 4 6 items in length nore Many NIH Toolbox Emotion Measures include items drawn from existing measures These were used with their author s permission Sources of items can be found on the NIH Toolbox website http www nihtoolbox org WhatAndWhy Emotion Acknowledgements Pages default aspx Return to TOC ix C 4 Motor Domain Motor function is the ability to use and control muscles and movements Motor performance includes voluntary control of both fine and gross motor functions including dexterity strength balance locomotion and endurance Motor performance also requires the interaction of multiple body systems including the nervous muscular cardiovascular and sensory perceptual
17. change data security Settings settings view app diagnostic info Once the app is launched users will see 4 buttons on the home screen Participants Batteries Export Data and Settings This section of the manual is organized according to the functions achieved by tapping one of those buttons Data security is described at the end of the section noe Required setting A passcode must be set on the iPad running the NIH Toolbox app for security purposes The app will not launch if a passcode is not set noe Recommended setting Disable all pop up messages i e calendar alerts on the iPad running the NIH Toolbox app This will ensure smooth uninterrupted data collection Return to TOC 12 B 4 2 Participants Create a new participant Step 1 Tap Add New Participant in the upper right corner of the Participant screen Participants Step 2 Complete the new participant information Participant 2 Gender Birthdate Highest Education Level Completed Mother s Education Handedness Race Ethnicity Assessments Add New Assessment Return to TOC in e Identifier any alphanumeric combination or special symbols you wish to assign to this participant This is the only field that is ALWAYS required e Name the participant s name This is the only field that is ALWAYS optional regardless of the function you wish to use Gender Birthdate Highest Education Level Completed Mother s Education Handedness
18. is displayed where appropriate Read the screen would like you to use the pointer index finger of this point to dominant right or left as appropriate hand to answer Let s look at these two faces One of them is a SMILEY face and the other is a FROWN face point to each Touch and hold button that says Touch and hold here to continue Read the screen Now I am going to show you some pictures On each screen there will be two pictures Sometimes the pictures look alike or the same and sometimes the pictures do not look alike and are NOT the same When the pictures look alike or the same you should choose the SMILEY face When they do NOT look alike or the same you should choose the FROWN face Touch and hold button that says Touch and hold here to continue Return to TOC is Ages 3 6 Practice Item 1 Read the screen Look at the boxes on the screen in them are two pictures this picture point to left box and this picture point to right box These two pictures look alike or the same so we ll choose the SMILEY face Let s choose the SMILEY face together Y x kd V y v E i Py A Audio recording says Great job when the SMILEY face is touched Next item will appear Ages 3 6 Practice Item 2 Read the screen Look at these pictures here This picture point and this picture point do NOT look alike or the same This picture point is purple but this picture point is oran
19. Ask this of the child If child says YES touch and hold the YES button If the child says NO touch any of the pictures and the pop up will disappear If no picture is moved out of a gray box the pop up will continue to be on the screen The pop up will close if a picture is moved back to the yellow box and will reappear each time all pictures have been placed in gray boxes Logic 1 If child gives correct response Test Item will be presented 2 If child gives incorrect response Have a Birthday Party will be presented again with an audio recording saying Let s try that again After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to Have a Birthday Party Now you move the pictures in the same way you saw them on the screen 3 If child gives incorrect response again 2 above is repeated up to two additional times or a total of 4 trials 4 If child fails all 4 trials test will discontinue Test Sequences Children ages 3 4 are presented with two trials of a 6 step sequence Read the screen Now we are going to play the game with more pictures This time you will see how to Play in the Park Form A Go to the Fair Form B Work on the Farm Form C When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue Test Item Trial 1 As the pictures are presented an audio recording will say appropriate labels Fo
20. If participant does not touch the flower the flower remains on the screen Read Good Now we are going to do some more Touch the button at the bottom of the screen that says Touch and Hold Here to Continue Read Now touch the star After participant touches the star the next screen appears If participant does not touch the star the star remains on the screen Read Good Let s do one more Touch the button at the bottom of the screen that says Touch and Hold Here to Continue Read Now touch the apple After participant touches the apple the next screen appears If participant does not touch the apple the apple remains on the screen Read Good Now you are ready to continue When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue Return to TOC oe C 2 Cognition Domain Cognition refers to the mental processes involved in gaining knowledge and comprehension such as thinking knowing remembering judging and problem solving These higher level functions of the brain encompass language imagination perception and the planning and execution of complex behaviors woe There is an Early Childhood Cognition Battery designed for ages 3 6 and a Cognition Battery for ages 7 85 or you can create a custom battery Early Childhood Cognition Battery NIH Toolbox instrument development focused special attention on assessing young children to ensure that all tests and surveys
21. Instructions Now it s going to be your turn to put the elephant in the elephant box E reads screen after 2 seconds Touch and Hold Here to continue button appears Then E touches and holds the button to continue OK let s play E reads screen and then touches and holds button to advance to next screen 1B Screen 3 Rule reminder 1 If it s an elephant then it goes in the elephant box Appears above the elephant box E reads screen and points to elephant box then E touches and holds button to advance to next screen 1B Screen 4 Here is an elephant Where does it go E reads screen C touches Live trial 1 a box 1B Screen 5 Elephants go here Appears above the elephant E reads screen points to Rule reminder 2 box elephant box and then E touches and holds button to continue Return to TOC 77 1B Screen 6 Live trial 2 Here is an elephant Where does it go E reads screen C touches a box 1B Screen 7 Rule reminder 3 If i s an elephant then it goes in the elephant box Appears above the elephant box E reads screen and points to elephant box then E touches and holds button to advance to next screen 1B Screen 8 Here is an elephant Where does it go E reads screen C touches Live trial 3 a box 1B Screen 9 Elephants go here Appears above the elephant E reads screen and points Rule reminder 4 box to el
22. Look at this The hungry Fish has friends These fish friends are NOT hungry only the MIDDLE Fish is hungry Watch me while touch the button that is pointing the same way that the hungry MIDDLE Fish is swimming E reads screen and then E touches right arrow When correct arrow is touched bubbles sound plays and iPad says Mmm thank you Touch and hold here to continue appears on screen E touches and holds button to continue DEXT Screen 18 Practice Trial 3 Now it s your turn to feed the hungry MIDDLE fish want you to touch the button pointing the same way the MIDDLE Fish is swimming E reads screen C touches an arrow If incorrect iPad says Let s try again Repeats until correct If correct bubbles sound plays and iPad says Mmm thank you Touch and hold here to continue appears on screen E touches and holds button to continue DEXT Screen 19 Now you try E reads screen and then E touches and Transition e holds button to continue Keep your eyes on the star in the middle of the screen DEXT Screens 5 items Spacing Size Color block If either arrow is touched bubbles sound 20 24 plays If neither arrow is touched moves on to new item after 10 seconds DEXT Screens 25 29 5 items Size Color block If either arrow is touched bubbles sound plays If neither arrow is touched moves on to new item after 10 seconds DEXT Screens 5 items Color blo
23. SMILEY face the audio recording says These pictures do not look alike and are NOT the same One picture is a flower with a stem and one picture is only the top of a flower with no stem Choose the FROWN face FROWN face will flash item will stay on screen If no response the audio recording repeats Are these the same If child chooses correctly the audio recording will say Great job Next item will appear If child chooses incorrectly another time iPad program moves to next practice item after repeating explanation above Ages 3 6 Practice Item 5 Audio recording says Are these the same Pictures will stay on screen until there is a response and audio recording will repeat Are these the same oe If correct SMILEY face the audio recording says Great job Next item will appear If incorrect FROWN face the audio recording says These pictures look alike the same Both are pictures of a present or gift box so choose the SMILEY face SMILEY face will flash item will stay on screen If no response the audio recording repeats Are these the same If child chooses correctly the audio recording will say Great job Next item will appear If child chooses incorrectly another time iPad program moves to next practice item after repeating explanation above Ages 3 6 Practice Item 6 Audio recording says Are these the same Pictures will stay on screen until there is a response and audio recording will repeat Are
24. a tone will sound After a few more seconds the examiner will be able to touch the PASS or STOP FAIL button Whenever the PASS or the STOP FAIL button is touched a pop up window asking for confirmation of the choice will appear The examiner must confirm his her choice to move onto the next trial After participant completes one or both trials say Are you ready for the next one Proceed with the next pose or allow the participant to rest following the procedures noted above Pose 4 Screen Foam surface feet together eyes closed is the same as Pose 3 except that the participant s eyes are closed The examiner should demonstrate the pose describing what he she is doing as it is being done The participants turn is next the examiner should ask the participant to stand in the desired position saying Please step onto the foam and put your feet together heels and balls of feet touching and stand as still as possible with your arms crossed on your chest and then close your eyes like this demonstrate for participant Ready After the participant assumes the position the examiner touches the START button and says Go The examiner should check the participant s posture The iPad screen will display the elapsed time of the trial so the examiner can easily see it while assuring the safety of the participant Choose STOP FAIL if the participant did not successfully complete the trial for any reason If the first trial is failed for any
25. appears Then E touches and holds button to advance to next screen 2A Screen 13 Live Trial 2 Here is a big kitty Where does it go E reads screen C touches a box 2A Screen 14 Rule reminder 3 If it s a little kitty then it goes in the little kitty box If it s a big kitty then it goes in the big kitty box Text appears above relevant boxes E reads screen After 5 seconds Touch and Hold Here to Continue button appears Then E touches and holds button to continue Return to TOC 80 2A Screen 15 Live Trial 3 Here is a little kitty Where does it go E reads screen C touches a box 2A Screen 16 Rule reminder 4 Little kitties go here Big kitties go here Text appears above relevant boxes E reads screen After 3 seconds Touch and Hold Here to Continue button appears E touches and holds button to continue 2A Screen 17 Live trial 4 Here is a big kitty Where does it go E reads screen C touches a box 2A Screen 18 Rule reminder 5 If it s a little kitty then it goes in the little kitty box If it s a big kitty then it goes in the big kitty box Text appears above relevant boxes E reads screen After 5 seconds Touch and Hold Here to Continue button appears E touches and holds button to continue 2A Screen 19 Live Trial 5 Here is a big kitty Where does it go E reads screen
26. decoding skills measured by the NIH Toolbox Oral Reading Recognition Test Processing Speed The amount of time it takes to mentally process a set amount of information or the amount of information that can be processed within a certain unit of time It is a measure that reflects mental efficiency and is measured by the NIH Toolbox Pattern Comparison Processing Speed Test Working Memory The capacity of an individual to hold information in a short term buffer and manipulate the information It is measured by the NIH Toolbox List Sorting Working Memory Test Time to Cognition Battery Instruments Administer minutes NIH Toolbox Picture Vocabulary Test NIH Toolbox Flanker Inhibitory Control and Attention Test 3 85 NIH Toolbox List Sorting Working Memory Test 7 85 NIH Toolbox Dimensional Change Card Sort Test 3 85 NIH Toolbox Pattern Comparison Processing Speed Test 7 85 NIH Toolbox Picture Sequence Memory Test 3 85 NIH Toolbox Oral Reading Recognition Test 7 85 CO NO AINI amp Part of the NIH Toolbox Early Childhood Cognition Battery Return to TOC i In addition to the instruments available as part of the cognition battery which may also be administered individually there are Supplemental instruments that may be administered to participants either in addition to or more likely in lieu of cognition battery instruments assessing the same constru
27. following the procedures noted above Pose 5 Flat surface tandem stance eyes open The examiner should demonstrate the pose describing what he she is doing as it is being done The participant s turn is next the examiner should ask the participant to stand in the desired position saying Please stand with the heel of one foot touching the toes of the other foot on the ground Keep them in a straight line Stand as still as possible with your eyes open and with your arms crossed on your chest like this demonstrate for participant Before you do this try each foot in front and decide for yourself which one is more comfortable Then focus on the X on the wall in front of you Ready After the participant assumes the position the examiner touches the START button and says Go The examiner should check the participant s posture The iPad screen will display the elapsed time of the trial so the examiner can easily see it while assuring the safety of the participant Choose STOP FAIL if the participant did not successfully complete the trial for any reason If the first trial is failed for any reason start he second trial of this pose the examiner should say Let s try that one again Please stand with the heel of one foot touching the toes of the other foot on the ground Keep them in a straight line Stand as still as possible with your eyes open and with your arms crossed on your chest like this demonstrate for
28. o During Live Items Return to active screen pause not recorded in data Stop exit the instrument by selecting stop with the intention of resuming at a later time o During instructions Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Practice NO PRACTICE IN OR o During Live Items Participant sees item equivalent to last item shown Dichotomous engine will find the un administered item whose difficulty setting is closest to the user s theta which will be used for restarting On restart the engine is provided with the user s existing theta score instead of the starting theta value 199 Return to TOC Emotion Emotion Fixed Form e Skip o Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted e Pause perform admin gesture and return to instrument without selecting stop or skip o During Instructions Return to active screen pause not recorded in data o During Practice NO PRACTICE IN EMOTION o During Live Items Return to active screen pause not recorded in data e Stop exit the instrument by selecting stop with the intention of resuming at a later time o During instructions Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Practice NO PRACTICE IN EMOTION o During Live Items Participant sees last live item
29. pointing this way choose this button E points then chooses arrow button If the MIDDLE fish is pointing this way choose this button E points then chooses arrow button Transition to more practice items Now you try Keep your eyes on the star in the middle of the screen E reads screen then touches and holds button to continue Practice Items set 2 4 practice items Return to TOC 48 More practice if less than 3 out of 4 correct on set 2 iPad screen written content Let s practice some more If the MIDDLE fish is pointing this way choose this button Examiner E Action E points then chooses arrow button If the MIDDLE fish is pointing this way choose this button E points then chooses arrow button Transition to more practice items Now you try Keep your eyes on the star in the middle of the screen E reads screen then touches and holds button to continue Practice Items set 3 4 practice items Test ends if less than 3 out of 4 correct on set 3 Test items Now you re ready to do this without me E reads screen then touches transition Keep your eyes on the star in the middle of the and holds button to continue screen Test items 20 test items fish Test ends if less than 90 success on fish Home Base training if 90 or greater success on fish Now you will do the same thing but you will
30. touch the button at the bottom of the screen that says Touch and Hold Here to Continue As pictures are presented an audio recording will say the appropriate labels First put up the tent Then go for a hike Then catch a fish And last roast a marshmallow After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to Go Camping Now you move the pictures in the same way you saw them on the screen When all pictures have been placed in gray boxes a pop up will appear on the screen Are you finished Ask this of the child If child says YES touch and hold the YES button If the child says NO touch any of the pictures and the pop up will disappear If no picture is moved out of a gray box the pop up will continue to be on the screen The pop up will close if a picture is moved back to the yellow box and will reappear each time all pictures have been placed in gray boxes If child gives correct response Test Items will be presented If child gives incorrect response Go Camping will be repeated with an audio recording saying Let s try that again After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to Go Camping Now you move the pictures in the same way you saw them on the screen Logic 1 If child gives incorrect response again 2 above is repeated up to two additional times or a total of 4 trials
31. yellow box and will reappear each time all pictures have been placed in gray boxes Logic Test will terminate after the two test sequences have been presented C 2 6 4 Picture Sequence Memory Test Instructions Age 8 If the participant has difficulty dragging the pictures across the screen during the demonstration sequence practice sequences or the actual test sequences he she may point and the examiner will move the pictures in the way the participant indicates The examiner should ensure the participant completely understands how the process will work and can say something like the following You point to the picture you want to move then point to the gray box where you want to move it I ll move it there for you The test begins with a Title Screen NIH Toolbox PSM 8 Form A B or C At the bottom of the screen is a button Touch and Hold Here to Continue Touch and hold that button to begin the test On the next screen read the text Now we are going to play a memory game but first am going to teach you how to move the pictures on this screen When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue The next screen begins the three step demonstration sequence f the steps are not followed the Touch and Hold Here to Continue button will not be active Step 1 Moving Pictures from the Yellow Box to the Gray Boxes Read the text above the yellow box on the sc
32. 4 is complete End of DCCS Return to TOC 89 C 2 4 3 Dimensional Change Card Sort Test Instructions Ages 8 11 This table outlines the item content read by as well as the actions for the examiner Title Screen iPad screen written content NIH Toolbox DCCS 8 11 Examiner E Actions E touches and holds button to continue Home Base Intro We re going to play a matching game with colors and shapes But first we are going to learn about Home Base This is your Home Base Put your finger on the Home Base and wait for the next picture Reads screen and points to Home Base then touches and holds button to continue SHAPE intro We ll play the SHAPE game first In the SHAPE game E points to BOAT choose the picture that s the same SHAPE as the picture then demonstrates in the middle of the screen If it s a BOAT choose this use of button picture If it s a RABBIT choose that picture E points to RABBIT then touches and holds button to continue Transition Now you try E reads screen then Keep your eyes on the star Answer as fast as you can without making mistakes If you make a mistake just keep going Put your finger back on Home Base after you answer touches and holds button to continue Shape Practice Set 1 4 items sorted by shape More practice if less than 3 out of 4 correct on Set 1 Let s practice that some more In the SHAPE game choose the
33. 5 3 2 NIH Toolbox Visual Acuity Test Instructions Ages 8 Before beginning the testing set up the iPad on a stand that sits on a table such that the iPad is 3 meters from the participant Pair the wireless keyboard by Bluetooth with the iPad if it has not already been paired The task is introduced with the Title Screen NIH Toolbox Visual Acuity Test 8 At the bottom of the screen is a button that instructs the examiner to Press the Spacebar to continue Ask the participant if he she wears glasses or contact lenses for distance vision If the participant does wear lenses but indicates he she has forgotten them or does not have them for any reason the examiner may choose to continue testing or not it is at the examiner s discretion Moreover if the participant requires a very strong correction testing will not likely be valid without the corrective lenses The examiner should note any such irregularities and if testing is completed in such a case the results should be interpreted with caution Once the participant is seated in a chair that is 3 meters from the iPad say Now we are going to do an activity where you will tell me what letters you see on the screen You are going to look on this screen point to iPad and you will see a letter Each time want you to tell me the letter you saw on the screen If you are not sure it is OK to guess The letters will get smaller and smaller until you cannot really see them That is ok We
34. 8 Form A v2 0 NIH Toolbox PSM 8 Form B NIH Toolbox Picture Sequence Memory Test Age 8 Form B v2 0 NIH Toolbox PSM 8 Form C NIH Toolbox Picture Sequence Memory Test Age 8 Form C v2 0 NIH Toolbox FL 3 7 NIH Toolbox Flanker Inhibitory Control and Attention Test Ages 3 7 v2 0 NIH Toolbox FL 8 11 NIH Toolbox Flanker Inhibitory Control and Attention Test Ages 8 11 v2 0 NIH Toolbox FL 12 NIH Toolbox Flanker Inhibitory Control and Attention Test Age 12 v2 0 NIH Toolbox DCCS 3 7 NIH Toolbox Dimensional Change Card Sort Test Ages 3 7 v2 0 NIH Toolbox DCCS 8 11 NIH Toolbox Dimensional Change Card Sort Test Ages 8 11 v2 0 Return to TOC 211 Title screen displayed in the app Corresponding Instrument Name NIH Toolbox DCCS 12 NIH Toolbox Dimensional Change Card Sort Test Age 12 v2 0 NIH Toolbox 4 Meter Walk Gait Speed Test 7 NIH Toolbox 4 Meter Walk Gait Speed Test Age 7 v2 0 NIH Toolbox 9 Hole Pegboard Dexterity Test 3 NIH Toolbox 9 Hole Pegboard Dexterity Test Age 3 v2 0 NIH Toolbox Grip Strength Test 3 NIH Toolbox Grip Strength Test Age 3 v2 0 NIH Toolbox Standing Balance Test 3 6 NIH Toolbox Standing Balance Test Ages 3 6 v2 0 NIH Toolbox Standing Balance Test 7 NIH Toolbox Standing Balance Test Age 7 v2 0 NIH Toolbox 2 Minute Walk Endurance Test 3 NIH Toolbox 2 Minute Walk Endurance Test Age 3 v2 0
35. BEAR press 1 and then press spacebar An audio recording says That s right When it appears on the screen ask Are you ready When the participant answers affirmatively press the spacebar and 2 List Practice Item 2 will be presented Return to TOC os If participant answers the question incorrectly press 0 and then press spacebar Test will be discontinued 2 List Practice Item 2 Trial 1 After the pictures are presented and the screen is blank an audio recording says Say the food in size order from smallest to biggest and then say the animals in size order from smallest to biggest Correct Response If participant says PINEAPPLE FROG TIGER press 1 and then press spacebar An audio recording says That s right When it appears on the screen ask Are you ready When the participant answers affirmatively press the spacebar and the 2 list introduction screen will be presented Incorrect Response If participant does not say PINEAPPLE FROG TIGER press 0 and then press spacebar An audio recording says Let s try that again Trial 2 if Trial 1 was incorrect An audio recording continues You saw a frog a pineapple and a tiger The pineapple is a food the frog is the smallest animal and the tiger is the biggest animal Now say the food in size order starting with the smallest food and then the animals in size order from smallest to biggest Correct Response If participant says PINEAPPLE FROG TIGER press 1 and the
36. Example Pyrex Brown Solution Storage Bottles price for case of four 500 ml bottles is 173 65 A lab spoon Example Fisherbrand Lab Spoon price 13 93 each Plastic weigh boats Example Anti Static Weighing Boats price for small needed for quinine 39 for 500 price for large needed for NaCl 83 50 for 500 Food Kosher or USP grade Quinine monohydrochloride dihydrate Example Aldrich Quinine monohydrochloride dihydrate price 58 for 100 grams USP grade NaCl Example Spectrum Sodium Chloride Granular USP price 174 70 per 2 5 kg Can also be ordered in bulk Distilled or deionized water Example EartH2O Distilled Water available in grocery stores prices vary by location Note NIH Toolbox norms were collected using USP grade NaCl formula weight 58 44 available from Spectrum Chemicals and Kosher grade quinine monohydrochloride dihydrate formula weight 396 9 available from Sigma Aldrich Sterile cotton swabs Distilled deionized or other purified water for rinsing Example Aquafiina Dasani is NOT recommended because minerals are added back in after the purification Spittoon iPad stand Example Belkin Portable Tablet Stage price 97 99 Mixing instructions Make sure that balance is on a level surface Add weigh boat to balance pan and carefully zero the balance Then add 58 44 grams of NaCl to the weigh boat To mix the 1 Molar NaCl solution you will need to add the NaCl to 1 liter of purified water To d
37. FF Age 8 v2 0 7 NIH Toolbox Friendship FF Age 8 v2 0 5 NIH Toolbox Loneliness FF Age 8 v2 0 7 NIH Toolbox Perceived Rejection FF Age 8 v2 0 B NIH Toolbox Perceived Hostility FF Age 8 v2 0 5 NIH Toolbox Self Efficacy CAT Ages 13 17 v2 0 CAT NIH Toolbox Perceived Stress FF Ages 13 17 v2 0 10 NIH Toolbox Anger Affect FF Ages 8 17 v2 0 6 NIH Toolbox Sadness FF Ages 8 17 v2 0 8 8 NIH Toolbox Fear FF Ages 8 17 v2 0 NIH Toolbox Emotion Instructions Parent Report On the next screens you will see questions about your child s feelings and behaviors Read each question carefully and answer as best you can Please consider each question by itself and choose an answer that you believe honestly shows how your child feels and acts Select an answer by touching the answer choice on the screen After you make your choice the computer will automatically go on to the next question If you want to change your answer touch the GO BACK button to return to the question then touch a different answer choice A button at the bottom of the screen says Touch and Hold Here to Continue The content and order of measures within the parent report batteries are shown in the following tables 132 Return to TOC C 3 3 4 NIH Toolbox Emotion Parent Report Battery ages 3 7 Instrument name CAT or of Items in Fixed Form NIH Toolbox Emotion Instructions Parent Report NIH Toolbox Posit
38. If any other order press 0 If 1 goes to 1 list test items If 0 goes to Q2 Q2 Animals in size order starting with the smallest If Rabbit Sheep Elephant press 1 If any other order press 0 If 1 goes to 1 list test items If 0 goes to Q3 Q3 Animals in size order If Rabbit Sheep Elephant If 1 goes to 1 list test items If 0 test discontinued starting with the smallest press 1 If any other order press 0 1 List Test Items Say Let s look at some more pictures Remember after you see the pictures you will see a blank screen Once you see this blank screen want you to tell me what you just saw in size order from smallest to biggest It is important to pay attention to the size of the object on the screen when putting things in size order from smallest to biggest Are you ready Press the spacebar to continue and the presentation of the 1 List test items will begin As noted earlier after the examiner chooses 1 or 0 the question Are you ready appears on the screen Once confirming that the participant is ready and attending the examiner presses the spacebar to move on to the next item list of objects For the examiner there is a code at the bottom right side of the iPad screen to indicate which item is being administered The examiner should use this code to look up the correct response on the NIH Toolbox List Sorting Working Memory Test Examiner Answer Sheet a
39. Screening Participant sees item from last optotype size not responded to o During Live Items Participant sees item equivalent to last item shown NIH Toolbox Words In Noise Test e Skip o Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted e Pause perform admin gesture and return to instrument without selecting stop or skip o During Instructions Return to active screen pause not recorded in data o During Practice NO PRACTICE ITEMS IN WIN TEST o During Live Items Participant sees last live item not responded to e Stop exit the instrument by selecting stop with the intention of resuming at a later time o During instructions Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted o During Practice NO PRACTICE ITEMS IN WIN TEST o During Live Items Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted NIH Toolbox NIH Toolbox Regional Taste Intensity Test e Skip o Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted e Pause perform admin gesture and return to instrument without selecting stop or skip o During Instructions Return to active screen pause not recorded in data o During Practice Return to active screen pause not rec
40. The examiner should direct participant to sit in the chair while the examiner measures the distance from the last cone passed to the piece of tape The examiner should press NEXT button on the test trial screen to submit the trial data the laps The Next button becomes active at the end of the trial when 2 minutes have elapsed Once Next is pressed the app proceeds to the screen where more detailed measurements can be entered A new screen will appear This screen is a data screen that shows the Laps that were recorded on the previous screen and number wheels for the number of 10 feet single feet and inches measured after the participant completes the two minutes This data entry screen is given below Count the number of 10ft intervals from the last cone passed to the tape marking where the participant stopped and record that in the field 10 ft Marks below Then measure the distance from the last 10ft interval passed to where the participant stopped and record feet and inches in the corresponding fields below turns 8 al 10 ft marks 2 additional feet walked 3 additional inches walked 2 The examiner should record the distance from the last cone to where the participant stopped on this data screen and press NEXT to submit the data All the fields can be adjusted until NEXT is pressed C 5 Sensation Domain Sensation refers to the biochemical and neurologic process of detecting incoming n
41. You will squeeze the handle 2 times one practice and one test trial with each hand while your arm is against your side see note below and your elbow is bent like this demonstrate 90 degrees The handle won t move but the machine will show how hard you squeezed Press RESET and TEST then squeeze to demonstrate See Show participant the force measurement Do you have any questions After the participant demonstrates understanding touch the button at the bottom of the screen that says Touch and Hold Here to Continue 0 Against your side means next to but not touching your body Practice dominant hana Press RESET and TEST Say Let s practice with your RIGHT or LEFT as appropriate hand point to hand if needed When say squeeze want you to squeeze the handle hard but not as hard as you can Support dynamometer Continue Ready 3 2 1 squeeze After 3 4 seconds say Stop Press RESET and TEST on dynamometer before continuing Practice non dominant hana Continue Now we re going to practice with your RIGHT or LEFT as appropriate hand point to hand if needed When I say squeeze want you to squeeze the handle hard but not as hard as you can Support dynamometer Continue Ready 3 2 1 squeeze After 3 4 seconds say Stop Press RESET and TEST on dynamometer before continuing Test Trial dominant hand Say Now we re going to test each hand beginning with your RIGHT or L
42. and agrees that the use or disclosure of trade secrets in a manner inconsistent with the provisions of this Agreement may cause NU NIH irreparable damage for which remedies other than injunctive relief may be inadequate Accordingly User agrees that in any request by NU NIH to a court of competent jurisdiction for injunctive or other equitable relief seeking to restrain such use or disclosure User will not maintain that such remedy is not appropriate under the circumstances PERMISSIONS AND LICENSING POLICY Reproduction of any NIH Toolbox materials requires the prior written consent of NU NIH Questions and answers including practice questions and answers may not be reproduced without written permission regardless of the number of lines or items involved Test copies may not be bound in theses or reports placed in libraries generally circulated or accessible to the public or in any article or text of any kind NU NIH will consider requests for permission to reproduce modify or translate part or all of any copyrighted publication and will consider the granting of licenses for use of NU NIH copyrighted materials Requests to reproduce translate adapt modify or make special versions of these publications should be made by written request through the NU NIH Contact Us page on the NIH Toolbox website at www nihtoolbox org Please enter request details in the message box Once approved any reproduction must include acknowledgement of the
43. are trying to determine how small they can get before you cannot see them Are you ready to start Press Spacebar on keyboard to continue Visual Acuity Test with glasses or contact lenses if usually worn for distance vision The examiner should record the participant s response on the keyboard by entering the letter said Each time a letter is displayed say Tell me what you see At the examiner s discretion this can be replaced by Go ahead after a few letters have been displayed The examiner records the participant s response on the wireless keyboard specifically once the participant names the letter on the screen the examiner types that letter into the keyboard After typing the letter the examiner presses the spacebar to move on to the next letter The iPad software will automatically score the response and present the next item accordingly The next item will not appear until the examiner has recorded the participant s response to the item currently on screen The test will progressively present smaller letters if the participant answers correctly or larger ones if the participant answers incorrectly until an acuity score is established The test will automatically end when the program has calculated the acuity score Note If a participants Visual Acuity Test score is equivalent to 20 400 vision or worse it suggests serious uncorrected distance vision deficits exist A follow up evaluation by a vision professional is suggested
44. as Non Validated Adaptations of NIH Toolbox tests and test items made by User User may under no circumstances license distribute or share any components of NIH Toolbox with third parties regardless of the extent of modifications without official written consent of NU NIH User is entitled to no ownership claim of intellectual property as a result of making any NIH Toolbox modifications and is hereby enjoined from communicating or stating any such claims MAINTENANCE OF TEST SECURITY AND TEST USE Each person or institution using the NIH Toolbox must agree to comply with these basic principles of test security 1 2 3 4 Test takers must not receive test answers before beginning the test Test questions are not to be reproduced or paraphrased in any way Access to test materials must be limited to qualified persons with a responsible professional interest who agree to safeguard their use Test materials and scores may be released only to persons qualified to interpret and use them properly If a test taker or the parent of a child who has taken a test wishes to examine test responses or results the parent or test taker may be permitted to review the test and the test answers in the presence of a representative of the school college or institution that administered the test Such review should not be permitted in those jurisdictions where applicable laws require the institution to provide a photocopy of the test subsequent to
45. button Practice Screen 3 Say Now think about the brightest light you have ever seen Use the scale to rate the intensity or strength of the brightest light you have ever seen When you are finished touch the OK button If a participant has difficulty touching the screen he she may point and the examiner may touch The examiner should say something like the following to the participant You can point to your choice and then can touch the screen for you Test Items There are four trials quinine on the tongue tip salt on the tongue tip quinine in the whole mouth and salt in the whole mouth The examiner should follow the prescribed order Preparation for test items Read Now we are going to do the taste test Before we begin please rinse out your mouth two times with the bottled water and then spit the rinse water into this container show container Continue Now am going to ask you to rate the strength of these tastes First will put some of the solution across the tip of your tongue and ask for a rating To begin will put on these gloves See steps below Step 1 The examiner should put on gloves for the remainder of this measure Step 2 Say Then I will put this sterile cotton swab into the solution Put the swabs into the cups of solution The examiner should touch and hold button at the bottom of the screen to advance to next screen Step 2 Step 1 Step 3 Test item 1 Say Now hol
46. cases for use during administration of any or all instruments 1 http www otterbox com en us ipad cases 2 http www logitech com en us product blok protective case wt ac id global news blokcase 081515 If a less expensive alternative is desired and young children are not being tested here is a link to an example of a recommended case http Awww apple com shop product MGTM2ZM A ipad air smart cover black fnode a87dbdead2a27022cf9ab0e35304a975132e244355b424ba4a40d2b00bedcc62c3 99c0671951dea0e39b2001 13ed409bda61 1c17ef86559beeb743d176f9bf42813847c4c361127c 478b04af1540e623b25db8c477687d51c63802fa1 1df130e4e7decbc26fddbde805d751 bbf55deb NIH Toolbox Cognition instruments additional equipment and materials Instrument Equipment and Approximate NIH Toolbox Picture Materials Vendor Suggestion Cost Vocabulary Test None NIH Toolbox Flanker EE S S S S Download from NIH Inhibitory Control and Home Base Toolbox Website Free Attention Test E Bluetooth Wireless Keyboard Apple Store 69 00 Extra AA batteries for NIH Toolbox List the keyboard Any varies Sorting Working NIH Toolbox List Memory Test ue d Contact pus sdb Nica cognition nihtoolbox org Examiner Answer Sheet NIH Toolbox Dimensional Change Home Base idee Mg Free Card Sort Test NIH Toolbox Pattern Comparison u Processing Speed None Test NIH Toolbox Picture Sequence Memory None
47. choose one of two buttons on the screen that corresponds to the direction in which the MIDDLE fish or arrow is pointing On congruent trials all the fish or arrows are pointing in the same direction On incongruent trials the flanking fish or arrows are pointing in the opposite direction of the middle fish or arrow Congruent and incongruent trials are mixed The word middle appears on the screen for all participants for younger participants ages 3 11 an audio recording also says MIDDLE to remind participants where to focus a star in the middle of the screen All the instructions are on the iPad screen The examiner reads them to and or with the participant and points out the relevant aspects of the stimuli on the screen There are two versions of this measure for ages 3 7 The first is the standard NIH Toolbox Flanker test for ages 3 7 The second is an experimental version with developmental extension or DEXT that was designed to extend the range of assessment downward for those participants who have difficulty understanding the standard task Both versions yield a score for the standard measure and the DEXT version provides simple raw scores and percentages for the experimental items Standard administration all ages Practice items In this version all participants are first presented with four practice trials If the participant responds incorrectly an audio recording provides feedback and highlights the
48. composites for the Cognition Battery Instrument A set of items administered in a predetermined fashion that cannot be changed by the administrator Each instrument is an individual assessment resource that can be administered as a stand alone measure as part of a preset battery or as part of a custom battery Instruments are also referred to as measures and tests in this manual All of these words are used interchangeably Item A question or task within an instrument The instrument is comprised of items Custom Battery A user created and named battery containing one or more instruments in any desired order A custom battery may be created by saving a custom list of instruments for use in future assessments Once a custom battery has been administered to a participant it cannot be modified If a user wishes to edit the custom battery it must be saved under a new unique name noe Custom batteries are only available on the iPad on which it was created Future releases may enable a custom battery that can be shared across iPads with the same Apple ID An 6 Return to TOC administrator can create a custom battery that contains instruments from more than one domain and the battery can be given in any order specified by that administrator Assessment A group of instruments given to a participant These may or may not contain a custom or preset battery Return to TOC B 2 Getting the NIH Toolbox App B 2 1 Hardw
49. correct Very good that s right E reads screen Touch and Hold Here to Continue button appears E touches and holds button to continue to next screen 8b If incorrect Uh oh Remember in this game the big kitties go in the big kitty box and the little kitties go in the little kitty box Touch and Hold Here to Continue button appears after E touches and holds button screen says Can you show me where the big kitties go E reads screen and C touches a box triggering either 8a or When Touch and Hold Here to Continue button appears again E touches and holds button to continue 2A Screen 9 Transition OK let s put all the kitties in their boxes E reads screen Touch and Hold Here to Continue button appears then E touches and holds button to continue 2A Screen 10 Rule reminder 1 If it s a little kitty then it goes in the little kitty box If it s a big kitty then it goes in the big kitty box Text appears above relevant boxes E reads screen After 5 seconds Touch and Hold Here to Continue button appears Then E touches and holds button to move to next screen 2A Screen 11 Live Trial 1 Here is a little kitty Where does it go E reads screen C touches a box 2A Screen 12 Rule reminder 2 Little kitties go here Big kitties go here Text appears above relevant boxes E reads screen After 3 seconds Touch and Hold Here to Continue button
50. correct choice Similarly a separate audio file plays each time the participant gets a practice item correct Participants must get at least three out of four practice trials correct to advance to the test items If these participants get fewer than three out of four practice trials correct they can complete up to two more sets of four practice trials with the same cutoff to advance to the test trials Return to TOC i If the participant does not respond after five seconds to a practice trial prompt him her to do so by saying Choose one of the buttons Test Trials One block of 20 test trials is used for all participants 3 7 year olds have fish stimuli and ages 8 have arrow stimuli If a participant ages 3 7 misses no more than one congruent and one incongruent item on the fish trials he she will also receive a set of 20 arrow trials Training for home base precedes the arrow trials for both the 3 7 and 8 year olds Developmental Extension DEXT ages 3 7 In this version participants are given five practice trials If the participant responds incorrectly an audio recording provides feedback and highlights the correct choice Similarly a separate audio file plays each time the participant gets a practice item correct A participant must succeed in 4 out of 5 practice trials to move on If a participant does succeed the test administration continues in the same manner as the standard administration described above If
51. front of the picture on the wall The examiner should demonstrate the pose describing what he she is doing as it is being done The participants turn is next the examiner should ask the participant to stand in the desired position saying Please step onto the foam and put your feet together heels and balls of feet touching and stand as still as possible with your eyes open and your arms crossed on your chest like this demonstrate Focus on the X shown on the wall in front of you Ready After the participant assumes the position the examiner touches the START button and says Go The examiner should check the participant s posture The iPad screen will display the elapsed time of the trial so the examiner can easily see it while assuring the safety of the participant Choose STOP FAIL if the participant did not successfully complete the trial for any reason If the first trial is failed for any reason start the second trial of this pose the examiner should say Let s try that one again Please step onto the foam and put your feet together heels and balls of feet touching and stand as still as possible with your eyes open and your arms crossed on your chest like this demonstrate Focus on the X shown on the wall in front of you Ready The examiner touches the START button and says Go Again choose STOP FAIL if the participant did not successfully complete the trial for any reason After 50 seconds of elapsed trial time
52. given would be developmentally appropriate for ages 3 6 The Early Childhood Cognition Battery includes instruments to assess the following constructs Attention Episodic Memory Executive Function and Language Cognition Battery The NIH Toolbox Cognition Battery is recommended for ages 7 It consists of instruments that assess the following constructs Executive Function Attention Episodic Memory Language Processing Speed and Working Memory v Cognition instruments are not available for immediate use in the app To access these instruments a user must submit a short application for approval Users who have been approved to use NIH Toolbox Cognition instruments in Assessment Center web based version of NIH Toolbox will be approved without submitting any additional information New users will be asked to submit credentials demonstrating they have the appropriate knowledge skills training and experience to responsibly use NIH Toolbox measures or are working under the supervision of someone qualified to use those measures Application instructions can be found in the app when touching the lock icon next to any cognition instrument Once approved a user will receive a code via email to enter on their iPad and instruments can then be immediately administered The user will also receive other restricted materials at that time e g NIH Toolbox Oral Reading Recognition Test Pronunciation Guide and the NIH Toolbox List Sorting Working Memor
53. hand being tested should be flat on the table palm down until the administrator says Go At the bottom of the screen is a button Touch and Hold Here to Continue Touch and hold that button to begin the test Say In this activity we are going to see how fast you work with your hands You are going to use your RIGHT or LEFT as appropriate hand only point to hand if needed for understanding and then you will do it again with your LEFT or RIGHT as appropriate hand point to hand if needed Show participant the pegboard and say This is a pegboard and these are the pegs All the pegs are the same Pick up the pegs one at a time using your RIGHT or LEFT as appropriate hand only point to hand if needed Put them in the holes one at a time until all 9 holes are filled Then take them all out one at a time like this The examiner demonstrates the task and says as he she is working The pegs can be put in the holes or taken out in any order have extra pegs so if you drop a peg don t go after it Ill put in another one At the bottom of the screen is a button Touch and Hold Here to Continue Touch and hold that button to begin the test Dominant Hand Practice Have participant start with his her hand flat on table beside pegboard Remind participant that non dominant hand can be used to stabilize board and continue Let s practice with your RIGHT or LEFT as appropriate hand point to hand if needed You can use your othe
54. incorrect the picture of chocolate will flash and the voice on the iPad will say This is chocolate The screen will change to the chocolate picture and a voice on the iPad will ask Have you ever smelled chocolate Touch yes or no on the screen to indicate the child s answer then touch NEXT at the bottom of the screen to go on to the next item The answer choice can be changed between No and Yes until Continue is pressed to advance to next screen No Go Back is permitted in Picture Identification component Question 8 the voice on the iPad says Touch the picture of bubble gum If correct the voice on the iPad will say That s right Or Great Job Alternating throughout this part of the task If incorrect the picture of bubble gum will flash and the voice will say This is bubble gum The screen will change to the bubble gum picture and a voice on the iPad will ask Have you ever smelled bubble gum Touch yes or no on the screen to indicate the child s answer then touch NEXT at the bottom of the screen to go on to the next item The answer choice can be changed between No and Yes until Continue is pressed to advance to next screen No Go Back is permitted in Picture Identification component At the end of these questions the iPad screen will refresh and the voice on the iPad will ask the child to touch those pictures that were not correctly identified on the first trial These requests will be made one by one until all the
55. information button on the iPad and touch forget this device Before testing begins 1 The examiner should move the iPad to a portable tablet stand that is placed on a table or use another method such that the iPad is 3 meters from the participant and at eye level this may also necessitate adjusting the participant s chair height It is recommended that the examiner have a printed copy of all instructions close at hand before beginning this measure This is particularly important for the training and practice for the young children and may be important for older participants as well Alternatively for adults and older children the examiner may hold the iPad and read the initial instructional screens to the participant after which the iPad should be placed on the stand If using this procedure the examiner should try to stay close to the participant while reading from the iPad since explaining something from a distance of 3 meters may seem unusual and very different from other measures where the participant and examiner are sitting side by side and then walk over to the stand 3 meters away and place the iPad on it before starting the items 4 Since the participant s responses are recorded on the wireless keyboard the wireless keyboard must be paired by Bluetooth with the iPad 5 The examiner should ascertain if the participant wears corrective lenses for distance and ensure he she is wearing them If the participan
56. instrument Previous data are overwritten o During Practice Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Live Items Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted NIH Toolbox 2 Minute Walking Endurance Test e Pause perform admin gesture and return to instrument without selecting stop or skip o During Instructions Return to active screen pause not recorded in data o During Practice NO PRACTICE ITEMS IN ENDURANCE TEST o During Live Items Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted e Stop exit the instrument by selecting stop with the intention of resuming at a later time o During instructions Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Practice NO PRACTICE ITEMS IN ENDURANCE TEST o During Live Items Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted Sensation NIH Toolbox Pain Intensity Fixed Form e Skip o Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted e Pause perform admin gesture and return to instrument without selecting stop or skip o During Instructions Return to active scr
57. item 2 An audio recording says Let s try another one Spoon Touch the picture of Spoon If correct an audio recording says That s right If incorrect the Spoon picture will light up and an audio recording will say This is a spoon Let s try again The examiner should allow the participant up to three chances to answer this practice item correctly After three unsuccessful attempts by the participant the examiner should touch the picture of the spoon and say This is a spoon The introduction to the test items will appear automatically Test items The introductory screen to the test items is slightly different for participants ages 3 6 and those ages 7 The two screens are printed below Ages 3 6 Read Now let s try some more Remember you will hear a voice say a word and then you will see four pictures One of the pictures will show what the word means Touch that picture and you will hear a new word and see four more pictures Any questions When participant is ready touch button that says Touch and Hold Here to Continue Ages 7 Read Now you re going to do some more Remember you will hear a word and then you will see four pictures One of the pictures will show what the word means Touch that picture and you will hear a new word and see four more pictures Again touch the picture that shows what the word means If you don t know make your best guess Any questions When participant is ready touch button t
58. on the foam or in the tandem pose Each pose and trial is presented on a separate iPad screen These screens always have a description of the pose which trial and three buttons Start Stop Fail and Pass The Start and Stop Fail are enabled at the beginning of each trial the Pass button is only enabled after data is received from the balance pod A tone is played on the iPod once 50 seconds have elapsed All the buttons are disabled during the interval between the 50 seconds tone and when data are received on the iPad Standing Balance Test Trial 1 Position 1 Flat Surface Feet Together Eyes Open Whenever the PASS or the STOP FAIL button is touched a pop up window asking for confirmation of the choice will appear The examiner must confirm his her choice The task order is always the same Pose 1 flat surface feet together eyes open Pose 2 flat surface feet together eyes closed Pose 3 on foam feet together eyes open Pose 4 on foam feet together eyes closed Pose 5 flat surface tandem stance eyes open only given to participants ages 7 Throughout the task the computer may invoke Discontinue Rules automatically These are Rule 1 f the participant cannot successfully complete either trial of pose 1 the test will be discontinued Rule 2 f the participant cannot successfully complete either trial of pose 2 he she will not be asked to perform any more poses with eyes closed i e will
59. page to verify your email address Enter your email address and the password you created when you established your Apple ID Click Verify Address B 2 2 Downloading and Opening the NIH Toolbox App k o Tap on the App Store icon on your iPad Enter NIH Toolbox in the Search field in the upper right corner of the App Store and tap Search Once the NIH Toolbox app is displayed tap the Get button next to it It will turn into an INSTALL button Tap Install to confirm you wish to download and install the app If you are already signed in using your Apple ID a pop up screen will ask you to provide your password If you are not signed in you will be given the options of Use Existing Apple ID Create New Apple ID and Cancel Since you have already created your Apple ID tap the Use Existing Apple ID button and sign in using your Apple ID and password At this point the download will begin and the NIH Toolbox app will become available on your iPad If you cannot see the app on your iPad after downloading try swiping to the right or left to see all of the apps installed on your iPad Open the NIH Toolbox App by tapping the NIH Toolbox icon Accept the NIH Toolbox app Terms and Conditions see Appendix 1 When opening the app for the first time you will be asked to set up a passcode You will be asked to enter this passcode every time you open the app in the future Keep this passcode in a safe place noe The NIH Toolb
60. participant Focus on the X shown on the wall in front of you Ready The examiner touches the START button and says Go Again choose STOP FAIL if the participant did not successfully complete the trial for any reason After 50 seconds of elapsed trial time a tone will sound After a few more seconds the examiner will be able to touch the PASS or STOP FAIL button Whenever the PASS or the STOP FAIL button is touched a pop up window asking for confirmation of the choice will appear The examiner must confirm his her choice When the participant has completed pose 5 say We are done with this activity C 4 4 NIH Toolbox 4 Meter Walk Gait Speed Test This measure of gait speed is administered in an open hallway and can use part of the same course as the 2 Minute Walk Endurance Test See Appendix 6 The test is administered two times both at the participant s normal pace A practice trial precedes the timed trials The instructions are on and a timer is embedded in the iPad screen The timing begins START button when the participant steps over the starting line The foot does not need to be flat on the floor Timing stops when one of the participant s feet is completely across the end finish line the line at 4 meters not at 5 meters where the cone is The examiner should be positioned so that he she can easily see when the participant steps across each line If necessary walk behind and to the side of the participant as he she walk
61. point the same way Sometimes the middle arrow will point a different way like this picture of incongruent arrows You should always choose the button that matches the way the MIDDLE arrow is pointing E reads screen points to the arrows and demonstrates touching arrow button Transition to practice items Now you try Keep your eyes on the star Answer as fast as you can without making mistakes If you make a mistake just keep going Remember put your finger back on Home Base after you answer E reads screen then touches and holds button to continue Practice Items set 1 4 practice items More practice if less than 3 out of 4 correct on set 1 Let s practice some more If the MIDDLE arrow is pointing this way choose this button E reads screen and demonstrates touching arrow button If the MIDDLE arrow is pointing this way choose that button E demonstrates touching arrow button Return to TOC 54 iPad screen written content Examiner E Action Transition to more practice items Now you try Keep your eyes on the star Answer as fast as you can without making mistakes If you make a mistake just keep going Remember put your finger back on Home Base after you answer E reads screen then touches and holds button to continue Practice Items set 2 4 practice items More practice if less than 3 out of 4 correct on set 2
62. reads screen When Transition Touch and Hold Here to Continue button appears E touches and holds button to continue 3A Screen 9 If it s a flower then it goes in the flower box If it s E reads screen After 5 Rule reminder 1 a heart then it goes in the heart box Text appears above relevant boxes seconds Touch and Hold Here to Continue button appears Then E touches and holds button to advance to next screen 3A Screen 10 Live Trial 1 Here is a flower Where does it go E reads screen C touches a box 3A Screen 11 Rule reminder 2 Flowers go here Hearts go here Text appears above relevant boxes E reads screen After 3 seconds Touch and Hold Here to Continue button appears E touches and holds button to continue 3A Screen 12 Live Trial 2 Here is a heart Where does it go E reads screen C touches a box 3A Screen 13 Rule reminder 3 If it s a flower then it goes in the flower box If it s a heart then it goes in the heart box Text appears above relevant boxes E reads screen After 5 seconds Touch and Hold Here to Continue button appears E touches and holds button to continue 3A Screen 14 Live Trial 3 Here is a flower Where does it go E reads screen C touches a box 3A Screen 15 Rule reminder 4 Flowers go here Hearts go here Text appears above relevant boxes E reads screen After
63. ready wait and ask again in another 15 seconds If the participant is not ready by the end of the one minute rest period the test should be discontinued In such a case the examiner should say Let s go on to another activity As needed throughout the testing the examiner should remind the participant that he she can step out of the pose if he she is feeling unsafe or unable to hold the pose When the participant is ready for testing the examiner should touch and hold the button at the bottom of the screen to advance to the test itself Pose 1 Screen Flat surface feet together eyes open The examiner should demonstrate the pose describing what he she is doing as it is being done The participant s turn is next the examiner should ask the participant to stand in the desired position saying Please stand with your feet together heels and balls of feet touching and as still as possible with your eyes open and with your arms crossed on your chest like this demonstrate for participant Focus on this X shown on the wall in front of you Ready After the participant assumes the position the examiner touches the START button and says Go The examiner should check the participant s posture The iPad screen will display the elapsed time of the trial so the examiner can easily see it while assuring the safety of the participant In addition an audible tone will play when time has elapsed so the both the examiner and partici
64. reason start the second trial of this pose the examiner should say Let s try that one again Please step onto the foam and put your feet together heels and balls of feet touching and stand as still as possible with your arms crossed on your chest then close your eyes like this demonstrate for participant Ready The examiner touches the START button and says Go Again choose STOP FAIL if the participant did not successfully complete the trial for any reason After 50 seconds of elapsed trial time a tone will sound After a few more seconds the examiner will be able to touch the PASS or STOP FAIL button Whenever the PASS or the STOP FAIL button is touched a pop up window asking for confirmation of the choice will appear The examiner must confirm his her choice When the participant has completed pose 4 say We are done with this activity C 4 3 2 Standing Balance Test Instructions Ages 7 The task is introduced with the following Title Screen NIH Toolbox Standing Balance Test 7 At the bottom of the screen is a button Touch and hold here to continue Touch and hold that button to begin the test Participants are to stand in their bare stocking feet no shoes but paper booties can be offered While putting the belt and iPod on the participant say This is a test of your balance There are as many as 5 different poses that you will be asked to do During each pose you will be asked to stand as steady as possible for 50 seco
65. review If you are not certain of the effect of the laws in jurisdiction please contact your jurisdiction s professional organization USER QUALIFICATIONS Cognition test users must have the appropriate knowledge skills training and experience to responsibly use NIH Toolbox measures Test users are those persons responsible for the selection administration scoring and interpretation of tests and the communication of results Therefore NU NIH reserves the right to ask individuals requesting access to NIH Toolbox measures to provide documentation that they have the experience and training necessary to use those measures or are working under the supervision of someone qualified to use those measures In particular User may be asked to provide documentation of qualifications for measures classified as C Level C Level tests require a high degree of expertise in test interpretation and thus can only be requested by a User with state licensure or certification to practice in a field related to the request or a doctorate degree in psychology education ora closely related field with formal training in the ethical administration scoring and interpretation of clinical assessments related to the intended use of the assessment Any users of C Level assessments must be supervised by one or more users with C Level qualifications which must have been provided in advance to NU NIH per this process RULES GOVERNING USE OF THE NIH TOOLBOX BY V
66. says Now say the animals in size order starting with the smallest animal Correct Response If participant says RABBIT SHEEP ELEPHANT press 1 and then press spacebar An audio recording says That s right When it appears on the screen ask Are you ready When the participant answers affirmatively press the spacebar and the 1 List introduction screen will be presented Incorrect Response If participant does not say RABBIT SHEEP ELEPHANT press 0 and then press spacebar An audio recording says Let s try that again Trial 2 if Trial 1 was incorrect An audio recording continues You saw a RABBIT SHEEP and ELEPHANT the RABBIT is smaller than the SHEEP and the SHEEP is smaller than the ELEPHANT The RABBIT is the smallest animal the SHEEP is the next biggest animal and the ELEPHANT is the biggest animal Now say the animals in size order starting with the smallest animal Correct Response If participant says RABBIT SHEEP ELEPHANT press 1 and then press spacebar An audio recording says That s right When it appears on the screen ask Are you ready When the participant answers affirmatively press the spacebar and the 1 List introduction screen will be presented Incorrect Response If participant does not say RABBIT SHEEP ELEPHANT press 0 and then press spacebar An audio recording says Let s try that once more Trial 3 if Trial 2 was incorrect After the pictures are presented again and the screen is blank an au
67. screen to advance to next screen Test Item 4 Hand the participant a small cup with salt solution NaCl and say Next would like you to sip all the solution in this cup Try not to drink the solution but hold it and gently move it around in your mouth until I tell you to spit it out in this container If you should accidentally swallow any it will not hurt you After counting one thousand one one thousand two one thousand three once the participant has sipped the solution the examiner should say Spit out the solution in your mouth and swallow whatever remains Then rate the strength or intensity of the taste on the same scale you used before Touch the OK button when you are finished Final Screen After the last item is administered give the participant the bottle of water and encourage him her to drink it and or rinse some more The examiner should say Now that we have finished you might want to drink some more water to clean out your mouth The examiner should touch and hold button at the bottom of the screen to advance to next screen The participant may be offered a candy to help overcome any remaining taste in his her mouth Sugar free candy may be needed for diabetic participants Appendix 1 NIH Toolbox App Terms and Conditions The NIH Toolbox Terms and Conditions contained in this document hereinafter referred to as NTAC serve as an agreement between Northwestern University NU and the Nati
68. see arrows instead of fish But first we are going to learn about Home Base This is your Home Base Put your finger on the Home Base and wait for the next picture In this game put your finger back on Home Base after each answer E reads screen and points to the home base then touches and holds button to continue Like before choose the button that matches the way the middle arrow is pointing E points then chooses arrow button Sometimes all the arrows will point the same way Sometimes the middle arrow will point a different way You should always choose the button that matches the way the MIDDLE arrow is pointing E reads screen points to the arrows and demonstrates touching arrow button More test items arrows Now you try Keep your eyes on the star in the middle of the screen Remember put your finger back on Home Base after you answer E reads screen then touches and holds button to continue 20 test items arrows Return to TOC 49 C 2 2 2 NIH Toolbox Flanker Inhibitory Control and Attention Test Instructions Ages 3 7 with Developmental Extension DEXT This table outlines the item content read by and the actions to be performed by the examiner and the child Title Screen iPad screen written content NIH Toolbox FL 3 7 DEXT Child C amp Examiner E Actions E touches and holds button to continue PRACTICE Introduction Here is a
69. systems AON oo Open iTunes If you don t have iTunes you can download it here From the Store menu choose Create Apple ID Click Continue To proceed you ll need to agree to the Terms and Conditions and Apple Privacy Policy After you ve read the terms click the checkbox next to I have read and agree to these terms and conditions Click Agree Complete the form to create your free Apple ID The form includes security questions for your protection and asks for an optional rescue email address you need to be connected to the Internet for this link to work We recommend that you provide a rescue email address After you ve filled out the form click Continue If you receive a warning that the email address you entered is already associated with an Apple ID follow these instructions about using an existing Apple ID you need to be connected to the Internet for this link to work instead 9 Return to TOC 10 11 12 13 14 15 Provide a valid payment method and billing address Your account will be charged only when you make a purchase No purchase is necessary but Apple does require you to enter a credit card number to set up an Apple ID Provide the required billing information and click Continue Next you will need to verify your email address Check your email for a verification email from Apple In the verification email you receive from Apple click the Verify Now link You will be taken to the Apple ID
70. systems Motor Constructs Dexterity Strength Balance Locomotion Endurance Definition Dexterity is the coordination of small muscle movements that occur in body parts such as the ability to coordinate fingers to manipulate objects quickly and accurately It is measured by the NIH Toolbox 9 Hole Pegboard Dexterity Test Strength refers to a muscle s ability to generate force against physical objects Measuring handgrip assesses how strong one s hand grip is which in turn provides a good approximation of overall muscle strength It is measured by the NIH Toolbox Grip Strength Test Balance refers to the ability to orient the body in space maintain an upright posture under both static and dynamic conditions and move and walk without falling It is measured by the NIH Toolbox Standing Balance Test Locomotion refers to the act of moving from one place to the other place reflecting ambulation ability including walking distance velocity and quality of the gait over different environments and ground surfaces It is assessed by the NIH Toolbox 4 Meter Walk Gait Speed Test Endurance refers to how long a person can perform a particular activity requiring cardiopulmonary function biomechanical and neuromuscular function at a particular intensity Endurance assesses overall cardiovascular endurance It is measured by the NIH Toolbox 2 Minute Walk Endurance Test Time to Motor Battery Instruments Ages Administ
71. take them out Touch the STOP button as soon as the final peg is placed back in the cup After timer stops touch the NEXT button and confirm your choice in the pop up window There is a RESET button if for some reason the participant needs to start again If this happens the examiner should touch RESET and confirm your choice in the pop up window Start the trial over again removing all the pegs before starting Non Dominant Hand Practice Turn pegboard around so that the cup with the pegs is on the side of the non dominant hand Read Now we are going to do the same thing with your other hand Again pick up the pegs one at a time using only your LEFT or RIGHT as appropriate hand point to hand if needed Put them in the holes one at a time until all 9 holes are filled Then take them all out one at a time The pegs can be put in the holes or taken out in any order Have participant start with his her hand flat on table beside pegboard Remind participant that dominant hand can be used to stabilize board and continue Let s practice Remember you can use your other hand to hold the board in place At the bottom of the screen it says Right or Left as appropriate Hand Practice and there is a timer with START and RESET buttons Say Are you ready 3 2 1 Go Make sure to touch the START button as soon as you say GO As participant is placing the final peg say And take them out Touch the STOP button as soon
72. test so that RIGHT or LEFT is displayed where appropriate An audio recording says On each screen you are going to see two pictures Sometimes the two pictures are the same and sometimes the two pictures are NOT the same If the pictures look the same touch the Yes button If they do NOT look the same touch the NO button If you make a mistake during the practice you will hear a message to try again Use your dominant hand from handedness audio will say right or left index finger to respond Let s try some for practice When the audio recording is complete Touch and hold here to continue appears on the screen Touch and hold that button to begin the administration Practice Items There are 6 practice items The first practice item is introduced with an audio recording asking Are these the same Remember touch YES if they look alike or are the same and touch NO if they do not look alike and are NOT the same For the other five practice items an audio recording asks Are these the same If the participant answers correctly an audio recording says That s right The next item will appear If the participant answers incorrectly an audio recording explains why the answer is wrong The correct answer will flash item will stay on screen If participant chooses correctly an audio recording will say That s right and the next item will appear If the participant chooses incorrectly another time th
73. the gray box where you want to move it I ll move it there for you The test begins with a Title Screen NIH Toolbox PSM 5 6 Form A B or C At the bottom of the screen is a button Touch and Hold Here to Continue Touch and hold that button to begin the test On the next screen read the text Now we are going to play a memory game but first am going to teach you how to move the pictures on this screen When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue The next screen begins the three step demonstration sequence f the steps are not followed the Touch and Hold Here to Continue button will not be active Step 1 Moving Pictures from the Yellow Box to the Gray Boxes Read the text above the yellow box on the screen and demonstrate the actions described Say Here you see some pictures in a yellow box want to show you how to move the pictures to the gray boxes You can move pictures from this yellow box to the gray boxes like this Touch on the picture in the yellow box then drag the picture you touched to the gray box where you want to move it Now you try with this picture After the child demonstrates understanding of this step touch the button at the bottom of the screen that says Touch and Hold Here to Continue Step 2 Moving Pictures from the Gray Boxes to the Yellow Box Read the text above the yellow box on the screen and demonstrate the actions described
74. the middle of the Screen E reads screen then touches and holds button to continue Color Practice set 2 4 items sorted by color More practice if less than 3 out of 4 correct on set 2 Let s practice some more In the COLOR game choose the picture that is the same COLOR as the picture in the middle of the screen If it s WHITE choose this picture E chooses WHITE picture If its BROWN choose that picture E chooses BROWN picture Transition Now you try Keep your eyes on the star in the middle of the screen E reads screen then touches and holds button to continue Color Practice set 3 4 items sorted by color Test ends if less than 3 out of 4 correct on set 3 Return to TOC 71 iPad screen written content Examiner E Actions COLOR and SHAPE intro Now we re going to play with some different shapes and colors This time we ll use BALLS and TRUCKS that are YELLOW and BLUE E reads screen then touches and holds button to continue Pre switch intro Let s start with the COLOR game Remember the COLOR game In the COLOR game choose the picture that s the same COLOR as the picture in the middle of the screen If it s a BLUE one choose this picture E chooses BLUE picture And if it s a YELLOW one choose that picture E chooses YELLOW picture correct test terminates Transition Now you try E reads screen th
75. the middle of the screen Remember put your finger back on Home Base after you answer Examiner E Actions E reads screen then touches and holds button to continue Transition Now you try E reads screen then Keep your eyes on the star Answer as fast as you can touches and holds without making mistakes button to continue If you make a mistake just keep going Put your finger back on Home Base after you answer Test items 30 mixed items Return to TOC 95 C 2 5 NIH Toolbox Pattern Comparison Processing Speed Test The NIH Toolbox Pattern Comparison Processing Speed Test is designed to measure processing speed The test itself takes less than 90 seconds and requires participants to discern whether two side by side pictures are the same or not Younger children make this decision by choosing either a smiley face corresponding to a yes response or a frowny face corresponding to a no response Older children and adults Ages 7 make this decision with yes or no buttons on the screen Equipment needed e iPad e Small ball optional Practice Items Young children are administered two demonstration items and five practice items older children and adults are administered six practice items All participants touch the buttons that matches their choice smiley face or yes for same or look alike or frowny face or no for not the same or do no
76. the number of feet traversed is embedded on the iPad screen All the instructions appear on the iPad screen Participants should not do this test in bare feet high heeled or open back shoes sandals or flip flops Equipment and materials needed e iPad e Two cones e Chair e Measuring tape e Masking tape Detailed information on equipment and materials needed for all tests can be found in Appendix 4 Detailed information on setting up the walking courses for the NIH Toolbox 4 Meter Walk Gait Speed Test and 2 Minute Walk Endurance Test can be found in Appendix 6 C 4 5 1 NIH Toolbox 2 Minute Walk Endurance Test Instructions Ages 3 The task is introduced with the following Title Screen NIH Toolbox 2 Minute Walk Endurance Test 3 At the bottom of the screen is a button Touch and Hold Here to Continue Touch and hold that button to begin the test The examiner should observe how participants normally walk If they use a cane or other walking device and feel they need it for the walking test they may use it If the participant uses such a device the examiner should make a note of this First Screen Examiner should have participant sit in a chair near the beginning of the walking course Introduce the task say This is an activity that shows how physically fit you are by seeing how far you can walk in 2 minutes I will ask you to walk as fast as you can until ask you to stop I know this is hard for some people s
77. the picture of a emon If correct the voice on the iPad will say That s right Or Great Job Alternating throughout this part of the task If incorrect the picture of lemons will flash and the voice will say This is a lemon The screen will change to the Lemon picture and a voice on the iPad will ask Have you ever smelled a lemon Touch yes or no on the screen to indicate the child s answer then touch NEXT at the bottom of the screen to go on to the next item The answer choice can be changed between No and Yes until Continue is pressed to advance to next screen No Go Back is permitted in Picture Identification component Question 4 the voice on the iPad says Touch the picture of Play Doh If correct the voice on the iPad will say That s right Or Great Job Alternating throughout this part of the task If incorrect the picture of Play Doh will flash and the voice will say This is Play Doh The screen will change to the Play Doh picture and a voice on the iPad will ask Have you ever smelled Play Doh Touch yes or no on the screen to indicate the child s answer then touch NEXT at the bottom of the screen to go on to the next item The answer choice can be changed between No and Yes until Continue is pressed to advance to next screen No Go Back is permitted in Picture Identification component Question 5 the voice on the iPad says Touch the picture of cinnamon If correct the voice on the iPad
78. these the same 19 If correct FROWN face the audio recording says Great job Next item will appear If incorrect SMILEY face the audio recording says These pictures do not look alike and are NOT the same One flower is purple and the other flower is red so choose the FROWN face FROWN face will flash item will stay on screen If no response the audio recording repeats Are these the same If child chooses correctly the audio recording will say Great job Next item will appear If child chooses incorrectly another time iPad program moves to next practice item after repeating explanation above Ages 3 6 Practice Item 7 Audio recording says Are these the same Pictures will stay on screen until there is a response and audio recording will repeat Are these the same If correct SMILEY face the audio recording says Great job Practice items are complete If incorrect FROWN face the audio recording says These pictures look alike Both are pictures of red flowers so choose the SMILEY face SMILEY face will flash item will stay on screen If no response the audio recording repeats Are these the same If child chooses correctly the audio recording will say Great job Next item will appear If child chooses incorrectly another time iPad program moves to next practice item after repeating explanation above Test Items NOTE If the child has not correctly chosen the SMILEY or FROWN face afte
79. this letter word Say whichever is appropriate This prompt can be repeated as many times as needed After participant answers the examiner checks a pronunciation guide as needed and types 1 if the participant s pronunciation is correct or 0 if the response is incorrect After choosing 1 or 0 the examiner presses the spacebar to move on to the next word or letter Pressing the spacebar registers the choice in the scoring program until the spacebar is pressed the examiner may change his her choice without having to go back If the participant says don t know this one or can t read it say It is OK if you don t know the word or what it means just try to read it as best you can This prompt can be used to reassure participants if they refuse to read the letters words If after prompting a participant refuses to offer a response mark the item incorrect 0 and press the spacebar to move on to the next item NOTE The examiner can go back one previous item to change an answer if the participant self corrects or the examiner realizes a scoring error was made To do this press the left arrow on the keyboard then press 1 or 0 to indicate the score for the item to be corrected item Then press the spacebar and the next item will be presented this may or may not be the same word letter seen before the left arrow was pressed NOTE For the youngest children the initial items may require them to identify the letters in an array with th
80. trial and the criterion of three or more of four correct is not achieved Visual Acuity Testing The examiner should say You did great Now the letters will get smaller and smaller until you cannot really see them That is ok We want to know how small they can get before you cannot see them Press Spacebar to continue Each time a letter is displayed say Tell me or point to what you see The examiner records the correctness of the participant s response on the wireless keyboard specifically once the participant names for young children points on the HOTV sheet the letter on the screen the examiner types that letter into the keyboard After typing the letter the examiner presses the spacebar to move on to the next letter The next item will not appear until the examiner has recorded the child s response to the item currently on screen If the child is trying but struggling to verbalize the letters remind him her that pointing is OK saying You can show me what you see The test will progressively present smaller letters if the child answers correctly or larger ones if the child answers incorrectly until an acuity score is established The test will automatically end when the program has calculated the acuity score Note If a child s Visual Acuity Test score is equivalent to 20 400 vision or worse it suggests serious uncorrected distance vision deficits exist A follow up evaluation by a vision professional is suggested C
81. v2 0 8 NIH Toolbox Self Efficacy CAT Age 18 v2 0 CAT NIH Toolbox Perceived Stress FF Age 18 v2 0 10 NIH Toolbox Fear Affect CAT Age 18 v2 0 CAT NIH Toolbox Fear Somatic Arousal FF Age 18 v2 0 6 NIH Toolbox Sadness CAT Age 18 v2 0 CAT NIH Toolbox Anger Affect CAT Age 18 v2 0 CAT NIH Toolbox Anger Hostility FF Age 18 v2 0 5 NIH Toolbox Anger Physical Aggression FF Age 18 v2 0 5 C 3 3 2 NIH Toolbox Emotion Battery Ages 8 12 Instrument name NIH Toolbox Emotion Instructions Adult Child Fixed Form CAT or of Items in NIH Toolbox Positive Affect FF Ages 8 12 v2 0 NIH Toolbox General Life Satisfaction FF Ages 8 12 v2 0 NIH Toolbox Emotional Support FF Age 8 v2 0 NIH Toolbox Friendship FF Age 8 v2 0 NIH Toolbox Loneliness FF Age 8 v2 0 NIH Toolbox Perceived Rejection FF Age 8 v2 0 NIH Toolbox Perceived Hostility FF Age 8 v2 0 NIH Toolbox Self Efficacy CAT Ages 8 12 v2 0 NIH Toolbox Anger Affect FF Ages 8 17 v2 0 NIH Toolbox Sadness FF Ages 8 17 v2 0 NIH Toolbox Fear FF Ages 8 17 v2 0 Return to TOC 131 C 3 3 3 NIH Toolbox Emotion Battery Ages 13 17 Instrument name CAT or of Items in Fixed Form NIH Toolbox Emotion Instructions Adult Child NIH Toolbox Positive Affect CAT Ages 13 17 v2 0 CAT NIH Toolbox General Life Satisfaction CAT Ages 13 17 v2 0 CAT NIH Toolbox Emotional Support
82. was used when Mail was set up on this iPad When emailing the data files users should exercise caution and only email the data to secure email accounts e g their institutional email Option 2 iCloud drive To use this option users need to 1 Set up iCloud following the instructions at https www apple com icloud setup ios html 2 Activate the ability to upload data files via iCloud Tap click here or refer to the NIH Toolbox App Settings section for detailed instructions If iCloud is enabled on the iPad all of the files generated by this app will be immediately available in the iCloud Drive linked to the Apple ID used to install the app These files can be accessed by logging into iCloud from any browser using the Apple ID associated with the NIH Toolbox app that generated the files Return to TOC e Option 3 File sharing via iTunes After generating files on the Export Data screen plug the iPad into a computer with iTunes version 12 2 2 or later and launch iTunes 1 2 3 4 5 6 In iTunes when the iPad appears on the top line of icons click it Under the iPad click Apps to see the apps installed on the iPad While Apps is highlighted on the left scroll the right pane to get to the bottom to find File Sharing In the File Sharing section click on the NIH Toolbox app on the left The files that have been shared by the app will be shown on the right Use the Save To button at the lower right to cop
83. will say That s right Or Great Job Alternating throughout this part of the task If incorrect the picture of cinnamon will flash and the voice will say This is cinnamon The screen will change to the cinnamon picture and a voice on the iPad will ask Have you ever smelled cinnamon Touch yes or no on the screen to indicate the child s answer then touch NEXT at the bottom of the screen to go on to the next item The answer choice can be changed between No and Yes until Continue is pressed to advance to next screen No Go Back is permitted in Picture Identification component Question 6 the voice on the iPad says Touch the picture of coffee If correct the voice on the iPad will say That s right Or Great Job Alternating throughout this part of the task If incorrect the picture of coffee will flash and the voice will say This is coffee The screen will change and a voice on the iPad will ask Have you ever smelled coffee Touch yes or no on the screen to indicate the child s answer then touch NEXT at the bottom of the screen to go on to the next item The answer choice can be changed between No and Yes until Continue is pressed to advance to next screen No Go Back is permitted in Picture Identification component Question 7 the voice on the iPad says Touch the picture of chocolate If correct the voice on the iPad will say That s right Or Great Job Alternating throughout this part of the task If
84. your tongue out while you make the rating on the scale Touch the OK button when you are finished If you should accidentally swallow any it will not hurt you Transition screen 2 Have the participant rinse out his her mouth with the bottled water between Items 2 and 3 and read Please rinse out your mouth two times with the bottled water and spit the rinse water into this container The examiner should touch and hold button at the bottom of the screen to advance to next screen Test Item 3 Hand the participant a small cup with quinine and say Next would like you to sip all the solution in this cup Try not to drink the solution but hold it and gently move it around in your mouth until I tell you to spit it out in this container If you should accidentally swallow any it will not hurt you After the participant sips the solution the examiner should count for three seconds one thousand one one thousand two one thousand three and then say Spit out the solution in your mouth and swallow whatever remains Then rate the strength or intensity of the taste on the same scale you used before Touch the OK button when you are finished Transition screen 3 Have the participant rinse out his her mouth with the bottled water between Items 4 and 4 and say Please rinse out your mouth two times with the bottled water and spit the rinse water into this container The examiner should touch and hold button at the bottom of the
85. 3 seconds Touch and Hold Here to Continue button appears E touches and holds button to continue Return to TOC 84 3A Screen 16 Live trial 4 Here is a flower Where does it go E reads screen C touches a box 3A Screen 17 Rule reminder 5 If it s a flower then it goes in the flower box If it s a heart then it goes in the heart box Text appears above relevant boxes E reads screen After 5 seconds Touch and Hold Here to Continue button appears E touches and holds button to continue 3A Screen 18 Live Trial 5 Here is a heart Where does it go E reads screen C touches a box If less than 4 of 5 correct DEXT Phase 3 is discontinued If DEXT started at Phase 3 DEXT Phase 2A items are presented and depending on performance on Phase 2A items DEXT 2B OR DEXT 1A is presented When either or both depending on performance Phase 2A and 2B are administered the test ends When either or both depending one performance Phase 1A and 1B items are administered No Phase is administered more than once If 4 or more correct on DEXT Phase 3A the test continues the test ends to Phase 3B 3B Screen 1 Instructions Now we re going to play a new game We re not going to play the shape game anymore We re going to play the color game In the color game all the pink ones go in the pink box All the yellow ones go in the yellow box E reads screen Aft
86. ABBIT Shape Practice set 2 4 items sorted by shape More practice if less than 3 out of 4 Let s practice that some more In the SHAPE game choose the picture that s the same SHAPE as the picture in the middle of the screen If it s a BOAT choose this picture E chooses BOAT Return to TOC correct on set 2 iPad screen written content Examiner E Actions If its a RABBIT choose that picture E chooses RABBIT Shape Practice set 3 4 items sorted by shape Test ends if less than 3 out of 4 correct on set 3 COLOR intro We can also match by COLOR In the COLOR game E points to then choose the picture that s the same COLOR as the picture in chooses BROWN the middle of the screen If its BROWN choose this picture picture If its WHITE choose that picture E points to then chooses WHITE picture Transition Now you try E reads screen then Keep your eyes on the star Answer as fast as you can without making mistakes If you make a mistake just keep going Put your finger back on Home Base after you answer touches and holds button to continue Color Practice set 1 4 items sorted by color More practice if less than 3 out of 4 correct on set 1 Let s practice some more In the COLOR game choose the picture that s the same COLOR as the picture in the middle of the screen If it s WHITE choose this picture E chooses WHI
87. ARIOUS CATEGORIES OF USERS Universities schools organizations businesses clinics and hospitals are subject to the guidelines set forth above and must have appropriately qualified individuals on staff in order to use the NIH Toolbox cognition tests These individuals must complete a Registration Form and provide information as to their qualifications PROTECTIVE ORDERS User agrees to seek a protective order safeguarding the confidentiality of test materials classified by NU NIH as C level assessments if User is required to produce such materials in court or administrative proceedings NO WARRANTY NU NIH make no warranties expressed or implied including warranties of merchantability or fitness for a particular purpose NU NIH will not under any circumstances be liable for User s expense for delays for costs of substitute materials or for possible lost income grants profits or any other special or consequential damages that may result from using the NIH Toolbox LIMITATION OF LIABILITY In no event will NU NIH be liable for damages arising under this agreement or otherwise arising from the order s contemplated under this agreement NOTICES Any required notices shall be given in writing to User at the most recent contact information provided by User to NU NIH NU NIH may send You notice by electronic mail as an alternative to conventional mail 2015 Northwestern University and the National Institutes of Health Appendix 2
88. C touches a box If less than 4 of 5 correct DEXT Phase 2 is discontinued If DEXT started at Phase 2 Phase 1A items are presented depending on performance on Phase 1A items Phase 1B items may be presented as well Then the test is discontinued If 4 or more correct test continues to Phase 2B 2B Screen 1 Instructions OK now let s play a silly game Let s put all the big kitties in the little kitty box and put all the little kitties in the big kitty box This is a silly game E reads screen After 7 seconds Touch and Hold Here to Continue button appears E touches and holds button to continue 2B Screen 2 Instructions Let s try this silly game E reads screen After 1 second Touch and Hold Here to Continue button appears Then E touches and holds button to advance to next screen 2B Screen 3 Rule reminder 1 If it s a little kitty then it goes in the big kitty box If its a big kitty then it goes in the little kitty box Text appears above reversed boxes E read screens After 5 seconds Touch and Hold Here to Continue button appears E touches and holds button to continue 2B Screen 4 Here is a little kitty Where does it go E reads screen C Live trial 1 touches a box 2B Screen 5 Little kitties go here Big kitties go here Text E reads screen After 3 Rule reminder 2 appears above reversed boxes seconds Touch and Hold Here to Continue button ap
89. CAT Ages 8 12 v2 0 CAT NIH Toolbox Anger Parent Report CAT Ages 8 12 v2 0 CAT nore When using preset batteries correct instructions will be included automatically When using individual instruments to set up an assessment or build a custom battery users must select the correct version to precede Emotion instruments There are two versions of NIH Toolbox instructions NIH Toolbox Emotion Instructions Adult Child and NIH Toolbox Emotion Instructions Parent Report C 3 4 Emotion measures available in the NIH Toolbox App CAT Items Subdomain in FF Construct wn Toolbox Measure Positive Positive Affect NIH NIH Toolbox Positive Affect CAT Age 184 v2 0 1 CAT Positive Affect CAT NIH Toolbox Positive Affect CAT Age 184 v2 0 1 CAT 18 v2 0 General Life Satisfaction NIH Toolbox General Life Satisfaction CAT Age 18 v2 0 Meaning amp Purpose NIH Toolbox Meaning and Purpose CAT Age 18 v2 0 Positive Affect NIH Toolbox Positive Affect CAT Ages 13 17 v2 0 CAT I Lif i i General Life Satisfaction i Toolbox General Life Satisfaction CAT Ages 13 17 CAT Positive Affect NIH Toolbox Positive Affect FF Ages 8 12 v2 0 9 General Life Satisfaction NIH Toolbox General Life Satisfaction FF Ages 8 12 5 Positive Affect NIH Toolbox Positive Affect Parent Report CAT Ages 8 12 v2 0 CAT General Life Satisfaction NIH Toolbox General Life Satisfaction Parent Report FF Ages 3 12 5 Positive Affect NIH Toolbox Positive Affect
90. E arrow is pointing this way choose this button E reads screen and demonstrates touching arrow button If the MIDDLE arrow is pointing this way choose this button E demonstrates touching arrow button Transition to more practice items Now you try Keep your eyes on the star Answer as fast as you can without making mistakes If you make a mistake just keep going Remember put your finger back on Home Base after you answer E reads screen then touches and holds button to continue Return to TOC 56 Practice Items set 2 iPad screen written content 4 practice items Examiner E Action More practice if less than 3 out of 4 correct on set 2 Let s practice some more If the MIDDLE arrow is pointing this way choose this button E reads screen and demonstrates touching arrow button If the MIDDLE arrow is pointing this way choose this button E demonstrates touching arrow button Transition to more practice items Now you try Keep your eyes on the star Answer as fast as you can without making mistakes If you make a mistake just keep going Remember put your finger back on Home Base after you answer E reads screen then touches and holds button to continue Practice Items set 3 Test Items Introduction 4 practice items Test ends if less than 3 out of 4 correct on set 3 Now you re ready to do this without me Keep
91. EFT as appropriate hand When say squeeze this time want you to squeeze the handle as hard as you can Support dynamometer during testing Continue Ready 3 2 1 squeeze Harder harder harder After 3 4 seconds say Stop Record force to nearest tenth of a pound on the iPad screen Press RESET and TEST on dynamometer before next trial Touch Next button to record the data and move to non dominant hand test trial Test Trial non dominant Say Now we re going to test your LEFT or RIGHT as appropriate hand point to hand if needed When say squeeze this time want you to squeeze the handle as hard as you can Support dynamometer during testing Continue Ready 3 2 1 squeeze Harder harder harder After 3 4 seconds say Stop Record force to nearest tenth of a pound on the iPad screen Touch Next button to record the data and end the test Turn off dynamometer when testing is completed C 4 3 NIH Toolbox Standing Balance Test This task is designed to assess postural sway and to determine participants vestibulo spinal function Children ages 3 6 are asked to complete the first four poses participants ages 7 85 years are asked to complete all five poses There are exclusion rules for participants who are not tested by a trained professional These are e Weight over 250 pounds Diabetes depending on comfort Joint replacement s depending on comfort Previous stroke Parkinson s disease Di
92. ES touch and hold the YES button If the participant says NO touch any of the pictures and the pop up will disappear If no picture is moved out of a gray box the pop up will continue to be on the screen The pop up will close if a icture is moved back to the yellow box and will reappear each time all pictures have been placed in gray boxes Read the screen Now we re going to do the same pictures with some more pictures added Everyone is asked to do this more than once When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue Test Item Trial 2 As the pictures are presented an audio recording will say appropriate labels Form A Play in the park Form B Go to the fair Form C Work on the farm Fly a kite Play in the sand Go down the slide Pull the wagon Swing on the monkey bars Lay out the blanket Play catch Catch a butterfly Ride a bike Row the boat Read a book Kick the ball Take the baby for a walk Draw on the sidewalk Pet the dog Feed the ducks Push the swing Smell a flower Get a hot dog Go for a pony ride Pet the sheep Win a dog show Watch the rodeo Catch a pig Judge the cake See a puppet theater Watch a tractor pull Play in the band Go on a hay ride Take a picture of a clown Look at the babies Go on a ride Get some tickets Get some ice cream Play a game Milk a cow e Put the cow in the barn e Drive th
93. Emotion sensation A Cognition NIH Toolbox for Assessment of Neurological and Behavioral Function Administrator s Manual iPad App Version 1 1 2006 2015 National Institutes of Health and Northwestern University Table of Contents A Introduction to the NIH Toolbox App sisisictitinrcisinsciisnitimsitietiininnsineiin 4 Al What is the NIH Toolbox ADDS wasc sisiiscssigssctaiadgsetnindecidbadeicesadessssaduagisebideasssddadiasddadwasstaluddasatsteassdlaaaes 4 A2 Developmentofthe NIH TOOlDOX siesieaseeiitiannienieuainsntiaea nia eae I RE 4 A3 Characteristics of the NIH TOOIDOMAD D asini exitio EE Ek He a eio teo oae dad dieeidtedaee 5 B Learning about the NIH Toolbox App sssssssssssssssessssssoossssoossssoosssesesssesesssessoosessossssssssesese 6 Bi NIH Toolbox App SUUCEUFO iussi Lue ER HORE ERUDER CURRERE aaia aiaa HE RRAE EE A aa ARMES a aai 6 B2 Getting the NIH Toolbox Appena REEL ERE aiai eS 8 B 2 1 Hardware and Software Needed to Use the NIH Toolbox App esee 8 B 2 2 Downloading and Opening the NIH Toolbox App essen enne nnne 10 BS NIP TOODO SUDO evosaie utram cmo aae ne E p rutac It eaae Ro A RS o du Exo Esau Up od 11 BA UsingtheNIH ToolDOXADDi iui EE I RE EIER ERE OE HI EE EREE P Iac tte edt dies 12 84 1 NIH Toolbox App at Glance tette eiu o env eae audet vaeucdeste nn vade Due de 12 B 4 2 Participants m S S S G SSRR BB P 13 Le ud e
94. Fish This is the TAIL gt fish lt This is the MOUTH The fish is pointing this way the same way the fish is swimming E points to screen then touches and holds button to continue Here the MIDDLE fish is circled Can you point to the MIDDLE fish Child points E touches and holds button to continue Where is the MIDDLE fish here Child points E touches and holds button to continue Look at all the fish The fish in the MIDDLE is hungry E touches and holds button to continue To feed the MIDDLE fish choose the button that matches the way the MIDDLE fish is pointing E demonstrates using index finger to touch arrow button Here the MIDDLE fish is pointing this way SO l Il choose this button E demonstrates touching arrow button If the MIDDLE fish is pointing this way choose this button E demonstrates touching arrow button Sometimes all the fish point the same way Sometimes the MIDDLE fish points a different way like this incongruent fish You should always choose the button that matches the way the MIDDLE fish is pointing E points then chooses arrow button Here the MIDDLE fish is pointing this way so l Il choose this button E points then chooses arrow button Here the MIDDLE fish is pointing this way so l Il choose this button E points then chooses arrow button Return to TOC 50 iPad screen written content Ch
95. H Toolbox Emotion Age Specific Instructions and Instruments assesses 130 C 3 4 Emotion measures available in the NIH Toolbox App esses eene ene 134 CA Motor DOBallinu i boit IH Roo e a Rees qu eddtaqui dle dubena tM dolut esM aM AES 136 C 4 1 NIH Toolbox 9 Hole Pegboard Dexterity Test essen enne enne 137 C 4 2 NIH Toolbox Grip Strength Test seis en nnne nnn nnns 141 C 4 3 NIH Toolbox Standing Balance Test sisse esee einen enne nnne nnne enn 144 C 4 4 NIH Toolbox 4 Meter Walk Gait Speed Test sess esee eene enne nnne nnn 160 C 4 5 NIH Toolbox 2 Minute Walk Endurance Test esee eene enne 163 CS SensationDomalll ornan o esae taescu apta Re tassa CUPS E cecn tes MIS UE IM Cu E ORDIN DIUI 167 C 5 1 NIH Toolbox Pain Interference Survey 18 amp NIH Toolbox Pain Intensity Survey 184 169 C 5 2 NIH Toolbox Odor Identification Test essei eee nennen nennen nnn nnne enne na 170 C 5 3 NIH Toolbox Visual Acuity Test cssccccesssececeessececsensececseaececeeuececeesaececsesueeecsesueeeceeaeeesseaeeeees 176 C 5 4 NIH Toolbox Words in Noise Test esee eene nni inka AE EAA REA EA enter entren 182 C 5 5 NIH Toolbox Regional Taste Intensity Test esses essen nnne enne nnn 185 Appendix 1 NIH Toolbox App Terms and Conditions ecce eee ee ee eene eene 191 Appendix 2 Determining Handedness
96. Let s practice some more If the MIDDLE arrow is pointing this way choose this button E reads screen and demonstrates touching arrow button If the MIDDLE arrow is pointing this way choose that button E demonstrates touching arrow button Transition to more practice items Now you try Keep your eyes on the star Answer as fast as you can without making mistakes If you make a mistake just keep going Remember put your finger back on Home Base after you answer E reads screen then touches and holds button to continue Practice Items set 3 4 practice items Test ends if less than 3 out of 4 correct on set 3 Test Items Introduction Now you re ready to do this without me Keep your eyes on the star Answer as fast as you can without making mistakes If you make a mistake just keep going Remember put your finger back on Home Base after you answer E reads screen then touches and holds button to continue Test items 20 items arrows Return to TOC 55 C 2 2 4 NIH Toolbox Flanker Inhibitory Control and Attention Test Instructions Ages 12 This table outlines the item content read by as well as the actions for the examiner Title Screen iPad screen written content NIH Toolbox FL 12 Examiner E Action E touches and holds button to continue Home Base Introductions In this task you will see a row of arrows
97. Live Items Return to active screen pause not recorded in data e Stop exit the instrument by selecting stop with the intention of resuming at a later time o During instructions Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Practice Participant sees last practice item not responded to o During Live Items Participant sees last live item not responded to NIH Toolbox Pattern Comparison Processing Speed Test e Skip o Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted e Pause perform admin gesture and return to instrument without selecting stop or skip o During Instructions Return to active screen pause not recorded in data o During Practice Participant sees last live item not responded to o During Live Items Resume not allowed mark instrument as completed go to next instrument if applicable e Stop exit the instrument by selecting stop with the intention of resuming at a later time o During instructions Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Practice Participant sees last live item not responded to o During Live Items Resume not allowed mark instrument as completed go to next instrument if applicable NIH Toolbox Picture Sequence Memory Test e Skip o Resume not allowed mark ins
98. NIH Toolbox App Otherwise the two ways to create an Apple ID are described below How to Create an Apple ID on your iPad 1 From the Home Screen tap Settings gt iTunes amp App Stores 2 If an Apple ID is already signed in tap the Apple ID name and then tap Sign Out 3 Tap Create New Apple ID 4 Choose the appropriate store by tapping Store and select the country in which you are located 5 Tap Done to confirm your selection and then tap Next 6 To proceed agree to the Terms and Conditions and Apple Privacy Policy You can opt to have the Terms and Conditions and Privacy Policy emailed to you for easier reading by tapping Send by Email To do this enter a valid email address and then tap Send 8 Return to TOC ON 10 11 12 15 16 17 18 19 Tap the Agree button on the bottom right of the page Tap Agree again when the confirmation appears After you ve agreed to the terms and conditions you ll need to enter an email address and password and choose three security questions providing answers to each of them The email address you provide will be your new Apple ID Enter your email address and then tap Next You can also enter an optional rescue email address We recommend that you provide this rescue email address If you re trying to create an account using an existing Apple ID like your iCloud email address you ll receive a prompt telling you that your email address is already a
99. Parent Report CAT Ages 3 7 v2 0 CAT General Life Satisfaction NIH Toolbox General Life Satisfaction Parent Report FF Ages 3 12 5 Adult 18 Self Report E NIH Toolbox Emotional Support FF Age 18 v2 0 Ez aa l INIH Toolbox Emotional Support FF Age 18 v2 0 NIH Toolbox Instrumental Support FF Age 18 v2 0 08 NIH Tool liness FF 7 a Companionship oolbox Loneliness FF Age 18 v2 0 Social Distress NIH Toolbox Friendship FF Age 18 v2 0 in NIH Toolbox Perceived Hostility FF Age 18 v2 0 lt my NIH Toolbox Perceived Rejection FF Age 18 v2 0 8s Pediatric 8 17 Self Report es Social Support NIH Toolbox Emotional Support FF Ages 8 17 v2 0 NHTooboxFrendshpFFAgesB17vLO s NIH Toolbox Perceived Hostility FFAges 17v O s dii O ea O Coo oA arete O Companionship NH Toolbox Social Withdrawal Parent Report FF Ages 3 1220 a INIH Toolbox Positive Peer Interaction Parent Report FF Ages3 12v20 4 Social Distress NIH Toolbox Peer Rejection Parent Report FF Ages 3 12v20 o Positive Social NIH Toolbox Empathic Behaviors Parent Report CAT Ages 3 12 v2 0 SOCIAL RELATIONSHIPS Return to TOC La ri Set Report Pediatric 13 17 Self Report Pediatric 8 12 Self Report Pediatric 8 12 Parent Report NIH Toolbox Anger Affect CAT Age 18 v2 0 CAT Anger NIH Toolbox Anger Hostility FF Age 18 v2 0 5 Fear EFFICACY
100. RABBIT choose that picture E demonstrates use of button Transition Now you try E reads screen then touches and holds button to continue Shape Practice 5 items sorted by shape Keep your eyes on the star in the middle of the Screen If less than 4 out of 5 correct COLOR intro We can also match by COLOR In the COLOR E points to then chooses game choose the picture that s the same COLOR BROWN picture as the picture in the middle of the screen If it s BROWN choose this picture If it s WHITE choose that picture E points to then chooses WHITE picture Transition Now you try E reads screen then touches and holds button to continue Color Practice 5 items sorted by color If less than 4 out of 5 correct COLOR and SHAPE intro Now we re going to play with some different shapes and colors This time we ll use BALLS and TRUCKS that are YELLOW and BLUE E reads screen then touches and holds button to continue Pre switch intro Let s start with the COLOR game Remember the COLOR game In the COLOR game choose the picture that s the same COLOR as the picture in the middle of the screen If it s a BLUE one choose this E chooses BLUE picture Return to TOC picture And if it s a YELLOW one choose that picture E chooses YELLOW picture Transition Now you try E reads screen then Keep your eyes on the star in the middle of the
101. Say You can also move pictures from the gray boxes back to the yellow box like this Touch the picture you want to move Then drag that picture to the yellow box Now you move the other picture back to the yellow box After the child demonstrates understanding of this step touch the button at the bottom of the screen that says Touch and Hold Here to Continue Step 3 Moving Pictures between the Gray Boxes Read the text above the yellow box on the screen and demonstrate the actions described Say You can also move the pictures from one gray box to another like this First you touch the picture in one gray box Then drag that picture to the gray box where you want the picture to go Now you try it move the picture from here to here After the child demonstrates understanding of this step touch the button at the bottom of the screen that says Touch and Hold Here to Continue Introduction to the Practice Items Read the screen Now we re going to play the game You will see some pictures on the screen You should remember them and show them back to me in the same way you saw them on the screen When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue The next screen begins the practice sequences There are two practice sequences The child has four trials to complete each sequence If the child succeeds in four trials or less the next practice sequence or test sequence is present
102. T Screens 4 8 5 practice items with fish bowl on screen DEXT Screen 9 Demo Trial 2 Here s another HUNGRY Fish We don t see the food but it s still there am going to touch the button pointing the same way the hungry fish is swimming E reads screen and then E touches left arrow Screen won t advance until correct arrow is touched When correct bubbles sound plays and iPad says Mmm thank you Touch and hold here to continue appears on screen E touches and holds button to continue DEXT Screen 10 Practice Trial 2 Now it s your turn Touch the button that s pointing the same way this Fish is swimming E reads screen Child touches an arrow If incorrect iPad says Let s try again Repeats until correct arrow is touched If correct bubbles sound plays and iPad says Mmm thank you Touch and hold here to continue appears on screen E touches and holds button to continue DEXT Screen 11 Transition Let s try some more E reads screen and then E touches and holds button to continue Return to TOC 52 DEXT Screens 12 16 5 practice items without fish bowl If either arrow is touched bubbles sound plays If neither arrow is touched moves to new item after 10 seconds If less than 4 of 5 correct on screens 12 16 test is discontinued If 4 or more correct test continues to Screen 17 DEXT Screen 17 Demo Trial 3
103. T ages 3 7 In this version participants are given five practice trials on each dimension color and shape If the participant responds incorrectly an audio recording provides feedback and highlights the correct image Similarly a separate audio file plays each time the participant gets a practice item correct Participants must succeed in 4 out of 5 practice trials in this version to move on If they do succeed the test administration continues in the same manner as the standard administration described above If they do not succeed on the practice trials of one dimension they are directed to the developmental extension of this measure In addition participants will be directed to the developmental extension if they do not achieve 4 out of 5 correct on either the 5 color trials pre switch or the 5 shape trials post switch The logic underlying this developmental extension is detailed in the test instructions DCCS 3 7 DEXT Return to TOC bs Age specific test instructions NIH Toolbox Dimensional Change Card Sort Test Ages 3 7 NIH Toolbox Dimensional Change Card Sort Test Ages 3 7 with Developmental Extension DEXT NIH Toolbox Dimensional Change Card Sort Test Ages 8 11 NIH Toolbox Dimensional Change Card Sort Test Ages 12 Return to TOC 69 C 2 4 1 NIH Toolbox Dimensional Change Card Sort Test Instructions Ages 3 7 This table outlines the item content read by as well as the actions for the examiner iP
104. TE picture If its BROWN choose that picture E chooses BROWN picture Transition Now you try Keep your eyes on the star Answer as fast as you can without making mistakes If you make a mistake just keep going Put your finger back on Home Base after you answer E reads screen then touches and holds button to continue Color Practice set 2 4 items sorted by color More practice if less than 3 out of 4 correct on set 2 Let s practice some more In the COLOR game choose the picture that s the same COLOR as the picture in the middle of the screen If it s WHITE choose this picture E chooses WHITE picture If its BROWN choose that picture E chooses BROWN picture Transition Now you try Keep your eyes on the star Answer as fast as you can without making mistakes If you make a mistake just keep going Put your finger back on Home Base after you answer E reads screen then touches and holds button to continue Color Practice set 3 4 items sorted by color Test ends if less than 3 out of 4 correct on set 3 Return to TOC 94 Test item intro iPad screen written content Now we re going to play both games together Remember if you see the word SHAPE you choose the picture that is the same SHAPE as the picture in the middle of the screen If you see the word COLOR you choose the picture that is the same COLOR as the picture in
105. a clip as shown below It is critical that the iPod be inserted in the protective case in the correct orientation with the home button toward the floor as shown not upside down e Open the Standing Balance Test on the iPad and turn on the iPod as described above e Open the BalancePod App and select Start a Standing Balance Test if you have not already done so e On the iPad select the name of the iPod with which you want to pair the iPad when they are connected the DONE button becomes activated Select DONE Cancel iPod touch 08 e A green band will appear at the top of both the iPad and the iPod when they are paired and communicating e Asthe iPad and iPod are being calibrated a gray button tells you the status calibrating or calibrated Please wait while balance instrument is calibrating e When the word CALIBRATED appears on the iPad screen touch the Touch and hold here to continue button to start the test Return to TOC 149 Calibrated Touch and hold here to continue e It is possible but not common that the calibration might need to be repeated after the participant is prepared If this happens the following screen appears Touch the re connect button until the word CALIBRATED appears on the iPad screen and continue as described above Lost connection to BalancePod RE CONNECT Tap to calibrate Please wait while balance instrument is calibrating Prep
106. ad screen written content Examiner E Actions Title Screen NIH Toolbox DCCS 3 7 E touches and holds button to continue Practice Intro We re going to play a matching game with colors and shapes E reads screen then touches and holds button to continue Keep your eyes on the star in the middle of the Screen SHAPE Intro We ll play the SHAPE game first In the SHAPE E points to BOAT then game choose the picture that s the same SHAPE demonstrates use of as the picture in the middle of the screen If it s a button BOAT choose this picture If its a RABBIT choose that picture E demonstrates use of button Transition Now you try E reads screen then touches and holds button to continue Shape Practice set 1 4 items sorted by shape More practice if less than 3 out of 4 correct on set 1 Let s practice that some more In the SHAPE game choose the picture that s the same SHAPE as the picture in the middle of the screen If it s a BOAT choose this picture E reads screen then chooses BOAT If its a RABBIT choose that picture E reads screen then chooses RABBIT Transition Now you try Keep your eyes on the star in the middle of the screen E reads screen then touches and holds button to continue Shape Practice set 2 4 items sorted by shape More practice if less than 3 out of 4 correct on set 2 Let s practice that some more In the SHAPE g
107. after being scratched The examiner may need to remind the participant to smell the card as quickly as possible after scratching it If the participant says he she does not smell anything the examiner should scratch the card one more time and place it directly under the participant s nose then ask the participant to make his her best guess if he she is not sure The examiner should encourage the participant to smell the card more than once if needed If the participant has difficulty using the scratcher the examiner may scratch the card and hand it to the participant Similarly if the participant has difficulty touching the iPad screen the examiner may register the participant s choice by touching the screen for him her The examiner should repeat the sequence of handing the cards to the participant to scratch smell and identify until all the cards have been used For each trial or as needed repeat what was said above Take the scratcher and scratch this card smell it then look at the pictures on the screen Touch the picture that best shows the odor that you smelled on the card If you want to change your last answer touch the GO BACK button NOTE The participant is not permitted to go back beyond the last item he she attempted If the participant attempts to go back beyond the previous item say You can only go back to the last item you smelled When the participant has completed all nine cards say You have fi
108. all Take the baby fora walk Draw on the sidewalk Pet the dog Feed the ducks Push the swing Smell a flower Get a hot dog Go for a pony ride Pet the sheep Win a dog show Watch the rodeo Catch a pig Judge the cake See a puppet theater Watch a tractor pull Play in the band Go on a hay ride Take a picture of a clown Look at the babies Go on a ride Get some tickets Get some ice cream Play a game Milk a cow Put the cow in the barn Drive the tractor Feed the pig Load the cart Put the carrots in the basket Pick the fruit Fix the fence Cut the sheep s wool Cut the wheat Herd the goats Put up the scarecrow Collect the honey Shovel out the barn Peel the corn Chop some wood Collect the eggs Put the blanket on the horse Plant the tomatoes After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to how to Play in the Park Form A Go to the Fair Form B Work on the Farm Form C Now you move the pictures in the same way you saw them on the screen When all pictures have been placed in gray boxes a pop up will appear on the screen Are you finished Ask this of the child If child says YES touch and hold the YES button If the child says NO touch any of the pictures and the pop up will disappear If no picture is moved out of a gray box the pop up will continue to be on the screen The pop up will close if a picture is moved back to the
109. ame choose the picture that s the same SHAPE as the picture in the middle of the screen If i s a BOAT choose this picture E chooses BOAT If its a RABBIT choose that picture E chooses RABBIT Transition Now you try Keep your eyes on the star in the middle of the screen E reads screen then touches and holds button to continue Shape Practice set 3 4 items sorted by shape Test ends if less than 3 out of 4 correct on set 3 Return to TOC 70 iPad screen written content Examiner E Actions Keep your eyes on the star in the middle of the screen COLOR intro We can also match by COLOR In the COLOR E points to then game choose the picture that s the same COLOR chooses BROWN as the picture in the middle of the screen If it s picture BROWN choose this picture If its WHITE choose that picture E points to then chooses WHITE picture Transition Now you try E reads screen then touches and holds button to continue Color Practice set 1 4 items sorted by color More practice if less than 3 out of 4 correct on set 1 Let s practice some more In the COLOR game choose the picture that s the same COLOR as the picture in the middle of the screen If it s WHITE choose this picture E chooses WHITE picture If its BROWN choose that picture E chooses BROWN picture Transition Now you try Keep your eyes on the star in
110. and Hold Here to Continue Test Item Trial 2 As the pictures are presented an audio recording will say appropriate labels same as Trial 1 see above After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to Play in the Park or Go to the Fair or Work on the Farm Now you move the pictures in the same way you saw them on the screen When all pictures have been placed in gray boxes a pop up will appear on the screen Are you finished Ask this of the child If child says YES touch and hold the YES button If the child says NO touch any of the pictures and the pop up will disappear If no picture is moved out of a ray box the pop up will continue to be on the screen The pop up will close if a picture is moved back to the yellow box and will reappear each time all pictures have been placed in gray boxes Logic Test will terminate after the two test sequences have been presented C 2 6 2 Picture Sequence Memory Test Instructions Ages 5 6 If the child has difficulty dragging the pictures across the screen during the demonstration sequence practice sequences or the actual test sequences he she may point and the examiner will move the pictures in the way the child indicates The examiner should ensure the child completely understands how the process will work and can say something like the following You point to the picture you want to move then point to
111. and purpose e g meaning life satisfaction Social Relationships refers to the interactions between two or more people Dimensions of social relationships include structure extent and quality Stress amp Self Efficacy describes individual perceptions about the nature of events and their relationship to the perceived coping resources of an individual Return to TOC Ld Negative Affect refers to unpleasant feelings or emotions which exist on a continuum ranging from common and normal feelings of sadness fear and anger to more extreme feelings along the same continuum C 3 1 Emotion Constructs NIH Toolbox Emotion constructs are defined below Psychological Well Being Positive Affect Definition Feelings that reflect a level of pleasurable engagement with the environment such as happiness joy excitement enthusiasm and contentment General Life Satisfaction One s cognitive evaluation of life experiences whether people like their lives or not Life satisfaction includes both general e g my life is going well and domain specific e g am satisfied with my family life aspects Meaning and Purpose Social Relationships Social Support Characterized by the extent to which people feel their life matters or makes sense Definition The extent to which an individual views his her social relationships as available to provide aid in times of need or when problems arise It includes instrum
112. ap the Export Data button in the upper right corner of the screen to create update data files for export m 2015 09 07 10 06 13 Registration Data csv E 2015 09 07 10 06 13 Assessment Scores csv E 2015 09 07 10 06 13 Assessment Data csv cn 2015 09 04 13 03 07 Registration Data csv There are 3 types of data files generated here e Registration data contains participant information entered on this iPad e Assessment data contains data for every item administered to every participant on this iPad e Assessment scores contains scores for every instrument administered to every participant on this iPad Return to TOC al Step 3 Step 3 tap one of 3 symbols envelope iCloud iTunes 2015 09 07 10 06 13 Registration Data csv 2015 09 07 10 06 13 Assessment Scores csv x 2015 09 07 10 06 13 Assessment Data csv cn 2015 09 04 13 03 07 Registration Data csv Return to TOC in Option 1 E mail To use this option users need to 1 Setup the Mail app on the iPad Mail set up instructions can be accessed here httos support apple com en us HT201320 2 Activate the ability to email files Tap click here or refer to the NIH Toolbox App Settings section for detailed instructions Once both of the above conditions are met tap the envelope symbol next to the file to be sent via email This will create a new email message Enter the destination address and tap Send This message will arrive from the email address that
113. are and Software Needed to Use the NIH Toolbox App To get the NIH Toolbox App you will need the following an iPad and an Apple ID These are described in more detail below The NIH Toolbox App is only available through the App Store a digital distribution platform for mobile apps on Apple devices At this time only an iPad version of the app has been developed iPad You will need an iPad Air or iPad Air 2 with Wi Fi capacity that is running iOS version 8 4 or version 9 0 The NIH Toolbox App is not yet compatible with the iPad mini iPad Pro or other Apple devices e g iPhone To obtain the latest version of iOS see Settings General Software Updates on your iPad Apple ID You will need an Apple ID to use the App Store app which comes pre installed on your iPad An Apple ID is your all in one account used to log in to all Apple products You may already have an Apple ID If this is the case you may use this ID or you may want to consider setting up another Apple ID for your NIH Toolbox activity You can create an Apple ID as described below nore An Apple ID is associated with your billing information i e credit card While the NIH Toolbox App is free to install you must purchase a subscription to be able to administer the instruments More information about pricing options can be found at nihtoolbox org If you have an Apple ID that you can use for your NIH Toolbox activity you may skip to Downloading and Opening the
114. aring the Participant Ask permission from the participant to put the gait belt on him her Strap the Velcro gait belt onto the participant so that the belt is fit tightly around the pelvis with the top of the belt at the top of the hip bones The handles of the belt should be positioned behind the participant and may be used by the examiner in case of loss of balance by the participant If the participant has a smaller waist it may be necessary to wrap the belt a second time around the participant or to use a smaller gait belt If so be sure the accelerometer is still positioned appropriately For children ages 3 6 the iPod is worn on the back of the belt when possible the handles of the gait belt should be positioned on whichever side of the child is closest to where the examiner will be positioned For participants ages 7 85 the iPod is attached on the front of the belt approximately where a typical belt buckle would be located The handles should be to the back of the participant Participants are to stand in their bare stocking feet no shoes They can wear paper booties if they wish Place a chair placed behind the participant if rest is needed between trials The examiner should stand behind the participant to the side of participants ages 3 6 to be ready to prevent the participant from falling During testing the iPad should be placed on a table in close proximity to the examiner It is crucial that the iPad is never gr
115. as possible with your arms crossed on your chest and then close your eyes like this demonstrate Ready After the participant assumes the position the examiner touches the START button and says Go The examiner should check the participant s posture The iPad screen will display the elapsed time of the trial so the examiner can easily see it while assuring the safety of the participant Choose STOP FAIL if the participant did not successfully complete the trial for any reason If the first trial is failed for any reason start the second trial of this pose the examiner should say Let s try that one again Please step onto the foam and put your feet together heels and balls of feet touching and stand as still as possible with your arms crossed on your chest then close your eyes like this demonstrate Ready The examiner touches the START button and says Go Again choose STOP FAIL if the participant did not successfully complete the trial for any reason After 50 seconds of elapsed trial time a tone will sound After a few more seconds the examiner will be able to touch the PASS or STOP FAIL button Whenever the PASS or the STOP FAIL button is touched a pop up window asking for confirmation of the choice will appear The examiner must confirm his her choice to move onto the next trial After participant completes one or both trials say Are you ready for the next one Proceed with the next pose or allow the participant to rest
116. as the final peg is placed back in the cup After timer stops touch the NEXT button and confirm your choice in the pop up window There is a RESET button if for some reason the participant needs to start again If this happens the examiner should touch RESET and confirm your choice in the pop up window Start the trial over again removing all the pegs before starting Test Trial non dominant hand Say Now I will time how fast you can do this Pick up the pegs one at a time using only your LEFT or RIGHT as appropriate hand Put them in the holes one at a time until all 9 holes are filled Then take them all out one at a time The pegs can be put in the holes or taken out in any order Remember to work as fast as you can Have participant start with his her hand flat on table beside pegboard At the bottom of the screen it says Right or Left as appropriate Hand Trial and there is a timer with START and RESET buttons Say Are you ready 3 2 1 Go Make sure to touch the START button as soon as you say GO As participant is placing the final peg say And take them out Touch the STOP button as soon as the final peg is placed back in the cup After timer stops touch the NEXT button and confirm your choice in the pop up window There is a RESET button if for some reason the participant needs to start again If this happens the examiner should touch RESET and confirm your choice in the pop up window Start the t
117. board The usual keyboard on the iPad will not work when the external keyboard is working To turn off the external keyboard press the round button at the top right end of the keyboard move at least 15 meters from the iPad with the keyboard or touch the information button on the iPad and touch forget this device Using the Keyboard Once the participant answers gives the list of objects the examiner types 1 if the response list is correct or 0 if the response list is incorrect For the practice items after choosing 1 or 0 the examiner presses the spacebar to move on to the next item list of objects There is feedback presented by the prerecorded voice and repeated trials for errors For the test items after the examiner chooses 1 or 0 the question Are you ready appears on the screen The examiner presses the spacebar to move on to the next item list of objects after the participant answers the question affirmatively The Left arrow takes the participant back to the previous item Ctrl Shift on the Keyboard is equivalent to the gesture used to STOP an administration on the iPad Like the iPad when Ctrl Shift is entered on the keyboard a login screen will pop up and ask for the password of the user who started the assessment As described earlier three options will appear resume skip and stop Return to TOC s There are two different conditions 1 List and 2 List In the 1 List condition participants a
118. bout problems with their assessment Error The Handedness field is required in order to administer the 9 hole Pegboard instrument Warning The Education fields are required in order to calculate Fully Adjusted normed scores Error messages LI inform users about problems that prevent them from launching the assessment Users need to go back to the New Assessment screen via Participants and fix those problems before the assessment can be started Warning messages n users about missing information or characteristics of the assessment that users may want to revise before starting It is possible either to go back to the New Assessment screen and change them or to launch the assessment without making changes Return to TOC zl Pause Skip Stop An assessment can be paused at any time after launch Step 1 Put two fingers on the screen and rotate one of them clockwise as if making a half circle on the screen Step 2 Enter the administrator s passcode that was set up when the app was first launched NIH Toolbox Passcode ONG CD OOG Step 3 Select from the 3 options presented on the screen e Resume Instrument e Skip Instrument e Stop Assessment Return to TOC 22 Different instruments may behave differently if Resume Instrument or Stop Assessment is selected In most cases users will be taken back to where they were before pausing the assessment In some cases e g timed tests users will be tak
119. button screen says Can you show me where the blue ones go E reads screen and C touches a box triggering either 5a or b When Touch and Hold Here to Continue button appears again E touches and holds button to advance to next screen 4A Screen 6 Rule check Can you show me where the blue ones go in the color game E reads screen C touches a box 4A Screens 7a amp b Feedback 5a If correct Very good that s right E reads screen Touch and Hold Here to Continue button appears E touches and holds button to advance to next Screen 5b If incorrect Uh oh Remember in the color game if it s a blue one then put it in the blue box but if it s a red one put it in the red box Touch and Hold Here to Continue button appears after E touches and holds button screen says Can you show me where the red ones go E reads screen and C touches a box triggering either 5a or b When Touch and Hold Here to Continue button appears again E touches and holds button to advance to next screen Return to TOC 87 4A Screens 8 Now let s do some more like that E reads screen When Touch and Hold Transition Here to Continue button appears E touches and holds button to continue 4A Screen 9 If it s a red one then it goes in the red E reads screen After 5 seconds Rule reminder 1 box If it s a blue one then it goes in the blue box Text appea
120. button that instructs the examiner to Press the Spacebar to continue Because some children may not be able to name one or more of the letters HOTV a laminated card is also used with young participants allowing them to point to what they saw on the screen without verbalizing The examiner should be seated next to the child so that he she can see or hear what letter the child chooses A brief training is included before the test followed by a practice to assure that the child knows what needs to be done to complete the assessment If the child does not succeed with the practice as outlined below testing should be discontinued Training Once the child is seated in a chair that is 3 meters from the iPad say Now we are going to do an activity that shows us how well you can see pictures on the iPad screen Press Spacebar to continue Hand the child the laminated card and say Everything you will see is shown on this card This is a picture of an H this is a picture of an O this is a picture of a T and this is a picture of a V point to each letter while naming Now you try to name the pictures Encourage the child to name the letters as best he she can If the child names all four letters correctly say Good job If any are named incorrectly point to each letter and say only one time as before This is a picture of an H this is a picture of an O this is a picture of a T and this is a picture of a V Because letter naming is n
121. c instructions for administering them It is recommended that the iPad be placed in a case both for its protection and so that the angle of the iPad can be placed at multiple positions to ensure participant comfort Positioning the iPad so that it is at an angle of about 60 degrees from the table works best However if that setup is not effective for the participant the examiner should adjust the angle so that it is most comfortable while still being easily visible and accessible to touch Placing the iPad flat on the table is generally not recommended Please note that selected tests e g visual acuity require that the iPad be placed perpendicular to the table and at eye level for the participant using an iPad easel or something similar may be used for this and all other tests if preferred See Appendix 4 for more information on suggested equipment ve When an examiner administers an instrument to a participant within the app the first screen they will see is a title screen that contains the instrument name or a shortened version of the name Please note that the name displayed on this screen often does not exactly match the full name of the instrument displayed when the user examiner is selecting measures to be administered as part of an assessment Appendix 5 contains a key to these abbreviations The first column in the appendix shows the title screen as it is displayed at the start of the instrument and the second column gives the cor
122. ck If either arrow is touched bubbles sound 30 34 plays If neither arrow is touched moves on to new item after 10 seconds DEXT Screens 5 items Toolbox Flanker Fish block If either arrow is touched bubbles sound 35 39 plays If neither arrow is touched moves on to new item after 10 seconds After screen 39 DEXT ends Return to TOC 53 C 2 2 3 NIH Toolbox Flanker Inhibitory Control and Attention Test Instructions Ages 8 11 This table outlines the item content read by as well as the actions for the examiner iPad screen written content Examiner E Action Introductions Title Screen NIH Toolbox FL 8 11 E touches and holds button to continue Home Base In this task you will see a row of arrows pointing different E reads screen and ways But first we are going to learn about Home Base This is your Home Base Put your finger on Home Base and wait for the next picture points to the home base then touches and holds button to continue Practice Introduction You will see a row of arrows You should choose the button that matches the way the MIDDLE arrow is pointing E points to left arrow and demonstrates touching the correct arrow If the MIDDLE arrow is pointing this way choose this button E demonstrates touching arrow button If the MIDDLE arrow is pointing this way choose this button E demonstrates touching arrow button Sometimes all the arrows will
123. ct These supplemental instruments generally extend the age range or the floor of these constructs downward More information about these instruments is available below Time to Cognition Supplemental Instruments Ages Administer minutes NIH Toolbox Pattern Comparison Processing Speed Test NIH Toolbox Flanker Inhibitory Control and Attention Test with Developmental Extension Ex NIH Toolbox Dimensional Change Card Sort Test with 3 7 Developmental Extension Experimental Ore Time to Administer minutes column gives users an idea of how long each test NOTE might take however please note that testing times could vary based on how prepared the test administrator is going into the session individual differences among participants and or other unplanned activities that may occur during testing 42 Return to TOC C 2 1 NIH Toolbox Picture Vocabulary Test The NIH Toolbox Picture Vocabulary Test is a measure of receptive vocabulary administered in a computer adaptive test CAT format Equipment and materials needed e iPad The participant is presented with four pictures on the iPad screen and an audio recording saying a word The participant is instructed to touch the picture that most closely shows the meaning of the word After the participant makes a choice another set of pictures automatically appears with the next item and associated audio file Because the test uses a variable length CAT some partic
124. ctice Walk the path out and back one time go around the cone without slowing down Ready 3 2 1 Go When participant is finished say Do you have any questions Answer any questions participant has Touch and hold the button to move to the next screen Test Trial Screen e The test trial screen has a timer centered in the middle of the screen that shows 2 00 automatically when the screen appears The timer has a START STOP button and a RESET button e Touching START turns the button into a STOP button e Touching STOP activates the RESET button meaning START cannot be activated again until RESET is touched Once the RESET button is touched a pop up will appear that asks the examiner to confirm the RESET and if confirmed the timer will be reset e Resetting also presents the initial instructions at the top of the screen again e Directly below the timer is the lap turn button that records the number of times a user has passed a cone and next to the lap turn button is a button and below that is button e The and buttons allow the user to add or subtract laps in case an error was made e Acounter actively keeps track of how many times lap was touched or what the and buttons added or subtracted from that total e Atthe bottom of the screen there is text saying Each time the participant makes a turn press the Lap button to record it and If you make a mistake press the or button to add or
125. d if the child attempts to go back beyond the previous item say You can only go back to the last item you smelled When the child has completed all five cards say We are done with the smells The five odors presented are Lemon Play Doh Bubble Gum Chocolate and Popcorn C 5 2 2 NIH Toolbox Odor Identification Test Instructions Ages 10 The task is introduced with the following Title Screen NIH Toolbox Odor Identification Test 10 At the bottom of the screen is a button Touch and Hold Here to Continue Touch and hold that button to begin the test Instruction Screen The examiner says This task involves smelling various odors one at a time and then trying to identify them The odors that you will smell are chosen from a variety of foods and objects that people experience in everyday life We are using scratch n sniff cards to present the odors The examiner continues Take the scratcher and scratch the card Smell it right after you scratch it then look at the pictures on the screen Touch the picture that best shows the odor you smelled on the card A new set of pictures will then appear on the screen and you will be asked to identify the odor on the next card If you want to change your last answer touch the GO BACK button NOTE For the first item the GO BACK button is deactivated as there is no item before this one Scratch n Sniff Card Note The odor on the card is strongest immediately
126. d the examiner must adhere to this guide for all item scoring At the same time while scoring is strict it should take into consideration difficulties in pronunciation that can be attributed to dialect or articulation to the extent that these difficulties are consistent throughout the testing they should be accepted as correct pronunciations by the examiner C 2 7 1 Oral Reading Recognition Test Instructions Age 3 Before beginning the test the wireless keyboard should be paired by Bluetooth with the iPad if this has not already been done While administering this measure the examiner needs to be able to view the iPad and have the keyboard and word list and pronunciation guide easily accessible for scoring participant responses The task is introduced with the Title Screen NIH Toolbox OR 3 To check the Bluetooth connection the examiner is asked at the bottom of the page to Press Spacebar to Continue Touching the spacebar begins the test If the soacebar does not work try re pairing the keyboard or changing the batteries in the keyboard Say Now I m going to show you some letters and some words want you to read each letter or word out loud Read each one loud enough so that can hear you Some will be easy and some will be hard Don t worry if you don t know the word or its meaning just read it out loud the best you can Let s begin Press spacebar to continue When the first item appears say Tell me what is
127. d ask the participant to do another trial To do this on the screen press the RESET button to set the timer back to zero confirming when the pop up screen appears Then give the trial again following all instructions Test Trial 1 Screen Say This time am going to time you as you walk at your usual speed Are you ready 3 2 1 Go Make sure to touch the START button as soon as the participant steps over the starting line Touch the STOP button as soon as one of the participant s feet is completely across the finish line After timer stops touch the NEXT button and confirm your choice in the pop up window Test Trial 2 Screen Say Now I want you to repeat the walk Remember to walk at your usual pace and go all the way past the cone at the other end of the course Are you ready 3 2 1 Go Make sure to touch the START button as soon as the participant steps over the starting line Touch the STOP button as soon as one of the participant s feet is completely across the finish line After timer stops touch the NEXT button and confirm your choice in the pop up window If needed have the participant rest in a chair for at least one minute before the next task C 4 5 NIH Toolbox 2 Minute Walk Endurance Test This measure of endurance can be administered to participants ages 3 to 85 It is administered in an open hallway The participant should be wearing comfortable shoes such as athletic shoes A timer and grid for marking
128. d hold that button to begin the test Handedness If this was not entered during registration the iPad app will not allow this test to be administered Instead the examiner will need to ask a set of questions to ascertain handedness and to enter it in the participant registration screen Please refer to Appendix 2 for details Once handedness is entered in the participant registration screen it will automatically update the instructions on the test so that RIGHT or LEFT is displayed where appropriate Follow the set up instructions outlined in the Grip Strength Introduction and on the iPad screen specifically e Before beginning be sure to turn on the dynamometer e The hand for gripping the dynamometer is adjustable but should be set at the notch second closest to the unit touch information button for picture e Before each trial press RESET button and then TEST button on the dynamometer to record the grip strength force e Have the participant sit down in the chair so his her feet are on the floor or foot plate of the wheelchair and his her knees are at a 90 degree angle e Support the dynamometer for the participant and ensure that the participant is holding the arm being tested at a 90 degree angle next to but not touching his her body Touch the button at the bottom of the screen that says Touch and Hold Here to Continue Say We will use this machine show dynamometer to measure how strong your hands are
129. d making selections from the following categories All Domains e Cognition e Emotion e Motor e Sensation All Ages e Ages listed individually from 3 17 e Adult Return to TOC Ld All Types e CAT e FF Fixed Form for select NIH Toolbox Emotion instruments v Selected Instruments v Available Batteries Motor v Adult v All Types v Cs gt NIH Toolbox Motor Battery ages 7 Select v Available Instruments Motor Adult All Types v is E NIH Toolbox 2 Minute Walk Endurance Test Age 3 v2 0 Select NIH Toolbox 4 Meter Walk Gait Speed Test Age 7 v2 0 Select Selected instruments will move to the upper part of the screen and will be listed under Selected Instruments NIH Toolbox Touch Screen Tutorial Age 3 is available and recommended for anyone not familiar with using an iPad or similar devices It should be added as the very first instrument in the assessment oe NIH Toolbox Emotion Instructions Adult Child should be added immediately before the first NIH Toolbox Emotion instrument for the given participant Preset batteries do include appropriate instructions so instructions should only be added if the user is not selecting a preset emotion adult child battery NIH Toolbox Emotion Instructions Parent Report should be added immediately before the first NIH Toolbox Emotion instrument to be completed by parents about the given child Preset batteries do include appropriate instructions so instructions
130. d that button to begin Question 1 the voice on the iPad says Touch the picture of a flower If correct the voice on the iPad will say That s right Or Great Job Alternating throughout this part of the task If incorrect the picture of a flower will flash and the voice will say This is a flower The screen will change to the Flower picture and a voice on the iPad will ask Have you ever smelled a flower Touch yes or no on the screen to indicate the child s answer then touch NEXT at the bottom of the screen to go on to the next item The answer choice can be changed between No and Yes until Continue is pressed to advance to next screen No Go Back is permitted in Picture Identification component Question 2 the voice on the iPad says Touch the picture of popcorn If correct the voice on the iPad will say That s right Or Great Job Alternating throughout this part of the task If incorrect the picture of popcorn will flash and the voice will say This is popcorn The screen will change to the Popcorn picture and a voice on the iPad will ask Have you ever smelled popcorn Touch yes or no on the screen to indicate the child s answer then touch NEXT at the bottom of the screen to go on to the next item The answer choice can be changed between No and Yes until Continue is pressed to advance to next screen No Go Back is permitted in Picture Identification component Question 3 the voice on the iPad says Touch
131. d your tongue out If the participant has difficulty doing this show him her the picture or demonstrate Say am going to start on your left side and gently put some solution across the tip of your tongue The examiner should carefully and gently apply the solution in a slow continuous motion from the left side of the tongue across the tip and finishing on the right side of the tongue Move from left side tothe middle to the right side Using the cotton swab paint the quinine on the tip of the tongue as described earlier and say Now show me the strength or intensity of the taste on the scale you used before Keep your tongue out while you make the rating on the scale Touch the OK button when you are finished If you should accidentally swallow any it will not hurt you Transition screen 1 Have the participant rinse out his her mouth with the bottled water between Items 1 and 2 and read Please rinse out your mouth two times with the bottled water and spit the rinse water into this container The examiner should touch and hold button at the bottom of the screen to advance to next screen Return to TOC 108 Test Item 2 Read Now hold your tongue out again am going to gently put some solution across the tip of your tongue Using the cotton swab paint the salt solution NaCl on the tip of the tongue as described earlier and say Now show me the strength or intensity of the taste on the scale you used before Keep
132. dio recording says You saw a RABBIT SHEEP and ELEPHANT the RABBIT is smaller than the SHEEP and the SHEEP is smaller than the ELEPHANT The RABBIT is the smallest animal the SHEEP is the next biggest animal and the ELEPHANT is the biggest animal Now say the animals in size order starting with the smallest animal Correct Response If participant says RABBIT SHEEP ELEPHANT press 1 and then press spacebar An audio recording says That s right When it appears on the screen ask Are you ready When the participant answers affirmatively press the spacebar and presentation of the 1 List introduction screen will be presented If participant answers the question incorrectly press 0 and then press spacebar Test will be discontinued Return to TOC os The 1 list practice items are summarized in the table below P1 Presentation Horse Dog Flashing Question Response Next step Q1 Smaller first then If Dog Horse press 1 If Horse If 1 goes to P2 If 0 goes Bigger Dog press 0 to Q2 Q2 Smaller first then If Dog Horse press 1 If Horse If 1 goes to P2 If O goes Bigger Dog press 0 to Q3 Q3 Smaller first then If Dog Horse press 1 If Horse If 1 goes to P2 If 0 test Bigger Dog press 0 discontinued P2 Presentation Elephant Rabbit Sheep flashing Question Response Next step Q1 Animals in size order starting with the smallest If Rabbit Sheep Elephant press 1
133. ds button to continue Where is the MIDDLE fish here Child points E touches and holds button to continue Look at all the fish The fish in the MIDDLE is hungry E touches and holds button to continue To feed the MIDDLE fish choose the button that matches the way the MIDDLE fish is pointing E demonstrates using index finger to touch arrow button Here the MIDDLE fish is pointing this way so PII choose this button E demonstrates touching arrow button If the MIDDLE fish is pointing this way choose this button E demonstrates touching arrow button Sometimes all the fish point the same way Sometimes the MIDDLE fish points a different way like this incongruent fish You should always choose the button that matches the way the MIDDLE fish is pointing You will hear the word MIDDLE to remind you E points then chooses arrow button Here the MIDDLE fish is pointing this way so II choose this button E points then chooses arrow button Here the MIDDLE fish is pointing this way so lII choose this button E points then chooses arrow button Transition to practice items Now you try Keep your eyes on the star in the middle of the screen E reads screen then touches and holds button to continue Practice Items set 1 4 practice items More practice if less than 3 out of 4 correct on set 1 Let s practice some more If the MIDDLE fish is
134. e E chooses BALL When you hear the word COLOR choose the picture that s the same COLOR as the picture in the middle of the screen If it s a BLUE one choose this picture E chooses BLUE picture And if its a YELLOW one choose that picture E chooses YELLOW picture Transition Now you try Keep your eyes on the star in the middle of the screen Try to answer as fast as you can Remember Put your finger back on Home Base after you answer E reads screen then touches and holds button to continue Test items 30 mixed items Return to TOC 75 1A Screen 1 Instructions Now we are going to play a different game Look what have here have a fish Look at these boxes down here This box has an elephant in it and this box has a fish in it I m going to put the fish in the fish box because that is where it belongs E reads screen and points out the relevant aspects After 10 seconds the Touch and Hold Here to Continue button appears E then touches and holds the button to continue 1A Screen 2 Demonstration See here is a fish It goes in the fish box E reads screen and touches the fish box which makes a clicking sound The Touch and Hold Here to Continue button appears then E touches and holds the button to continue 1A Screen 3 Fish Rule check Now it s going to be your turn to play the fish game Can you show me where the fis
135. e 18 NIH Toolbox Emotion Battery ages 8 12 NIH Toolbox Emotion Battery ages 13 17 NIH Toolbox Emotion Parent Report Battery ages 3 7 and NIH Toolbox Emotion Parent Report Battery ages 8 12 Users wishing to select specific measures or create custom batteries can find the complete list of available measures here noe There are two versions of NIH Toolbox Emotion instructions NIH Toolbox Emotion Instructions Adult Child and NIH Toolbox Emotion Instructions Parent Report When using individual instruments to set up an assessment or build a custom battery users must select the correct version to precede Emotion instruments All preset Emotion batteries include appropriate instructions C 3 2 General Instructions The participant answers emotion measures at his her own speed An examiner need not be involved After a question is answered the screen advances automatically to the next question All measures for the youngest age group 3 7 are parent proxy report measures On these measures the proxy parent or guardian responds to questions about the child according to how he she thinks the child is doing For 8 12 year old children measures come in both self and parent report versions For ages 13 only self report measures are available C 3 3 NIH Toolbox Emotion Age Specific Instructions and Instruments Self report and parent report instruments have slightly different instructions on the screen these are given below
136. e START button and says Go The examiner should check the participant s posture The iPad screen will display the elapsed time of the trial so the examiner can easily see it while assuring the safety of the participant Choose STOP FAIL if the participant did not successfully complete the trial for any reason If the first trial is failed for any reason start he second trial of this pose the examiner should say Let s try that one again Please stand with your feet together heels and balls of feet touching and as still as possible with your eyes closed and with your arms crossed on your chest like this demonstrate Ready The examiner touches the START button and says Go Again choose STOP FAIL if the participant did not successfully complete the trial for any reason After 50 seconds of elapsed trial time a tone will sound After a few more seconds the examiner will be able to touch the PASS or STOP FAIL button Whenever the PASS or the STOP FAIL button is touched a pop up window asking for confirmation of the choice will appear The examiner must confirm his her choice to move onto the next trial After participant completes one or both trials say Are you ready for the next one Proceed with the next pose or allow the participant to rest following the procedures noted above Pose 3 Screen Foam surface feet together eyes open The examiner should pick up the blue pad and place it on the floor one meter in
137. e program automatically moves to the next practice item after repeating the explanation above Practice item Correct response Incorrect response 1 Yes both yellow flowers No 2 No a flower with stem amp top of a flower Yes 3 No one present amp many presents Yes 4 Yes both single presents No 5 No purple flower amp red flower Yes 6 Yes both red flowers No NOTE If a participant makes an error a second time after being corrected on two different practice items the test will discontinue Test Items An audio recording introduces the test items Now we ll do some more Remember use your right left audio will say the dominant one index finger to respond Touch YES if the pictures look the same and touch NO if they do NOT look the same It is important that you choose as quickly as you can When the audio file is complete Touch and hold here to continue appears on the screen Touch and hold that button to continue with the test items For both test and practice items if the participant does not respond within 10 seconds the audio asks Are these the same When either 130 items appear or 85 seconds of testing time has occurred the test will end if a participant is working on an item when time is up he she will be permitted to complete it C 2 6 NIH Toolbox Picture Sequence Memory Test In this measure of episodic memory sequences of pictured objects and activities are pr
138. e tractor e Feed the pig e Load the cart e Put the carrots in the basket e Pick the fruit e Fix the fence e Cut the sheep s wool e Cutthe wheat e Herd the goats e Putup the scarecrow e Collect the honey e Shovel out the barn e Peel the corn e Chop some wood e Collect the eggs e Put the blanket on the horse e Plant the tomatoes After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to Play in the park Form A Go to the fair Form B Work on the farm Form C Now you move the pictures in the same way you saw them on the screen When all pictures have been placed in gray boxes a pop up will appear on the screen Are you finished Ask this of the participant If participant says YES touch and hold the YES button If the participant says NO touch any of the pictures and the pop up will disappear If no picture is moved out of a gray box the pop up will continue to be on the screen The pop up will close if a picture is moved back to the yellow box and will reappear each time all pictures have been placed in gray boxes Logic Test will terminate after the two test sequences have been presented C 2 7 NIH Toolbox Oral Reading Recognition Test The NIH Toolbox Oral Reading Recognition Test is a measure of reading decoding skills These skills are part of what are considered crystalized abilities abilities that are dependent on past learning and exposure t
139. each item you will hear a word and see four pictures on the screen Touch the picture that you think best matches the meaning of the word that was said If you are not sure make your best guess If you need to hear the word again touch the button that has a picture of an EAR also called the PLAY AGAIN button After you touch a picture you will hear a new word and see more pictures You will keep hearing words and touching pictures until you are done If you want to change your last answer touch the button with the HAND that says GO BACK The pictures you just saw will reappear and you will hear the word again Touch your choice and then more words and pictures will appear Tell me when you are ready to start When participant is ready touch button that says Touch and Hold Here to Continue Practice item 1 An audio recording says Let s try one for practice Banana Touch the picture of Banana If correct the audio recording says That s right The program will automatically go to the next practice item If incorrect the Banana picture will light up and an audio recording will say This is a banana Let s try again The examiner should allow the participant up to three chances to answer this practice item correctly After three unsuccessful attempts by the participant the examiner should touch the picture of the banana and say This is a banana The next practice item will appear automatically Return to TOC xi Practice
140. each you how to move the pictures on this screen When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue The next screen begins the three step demonstration sequence f the steps are not followed the Touch and Hold Here to Continue button will not be active Step 1 Moving Pictures from the Yellow Box to the Gray Boxes Read the text above the yellow box on the screen and demonstrate the actions described Say Here you see some pictures in a yellow box want to show you how to move the pictures to the gray boxes You can move pictures from this yellow box to the gray boxes like this Touch on the picture in the yellow box then drag the picture you touched to the gray box where you want to move it Now you try with this picture After the child demonstrates understanding of this step touch the button at the bottom of the screen that says Touch and Hold Here to Continue Step 2 Moving Pictures from the Gray Boxes to the Yellow Box Read the text above the yellow box on the screen and demonstrate the actions described Say You can also move pictures from the gray boxes back to the yellow box like this Touch the picture you want to move Then drag that picture to the yellow box Now you move the other picture back to the yellow box After the child demonstrates understanding of this step touch the button at the bottom of the screen that says Touch and Hold Here to Continue S
141. eading the screen You will hear a woman asking you to repeat various words Repeat the words she asks out loud so that can hear you For example if you hear her say Say the word dog you would say dog If you are not sure what she said just say what you think you heard You will also hear people talking in the background Do your best to ignore them and to focus on the woman s voice asking you to repeat the words You will hear words in only one ear and then in the other Do you have any questions Answer any questions and say Let s begin The examiner should place the earphones on the participant s head making sure that the right earphone is over the right ear and the left earphone is over the left ear Touch the button at the bottom of the screen that says Touch and Hold Here to Continue This will start the test First Ear A series of five words will appear on the iPad screen along with the current dB level and the ear being tested The associated audio files will play in the participant s earphones The examiner should listen carefully to the participant s responses and touch any word that is said correctly Incorrect words are not marked Each screen represents a different background noise level and on each the examiner touches the word s that the participant correctly identifies If the participant correctly repeats at least one word at a level the audio files will continue to present words to that ear If a
142. eater than a few feet certainly less than 15 away from the iPod and gait belt unit the participant is wearing during testing While it might be easiest to hold the iPad during testing in the event that a participant requires help after a stumble or fall the examiner might have to drop the iPad and endanger its integrity Return to TOC 18 Each participant will be given up to two trials to be successful Use the following guidelines to stop a trial as any of these are evidence that the participant is no longer holding the pose and has failed the trial 1 If the arms come off of the chest If the knees bend If the feet move out of original position move or swivel out or are lifted kK WwW N If the participant bends forward at the waist more than 45 degrees If this happens the examiner will have to support the participant with the belt 5 If the participant opens his her eyes during an eyes closed pose poses 2 and 4 6 If the participant says something like I cannot do that or I do not feel safe trying that As needed throughout testing remind the participant that he she can step out of the pose if he she is feeling unsafe or unable to hold the pose A second trial should be attempted if the first trial is not successfully completed the examiner should stand close to the participant to prevent actual falls Some participants will succeed on the second trial even if they failed the first trial particularly
143. ed If the child fails all four trials of either practice sequence the test is discontinued Practice Sequence 1 Say Now you will see how to Have a Birthday Party When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue As pictures are presented an audio recording will say the appropriate labels First bake the cake Next frost it And last put on the candles After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to Have a Birthday Party Now you move the pictures in the same way you saw them on the screen When all pictures have been placed in gray boxes a pop up will appear on the screen Are you finished Ask this of the child If child says YES touch and hold the YES button If the child says NO touch any of the pictures and the pop up will disappear If no picture is moved out of a gray box the pop up will continue to be on the screen The pop up will close if a picture is moved back to the yellow box and will reappear each time all pictures have been placed in gray boxes Logic 1 If child gives correct response Practice sequence 2 Go Camping will be presented 2 If child gives incorrect response Have a Birthday Party will be presented again with an audio recording saying Let s try that again After the pictures are presented and as the pictures are scrambled an audio recording will
144. een pause not recorded in data o During Practice NO PRACTICE IN PAIN INTENSITY o During Live Items Return to active screen pause not recorded in data e Stop exit the instrument by selecting stop with the intention of resuming at a later time o During instructions Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Practice NO PRACTICE IN PAIN INTENSITY o During Live Items Participant sees last live item not responded to NIH Toolbox Pain Interference CAT e Skip o Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted e Pause perform admin gesture and return to instrument without selecting stop or skip o During Instructions Return to active screen pause not recorded in data o During Practice NO PRACTICE IN PAIN INTERFERENCE o During Live Items Return to active screen pause not recorded in data e Stop exit the instrument by selecting stop with the intention of resuming at a later time o During instructions Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Practice NO PRACTICE IN PAIN INTERFERENCE o During Live Items Participant sees item equivalent to last item shown NIH Toolbox Odor Identification Test e Skip o Resume not allowed mark instrument as completed go to next instrument if applicab
145. electing stop or skip o During Instructions Return to active screen pause not recorded in data o During Practice Return to active screen pause not recorded in data o During Live Items Resume not allowed mark instrument as completed go to next instrument if applicable e Stop exit the instrument by selecting stop with the intention of resuming at a later time o During instructions Resume not allowed mark instrument as completed go to next instrument if applicable o During Practice Resume not allowed mark instrument as completed go to next instrument if applicable o During Live Items Resume not allowed mark instrument as completed go to next instrument if applicable NIH Toolbox 4 meter Walk Gait Speed Test e Skip o Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted e Pause perform admin gesture and return to instrument without selecting stop or skip o During Instructions Return to active screen pause not recorded in data o During Practice Return to active screen pause not recorded in data o During Live Items Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted e Stop exit the instrument by selecting stop with the intention of resuming at a later time o During instructions Participant sees first item aka resume at beginning of
146. en touches and holds Keep your eyes on the star in the middle of the button to continue screen Color items 5 items sorted by color if child does not get 4 of 5 Test ends if less than 4 of 5 correct Post switch intro Now we re going to play the SHAPE game Remember the SHAPE game In the SHAPE game choose the picture that s the same SHAPE as the picture in the middle of the screen If it s a TRUCK choose this picture E chooses TRUCK And if it s a BALL choose that picture E chooses BALL Transition Now you try E reads screen then touches and holds Keep your eyes on the star in the middle of the button to continue screen Shape items 5 items sorted by shape Test ends if less than 4 of 5 correct Home Base before Mixed Items We can also play both games together But first we are going to learn about Home Base This is your Home Base Put your finger on the Home Base and wait for the next picture In this new game put your finger back on Home Base after each answer E reads screen and points to the home base then touches and holds button to continue Transition to Mixed Trials Now we are ready to play both games together Remember when you hear the word SHAPE choose the picture that s the same SHAPE as the picture in the middle of the screen If it s a TRUCK choose this picture E chooses TRUCK And if it s a BALL choose that picture E ch
147. en back to the beginning of the instrument In select cases an instrument may not be restarted once paused Detailed rules for each test are available in Appendix 3 If Skip Instrument is selected users will be asked the reason for skipping Safety Exclusion Participant Respondent Refused No Time Physical Limitations Communication Problems Language Barrier Equipment Failure Ineligible Participant IIl Emergency Target Respondent Unavailable Other Once the reason that best describes why the instrument was skipped is selected users will be taken to the beginning of the next instrument or the end of the assessment if this was the last instrument in their assessment If Other is selected users will be taken to a text screen where they will be required to enter another reason and then allowed to skip the instrument If Stop Assessment is selected users will be asked the reason for stopping Safety Exclusion Participant Respondent Refused No Time Physical Limitations Communication Problems Language Barrier Equipment Failure Ineligible Participant Ill Emergency Target Respondent Unavailable Other Select the reason that best describes why the assessment is being stopped and proceed to the main screen of the app If Other is selected users will be taken to a text screen where they will be required to enter another reason and then allowed to stop the assessment If an instrument is paused skipped
148. endix 2 for details Once handedness is entered in the participant registration screen it will automatically update the instructions on the test so that RIGHT or LEFT is displayed where appropriate IMPORTANT REMINDER Unlike some of the other tasks if participants have difficulty touching the screen the examiner cannot answer for them as this task measures processing speed and having the examiner answer would compromise the accuracy of this measurement we Participants may be given a small stress ball to keep in their non dominant hand Age specific test instructions NIH Toolbox Pattern Comparison Processing Speed Test Instructions Ages 3 6 NIH Toolbox Pattern Comparison Processing Speed Test Instructions Ages 7 Return to TOC id C 2 5 1 Pattern Comparison Processing Speed Test Instructions Ages 3 6 The task is introduced with the Title Screen NIH Toolbox PC 3 6 At the bottom of the screen is a button Touch and Hold Here to Continue Touch and hold that button to begin the test Handedness If this was not entered during registration the iPad app will not allow this test to be administered Instead the examiner will need to ask a set of questions to ascertain handedness and to enter it in the participant registration screen Please refer to Appendix 2 for details Once handedness is entered in the participant registration screen it will automatically update the instructions on the test so that RIGHT or LEFT
149. endix 5 Key to Instrument Name Abbreviations Title screen displayed in the app Corresponding Instrument Name NIH Toolbox Touch Screen Tutorial 3 NIH Toolbox Touch Screen Tutorial Age 3 NIH Toolbox PVT 3 NIH Toolbox Picture Vocabulary Test Age 3 v2 0 NIH Toolbox OR 3 NIH Toolbox Oral Reading Recognition Test Age 3 v2 0 NIH Toolbox LS 7 NIH Toolbox List Sorting Working Memory Test Age 7 v2 0 NIH Toolbox PC 7 NIH Toolbox Pattern Comparison Processing Speed Test Age 7 v2 0 NIH Toolbox PSM 3 4 Form A NIH Toolbox Picture Sequence Memory Test Ages 3 4 Form A v2 0 NIH Toolbox PSM 3 4 Form B NIH Toolbox Picture Sequence Memory Test Ages 3 4 Form B v2 0 NIH Toolbox PSM 3 4 Form C NIH Toolbox Picture Sequence Memory Test Ages 3 4 Form C v2 0 NIH Toolbox PSM 5 6 Form A NIH Toolbox Picture Sequence Memory Test Ages 5 6 Form A v2 0 NIH Toolbox PSM 5 6 Form B NIH Toolbox Picture Sequence Memory Test Ages 5 6 Form B v2 0 NIH Toolbox PSM 5 6 Form C NIH Toolbox Picture Sequence Memory Test Ages 5 6 Form C v2 0 NIH Toolbox PSM 7 Form A NIH Toolbox Picture Sequence Memory Test Age 7 Form A v2 0 NIH Toolbox PSM 7 Form B NIH Toolbox Picture Sequence Memory Test Age 7 Form B v2 0 NIH Toolbox PSM 7 Form C NIH Toolbox Picture Sequence Memory Test Age 7 Form C v2 0 NIH Toolbox PSM 8 Form A NIH Toolbox Picture Sequence Memory Test Age
150. ental and emotional social support Emotional Support perception that people in one s social network are available to listen to one s problems with empathy caring and understanding nstrumental Support perception that people in one s social network are available to provide material or functional aid in completing daily tasks Companionship Characterized by self reported perceptions of the availability of friends or companions with whom to interact or affiliate i e friendship and perceptions that one is alone lonely or socially isolated i e loneliness Social Distress The extent to which an individual perceives his her daily interactions as negative or distressing Positive Social Development Stress amp Self Efficacy Perceived Stress Characterized by parents evaluation of their children s empathic behaviors Definition Individual perceptions about the nature of events and their relationship to the values and coping resources of an individual Self Efficacy Negative Affect Fear A person s belief in their capacity to manage their functioning and have control over meaningful events Definitions Characterized by symptoms of anxiety that reflect autonomic arousal and perceptions of threat Sadness Distinguished by low levels of positive affect and comprised of symptoms that are primarily affective poor mood and cognitive negative perceptions of self the world and the future i
151. ephant box then E touches and holds button to advance to next screen 1B Screen 10 Live Trial 4 Here is an elephant Where does it go E reads screen C touches a box 1B Screen 11 Rule reminder 5 If it s an elephant then it goes in the elephant box Appears above the elephant box E reads screen and points to elephant box then E touches and holds button to advance to next screen 1B Screen 12 Live Trial 5 Here is an elephant Where does it go E reads screen C touches a box If less than 4 of 5 correct the test is discontinued If 4 or more correct the test continues to DEXT Phase 2 Return to TOC 78 2A Screen 1 Now we re going to play a different game Here E reads screen and points Instruction have a little kitty and a big kitty Look at these out the relevant aspects boxes down here This one has a little kitty in it After 10 seconds Touch and this one has a big kitty in it I m going to put and Hold Here to Continue the little kitties in the little kitty box And I m going button appears Then E to put the big kitties in the big kitty box touches and holds button to continue 2A Screen 2 Here is a big kitty It goes in the big kitty box E reads screen and Demonstration touches the big kitty box which makes a clicking sound Touch and Hold Here to Continue button appears then E touches and holds button to conti
152. er minutes NIH Toolbox 9 hole Pegboard Dexterity Test 3 85 4 NIH Toolbox Grip Strength Test 3 85 3 NIH Toolbox Standing Balance Test 3 85 7 NIH Toolbox 4 Meter Walk Gait Speed Test 7 85 3 NIH Toolbox 2 Minute Walk Endurance Test 3 85 4 O1 Time to Administer minutes column gives users an idea of how long each test might take however please note that testing times could vary based on how prepared the test administrator is going into the session individual differences among participants as well as other unplanned activities that may occur during testing Return to TOC Lu C 4 1 NIH Toolbox 9 Hole Pegboard Dexterity Test The NIH Toolbox 9 Hole Pegboard Dexterity Test assesses fine motor dexterity Dexterity is a central component of hand function and relates to both the speed and accuracy of hand movements during the manipulation of objects In this task a nine hole pegboard is used to assess dexterity and the data are recorded using an on screen timer on the iPad The protocol includes one practice and one timed trial with each hand Equipment and materials needed e iPad e Jamar or Rolyan 9 Hole Peg Test kit e Jamar 9 Hole Peg Test kit replacement pegs Detailed information on equipment and materials needed for all tests can be found in Appendix 4 Set up 1 Place the pegboard on the table positioning it in front and at the center of the participant s body Place the cup with the 9 pegs on the side of t
153. er 10 seconds Touch and Hold Here to Continue button appears E touches and holds button to advance to next screen 3B Screen 2 Instructions Let s try this game E reads screen After 1 second Touch and Hold Here to Continue button appears E touches and holds button to continue 3B Screen 3 Rule reminder 1 If it s a pink one then it goes in the pink box If it s a yellow one then it goes in the yellow box Text appears above relevant boxes E reads screen After 5 seconds Touch and Hold Here to Continue button appears E touches and holds button to continue 3B Screen 4 Here s a yellow one Where does it go E reads screen C touches a Live trial 1 box 3B Screen 5 If it s a pink one then it goes in the pink box Ifits E reads screen After 3 Rule reminder 2 a yellow one then it goes in the yellow box Text appears above relevant boxes seconds Touch and Hold Here to Continue button appears E touches and holds button to continue 3B Screen 6 Here s a pink one Where does it go E reads screen C touches a Live trial 2 box 3B Screen 7 If it s a pink one then it goes in the pink box If its E reads screen After 5 Rule reminder 3 a yellow one then it goes in the yellow box Text appears above relevant boxes seconds Touch and Hold Here to Continue button appears E touches and holds button to continue Return to TOC 85
154. er piece of tape 2 to 3 long across the hallway For the Two minute Walk Endurance Test the cones should be placed at the sides of the first long mark and the last long mark of that course For the Four Meter Walk Gait Speed Test the cones should be placed at the side of the first long mark and the last long mark of that course For both measures a chair should be placed near the beginning of the course Setup for 2 Min and 4 M Walking Test 5 Feet 10 Feet 10 Feet 4 Meters 1 Meter 10 Feet Return to TOC 10 Feet 216 Appendix 7 NIH Toolbox Regional Taste Test Materials and Taste Solutions Mixing Instructions Equipment and materials needed An electronic balance scale readable to at least 0 01 grams and preferably 0 001 grams Examples Ohaus Aventurer Pro Series or Denver Instrument Summit Series prices run around 1000 Magnetic stirrer Example Fisher Scientific Isotemp Basic Magnetic Stirrer 7 x 7 in 120 volt price is 295 Stir bar 1 or 1 5 inches in length Example Fisher Scientific Stir Bars 9 5 dia X 25 4 mm L price 7 79 Plastic coated magnetic retrieving rod Example Fisher Brand Stir Bar Retriever 12 inch price 16 27 each A 1 liter graduated cylinder Example Fisherbrand Serialized Class A Graduated Cylinder price 169 42 each A more affordable Polypropylene graduated cylinder is an option if cost is factor Solution storage bottles light occluding are required for quinine
155. erve impulses as nervous system activity Sensory processes are vital to one s level of independence in relationships with others academic and occupational endeavors and activities of daily living Sensation amp Pain Definition Constructs Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage Pain It is measured by the NIH Toolbox Pain Interference Survey and the NIH Toolbox Pain Intensity Survey The human olfactory system allows us to detect odors to recognize and Olfaction discriminate odor qualities and to identify the sources of odors in our world It is measured by the NIH Toolbox Odor Identification Test Vision is a complex sensation that provides us with a personal conscious representation of our surrounding environment Visual impairment can impose various limitations on a person s functional Vision ability including reading mobility which includes driving visual information processing also called seeing and visually guided motor behavior also called manipulation It is measured by the NIH Toolbox Visual Acuity Test Audition or hearing is the processing of sound in the environment It is Amen measured by the NIH Toolbox Words in Noise WIN Test Taste perception also known as gustation arises from stimulation of Taste taste receptors which are composed of epithelial cells found most fre
156. es in the same way you saw them on the screen When all pictures have been placed in gray boxes a pop up will appear on the screen Are you finished Ask this of the child If child says YES touch and hold the YES button If the child says NO touch any of the pictures and the pop up will disappear If no picture is moved out of a gray box the pop up will continue to be on the screen The pop up will close if a picture is moved back to the yellow box and will reappear each time all pictures have been placed in gray boxes Logic Test will terminate after the two test sequences have been presented C 2 6 3 Picture Sequence Memory Test Instructions Age 7 If the child has difficulty dragging the pictures across the screen during the demonstration sequence practice sequences or the actual test sequences he she may point and the examiner will move the pictures in the way the child indicates The examiner should ensure the child completely understands how the process will work and can say something like the following You point to the picture you want to move then point to the gray box where you want to move it I ll move it there for you The test begins with a Title Screen NIH Toolbox PSM 7 Form A B or C At the bottom of the screen is a button Touch and Hold Here to Continue Touch and hold that button to begin the test On the next screen read the text Now we are going to play a memory game but first am going to t
157. es understanding of this step touch the button at the bottom of the screen that says Touch and Hold Here to Continue Introduction to the Practice Items Read the screen Now we re going to play the game You will see some pictures on the screen You should remember them and show them back to me in the same way you saw them on the screen When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue The next screen begins the one practice sequence for these ages The participant has four trials to complete the sequence If the participant succeeds in four trials or less the test sequences are presented If the participant fails all four trials of the practice sequence the test is discontinued Practice Sequence Say Now you will see how to Go Camping When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue As pictures are presented an audio recording will say the appropriate labels First put up the tent Then go for a hike Then catch a fish And last roast a marshmallow After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to Go Camping Now you move the pictures in the same way you saw them on the screen When all pictures have been placed in gray boxes a pop up will appear on the screen Are you finished Ask this of the participant If pa
158. esented in a particular order The participants are asked to reproduce the sequence of pictures that is shown on the screen Equipment and materials needed e iPad There are three different sets forms of test items for this measure forms A B and C Each form has different test items that yield equivalent scores and can be used in a repeated measures research design to minimize practice effects The forms are typically given in alphabetical order but may be given in any order as indicated by the user There are also different practice sequences and test items for participants of different ages 3 4 5 6 7 and 8 For each age group there is the option to use one of the three forms A B or C Special Instructions For all participants a demonstration sequence shows participants how to move the pictures on the screen After this there are practice sequences that differ for participants of differing ages 3 4 5 6 7 and 8 years In addition the test sequences differ in length for participants of differing ages Participants respond by dragging pictures from the yellow box on the screen into the gray boxes on the screen They may verbalize the picture labels as they move the pictures If however verbalizing the picture labels seems to interfere with the participant s performance the examiner should say You don t need to say the words labels If participants indicate that saying the labels helps them the examiner may reassure t
159. esponse Go Camping will be repeated with an audio recording saying Let s try that again After the pictures are presented and as the pictures are scrambled an audio recording will say Thats how to Go Camping Now you move the pictures in the same way you saw them on the screen 3 If child gives incorrect response again 2 above is repeated up to two additional times or a total of 4 trials 4 If child fails all 4 trials test will discontinue Test Sequences Children ages 5 6 will be presented with two trials of a 9 step sequence Read the screen Now we are going to play the game with more pictures This time you will see how to Play in the Park Form A Go to the Fair Form B Work on the Farm Form C When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue Test Item Trial1 As the pictures are presented an audio recording will say appropriate labels Form A Play in the park Form B Go to the fair Form C Work on the farm e Fly a kite e Play in the sand e Go down the slide e Pull the wagon e Draw on the side walk e Pet the dog e Feed the ducks e Push the swing e Smell a flower e Get a hot dog e Go for a pony ride e Pet the sheep e Win a dog show e Go on aride e Get some tickets e Get some ice cream e Play a game e Milk a cow Put the cow in the barn Drive the tractor Feed the pig Load the cart Peel the corn Chop some
160. ess 0 and then press spacebar An audio recording says Let s try that again Trial 2 if Trial 1 was incorrect An audio recording continues You saw a DOG and a HORSE the DOG is smaller than the HORSE Now say the animals in size order Correct Response If participant says DOG HORSE press 1 and then press spacebar An audio recording says That s right When it appears on the screen ask Are you ready When the participant answers affirmatively press the spacebar and 1 List Practice Item 2 will be presented Return to TOC 2l Incorrect Response f participant does not say DOG HORSE press 0 and then press spacebar An audio recording says Let s try that one more time Trial 3 if Trial 2 was incorrect After the pictures are presented one more time and the screen is blank an audio recording says You saw a DOG and a HORSE the DOG is smaller than the HORSE Now say the smaller animal and then the bigger animal Correct Response If participant says DOG HORSE press 1 and then press spacebar An audio recording says That s right When it appears on the screen ask Are you ready When the participant answers affirmatively press the spacebar and 1 List Practice Item 2 will be presented If participant answers the question incorrectly after 3 trials press 0 and then press spacebar Test will be discontinued 1 List Practice Item 2 Trial 1 After the pictures are presented and the screen is blank an audio recording
161. esume an Assessment All partially completed and not started no items administered assessments may be resumed though individual instruments within them may have varying rules see Appendix 3 Participant 98765 Participant gt 4 98765 Edit Assessments Add New Assessment Assessment 1 C Partially Completed Resume Return to TOC EP Generate a report Once an assessment is completed a simple report can be generated by tapping Report Reports contain demographic information and scores for any tests that were given during that specific assessment 4 Participant 6543 Participant gt 4 76543 Edit Assessments Add New Assessment te gt Assessment 1 i Completed 9 20 2015 Report A sample of the report can be seen below Done 2015 09 20 13 22 09 Participant Report 5X PIN 76543 Assessment Name Assessment 1 Date Completed 9 20 2015 Name Jim Age 47 Education Bachelor s degree e g BA AB BS Mother s Education High School Graduate Gender Male Handedness Right Race White Ethnicity Not Hispanic or Latino COGNITION NIH Toolbox Picture Vocabulary Test Age 3 v2 0 Uncorrected Standard Score 105 1 Age Corrected Standard Score 99 0 Fully Corrected T score 47 1 Return to TOC 20 B 4 3 Batteries View Existing Batteries Preset and Custom This is a quick way to view all the batteries available on this iPad and the instruments that comprise each Step 1 Tap the Ba
162. frost it And last put on the candles After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to Have a Birthday Party Now you move the pictures in the same way you saw them on the screen When all pictures have been placed in gray boxes a pop up will appear on the screen Are you finished Ask this of the child If child says YES touch and hold the YES button If the child says NO touch any of the pictures and the pop up will disappear If no picture is moved out of a gray box the pop up will continue to be on the screen The pop up will close if a picture is moved back to the yellow box and will reappear each time all pictures have been placed in gray boxes Logic 1 If child gives correct response Practice sequence 2 Go Camping will be presented 2 If child gives incorrect response Have a Birthday Party will be presented again with an audio recording saying Let s try that again After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to Have a Birthday Party Now you move the pictures in the same way you saw them on the Screen 3 If child gives incorrect response again 2 above is repeated up to two additional times or a total of 4 trials 4 If child fails all 4 trials test will discontinue Practice Sequence 2 Say That s right Now you will see how to Go Camping When finished reading
163. ge This means the pictures are NOT alike so we ll choose the FROWN face Let s choose the FROWN face together and then you will do some practice Audio recording says Great job when FROWN face is touched Next item will appear Ages 3 6 Practice Item 3 Audio recording says Are these the same Remember touch the SMILEY face if they look alike or are the same and touch the FROWN face if they do not look alike and are NOT the same Pictures will stay on screen until there is a response and audio recording will repeat Are these the same Return to TOC SE If correct SMILEY face the audio recording says Great job Next item will appear If incorrect FROWN face the audio recording says The pictures look alike the same Both pictures are flowers that are the same size and color so choose the SMILEY face SMILEY face will flash item will stay on screen If no response the audio recording repeats Are these the same If child chooses correctly the audio recording will say Great job Next item will appear If child chooses incorrectly another time iPad program moves to next practice item after repeating explanation above Ages 3 6 Practice Item 4 Audio recording says Are these the same Pictures will stay on screen until there is a response and audio recording will repeat Are these the same If correct FROWN face the audio recording says Great job Next item will appear If incorrect
164. h go in the fish game E reads screen C touches a box 1 Screens 4a amp b Feedback 4a If correct Very good that s right E reads screen Touch and Hold Here to Continue button appears Then E touches and holds button to advance to next screen 4b If incorrect Uh oh Remember in this game all fish go in the fish box Touch and Hold Here to Continue button appears after E touches and holds button screen says Can you show me where the fish go in the fish game E reads screen and C touches a box triggering either 4a or 4b When Touch and Hold Here to Continue button appears again E touches and holds button to advance to next screen 1A Screen 5 Transition OK let s play E reads screen and then touches and holds button to advance to next screen 1A Screen 6 Rule reminder 1 If it s a fish then it goes in the fish box Appears above the fish box E reads screen and points to fish box then E touches and holds button to advance to next screen 1A Screen 7 Here is a fish Where does it go E reads screen C touches Live Trial 1 a box 1A Screen 8 Fish go here Appears above the fish box E reads screen and points Rule reminder 2 to fish box then E touches and holds button to go to next screen Return to TOC 76 1A Screen 9 Live Trial 2 Here is a fish Where does it go E reads screen C touches a bo
165. hat says Touch and Hold Here to Continue An audio recording will introduce each word with the instructions Touch for participants ages 3 6 and just the Word for participants ages 7 The items will continue in this format until the test is completed Remember If a participant has difficulty touching the screen he she may point and the examiner can touch the screen In this case the examiner should say something like the following to the participant You can point to your choice and then I will touch the screen for you If the participant says that he she does not understand the word after several repetitions the examiner may say the word ONCE MORE Return to TOC 19 C 2 2 NIH Toolbox Flanker Inhibitory Control and Attention Test The NIH Toolbox Flanker Inhibitory Control and Attention Test is a measure of inhibitory control and attention The Flanker requires the participant to focus on a particular stimulus while inhibiting attention to the stimuli flanking it Equipment and materials needed e iPad e Home base Detailed information on equipment and materials needed for all tests can be found in Appendix 4 Younger participants first see a fish flanked by two other fish on each side If they perform well enough they continue to a version with an arrow flanked by other arrows on each side Older participants ages 8 85 years are always presented with arrows instead of fish All participants are instructed to
166. he belt should be on the participant s side A sheet of paper with an attractive picture or a large X should be placed on the wall at the participants eye level For the eyes open poses the participant will be asked to focus on this picture or X The participant is positioned one meter away from the wall directly in front of the picture or X The examiner should proceed through each of the poses with the participant until the test is completed After each trial or pose is completed the examiner should ask Are you ready for the next one If the participant says NO or otherwise indicates that he she needs to rest say Please sit in this chair to rest The examiner should note the time the participant begins resting a maximum of one minute of rest is permitted Every 15 seconds or so the examiner should ask Are you ready to continue If the participant indicates that he she is ready proceed with the next trial or pose If the participant is not ready wait and ask again in another 15 seconds If the participant is not ready by the end of the one minute rest period the test should be discontinued In such a case the examiner should say Let s go on to another activity As needed throughout the testing the examiner should remind the participant that he she can step out of the pose if he she is feeling unsafe or unable to hold the pose When the participant is ready for testing the examiner should touch and hold the button at the bot
167. he hand being tested 2 The participant may use the hand not being tested to stabilize the board 3 Make sure the hand being tested is flat on the table palm down until the administrator says Go 4 Use a placemat or piece of rubber shelving to keep the pegboard from slipping on the table This is a suggestion but is not required 5 All instructions as well as data screens are on the iPad Return to TOC ud C 4 1 1 9 Hole Pegboard Test Instructions for Ages 3 The task is introduced with the Title Screen NIH Toolbox 9 Hole Pegboard Dexterity Test 3 At the bottom of the screen is a button Touch and Hold Here to Continue Touch and hold that button to begin the test Handedness If this was not entered during registration the iPad app will not allow this test to be administered Instead the examiner will need to ask a set of questions to ascertain handedness and to enter it in the participant registration screen Please refer to Appendix 2 for details Once handedness is entered in the participant registration screen it will automatically update the instructions on the test so that RIGHT or LEFT is displayed where appropriate Follow the set up instructions outlined on the screen Place the pegboard on the table positioning it in front and at the center of the participant s body Place the cup with the 9 pegs on the side of the hand being tested The hand not being tested can be used to stabilize the board The
168. he participant is taught to use the scale and then is asked to rate the solutions as they are presented in different areas of the mouth using the same scale This activity requires more preparation and uses more materials than other tests the examiner needs to have the following equipment nearby before beginning the test e iPad with stand to minimize the possibility that liquid gets on the iPad e Laminated pictures of procedure e Gloves latex free e 2 sterile cotton swabs e Bottle of purified water at room temperature e Disposable cup for each participant e Cup basin spittoon or sink for spitting solutions and rinse water e Quinine solution in small cups e Salt solution NaCl in small cups The equipment needed and instructions for mixing the Salt and Quinine Solution are provided in Appendix 7 In the past these were produced by a third party that party is no longer producing the solutions The solutions can be mixed by any user or third party having the appropriate equipment to do so Most pharmacies and some universities have the necessary equipment and supplies to produce the solutions C 5 5 1 NIH Toolbox Regional Taste Intensity Test Instructions Ages 12 The task is introduced with the following Title Screen NIH Toolbox Regional Taste Test 12 At the bottom of the screen is a button Touch and Hold Here to Continue Touch and hold that button to begin the test The iPad should be positioned so that both the exa
169. he she does not succeed on the practice trials he she is directed to the developmental extension of this measure In addition participants will be directed to the developmental extension if they do not achieve at least 75 correct on congruent fish trials OR at least 25 correct on incongruent fish trials The logic underlying the developmental extension is detailed in the test instructions FLANKER 3 7 DEXT Age specific test instructions NIH Toolbox Flanker Inhibitory Control and Attention Test Instructions Ages 3 7 NIH Toolbox Flanker Inhibitory Control and Attention Test Instructions Ages 3 7 with Developmental Extension DEXT NIH Toolbox Flanker Inhibitory Control and Attention Test Instructions Ages 8 11 NIH Toolbox Flanker Inhibitory Control and Attention Test Instructions Ages 12 Return to TOC ar C 2 2 1 NIH Toolbox Flanker Inhibitory Control and Attention Test Instructions Ages 3 7 This table outlines the item content read by as well as the actions for the examiner iPad screen written content Examiner E Action Introduction This is the TAIL gt fish lt This is the MOUTH The fish is pointing this way the same way the fish is swimming Title Screen NIH Toolbox FL 3 7 E touches and holds button to continue PRACTICE Here is a Fish E points to screen then touches and holds button to continue Here the MIDDLE fish is circled Can you point to the MIDDLE fish Child points E touches and hol
170. hem that they may say the labels if they wish If participants look away from the screen while the pictures are being presented the examiner should remind them to Watch the screen Additionally examiners should not allow participants to touch the screen while the pictures are being presented If participants try to touch the screen while pictures are being presented or while the examiner is giving instructions say Do not touch the screen until tell you that it is your turn If necessary remind participants to Wait until tell you it is your turn to touch the screen If the participant has difficulty dragging the pictures across the screen during the demonstration sequence practice sequences or the actual test sequences he she may point and the examiner should move the pictures in the way the participant indicates The examiner should ensure the participant completely understands how the process will work and should say something like the following to the participant You point to the picture you want to move then oint to the grey box where you want to move it I ll move it there for you Age specific test instructions NIH Toolbox Picture Sequence Memory Test Ages 3 4 NIH Toolbox Picture Sequence Memory Test Ages 5 6 NIH Toolbox Picture Sequence Memory Test Age 7 NIH Toolbox Picture Sequence Memory Test Ages 8 Return to TOC i C 2 6 1 Picture Sequence Memory Test Instructions Ages 3 4 If the chi
171. his feature One set of instructions is used for all participants Each participant will see a series of letters and words presented one at a time on the computer screen Items are presented in order of difficulty the computer adjusts the difficulty level of items depending on the participant s performance The number of items presented will depend on age and performance for most participants the measure will last approximately 3 minutes and will contain about 25 items The computer will administer each item one by one in an untimed fashion until the test is completed The measure cannot be self administered an examiner must record whether each response is correct After the participant pronounces a letter or word the examiner checks a pronunciation key as needed and types 1 if the pronunciation is correct or 0 if the response is incorrect After choosing 1 or 0 the examiner presses the spacebar to move on to the next word or letter The examiner can go back and change one prior answer by touching the left arrow on the keyboard and choosing a new answer and then touching the spacebar to activate the next item Testing is automatically discontinued if a participant makes seven consecutive errors Note It is essential that the examiner thoroughly review and master the pronunciation guide before administering this test The examiner should not rely on his her understanding of word pronunciations based on previous experience Instea
172. hooses BROWN picture in the middle of the screen If its BROWN picture choose this picture If it s WHITE choose that picture E points to then chooses WHITE picture Transition Now you try E reads screen then Keep your eyes on the star Answer as fast as you can without making mistakes If you make a mistake just keep going Put your finger back on Home Base after you answer touches and holds button to continue Color Practice Set 1 4 items sorted by color More practice if less than 3 out of 4 correct on Set 1 Let s practice some more In the COLOR game choose the picture that s the same COLOR as the picture in the middle of the screen If it s WHITE choose this picture E chooses WHITE picture Return to TOC 91 iPad screen written content If its BROWN choose that picture Examiner E Actions E chooses BROWN picture Transition Now you try Keep your eyes on the star Answer as fast as you can without making mistakes If you make a mistake just keep going Put your finger back on Home Base after you answer E reads screen then touches and holds button to continue Color Practice Set 2 4 items sorted by color More practice if less than 3 out of 4 correct on Set 2 Let s practice some more In the COLOR game choose the picture that s the same COLOR as the picture in the middle of the screen If its WHITE choose th
173. iate labels Form A Play in the park Form B Go to the fair Form C Work on the farm e Flyakite e Play in the sand e Go down the slide e Pullthe wagon e Swing on the monkey bars e Lay out the blanket e Play catch e Catch a butterfly e Kick the ball e Take the baby for a walk e Draw on the sidewalk e Pet the dog e Feed the ducks e Push the swing e Smell a flower e Geta hot dog e Go for a pony ride e Pet the sheep e Win a dog show e Watch the rodeo e Catch a pig e Judge the cake e See a puppet theater e Take a picture of a clown e Look at the babies e Goon aride e Get some tickets e Get some ice cream e Play agame e Milk acow e Put the cow in the barn e Drive the tractor e Feed the pig e Load the cart e Put the carrots in the basket e Pick the fruit e Fix the fence e Cut the sheep s wool e Collect the honey e Shovel out the barn e Peel the corn e Chop some wood e Collect the eggs e Put the blanket on the horse e Plant the tomatoes After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to Play in the Park Form A Go to the Fair Form B Work on the Farm Form C Now you move the pictures in the same way you saw them on the screen When all pictures have been placed in gray boxes a pop up will appear on the screen Are you finished Ask this of the participant If participant says Y
174. ild C amp Examiner E Actions Transition to practice items Now you try Keep your eyes on the star in the middle of the screen E reads screen then touches and holds button to continue Practice items 5 practice items If less than 4 out of 5 correct Test items Now you re ready to do this without me E reads screen then touches and holds transition button to continue Keep your eyes on the star in the middle of the screen Test items 20 test items fish If 9 congruent trials correct OR 2 incongruent trials correct If correct on gt 11 congruent AND on 7 incongruent no more than 1 incorrect of each Now you will do the same thing but you Will see arrows instead of fish But first we are going to learn about Home Base This is your Home Base Put your finger on Home Base and wait for the next picture In this game put your finger back on Home Base after each answer E reads screen and points to the home base then touches and holds button to continue Like before choose the button that matches the way the middle arrow is pointing E points then chooses arrow button Sometimes all the arrows will point the same way Sometimes the middle arrow will point a different way You should always choose the button that matches the way the MIDDLE arrow is pointing E reads screen points to the arrows and demonstra
175. in the blue box Text appears above relevant boxes E reads screen After 5 seconds Touch and Hold Here to Continue button appears E touches and holds button to continue 4A Screen 18 Live Trial 5 Here is a red one Where does it go E reads screen C touches a box If less than 4 of 5 correct the test is discontinued If 4 or more correct the test continues to Phase 4B 4B Screen 1 Instructions Now we re going to play a different game We re not going to play the color game anymore We re going to play the shape game In the shape game all the stars go in the star box All the airplanes go in the airplane box E reads screen After 10 seconds Touch and Hold Here to Continue button appears E touches and holds button to advance to next screen 4B Screen 2 Let s try this game E reads screen After 1 second Touch Transition and Hold Here to Continue button appears E touches and holds button to continue 4B Screen 3 If it s an airplane then it goes in the E reads screen After 5 seconds Touch Rule reminder 1 airplane box If it s a star then it goes in the star box Text appears above relevant boxes and Hold Here to Continue button appears E touches and holds button to continue 4B Screen 4 Live trial 1 Here is an airplane Where does it go E reads screen C touches a box Return to TOC 88 4B Screen 5 Rule reminder 2
176. iner presses the spacebar to move on to the next item list of objects ve There is a code at the bottom right side of the iPad screen to indicate which item is being administered The examiner should use this code to look up the correct response on the NIH Toolbox List Sorting Working Memory Test Examiner Answer Sheet and then score the item using the keyboard 1 or 0 66 Return to TOC C 2 4 NIH Toolbox Dimensional Change Card Sort Test DCCS The NIH Toolbox Dimensional Change Card Sort Test is a measure of cognitive flexibility and attention Two target pictures are presented that vary along two dimensions e g shape and color Participants are asked to match a series of bivalent test pictures e g yellow balls and blue trucks to the target pictures first according to one dimension e g color and then after a number of trials according to the other dimension e g shape The relevant dimension for sorting is indicated by a cue word e g shape or color that appears on the screen for all participants and that for young children ages 3 11 is also spoken by a prerecorded audio file Equipment and materials needed e iPad e Home base Detailed information on equipment and materials needed for all tests can be found in Appendix 4 Practice items use white and brown colors and a Rabbit and Sailboat as shapes Test items use blue and yellow colors and a Ball and Truck as shapes All instructions are on
177. ing rod thoroughly before reusing Solution Storage Requirements Taste solutions should be made fresh each week stored under refrigeration when not in use and should be warmed to room temperature prior to use for testing Please do not freeze the solutions because the container may crack Note 3 4 hours is generally required for solutions to warm to room temperature Taste solutions should be stored in glass bottles with a non reactive lid Quinine is light sensitive so quinine should be stored in a light occluding glass bottle or a bottle wrapped in aluminum foil to minimize light exposure Use of Solutions for Taste Testing Each participant will be tested with 10 ml of quinine solution and 10 ml of NaCl solution Solutions should be at room temperature for testing Two labeled medicine cups should be used to hold the solutions for testing each participant 10 ml of quinine solution should be poured into one cup and 10 ml of NaCl solution should be poured into the second cup For tongue tip testing a clean cotton swab will be dipped once in the quinine solution and then used to paint the solution across the anterior tongue After the participant rinses his her mouth a second clean cotton swab will be dipped once in the NaCl solution and used to paint the solution across the anterior tongue The solution remaining in each of the two cups will then be used for whole mouth testing first with quinine and then with NaCl
178. ipants see fewer items than others The specific words presented depend on the participant s performance The number of items presented depends on age and performance for most participants the measure will last approximately 5 minutes and will contain about 25 items The computer will administer each item one by one in an untimed fashion until the test is completed The test uses age for participants younger than 18 and education for participants 18 and older to determine which items it initially presents There is however an override in the participant information screen If an examiner feels that a participant should begin the test at a level higher or lower than that determined by his her education and age the examiner should use this feature Using the override may shorten the test It is important to note that even if the override is not used the test will eventually arrive at the same score whether the examiner used the override or not General Instructions 1 The opening introductory instructions and the introductions to the test items are printed on the iPad screen and are read to the participants all other instructions are pre recorded 2 The introduction and test instructions differ somewhat for younger and older participants The required version will appear automatically for the examiner to read 3 Before beginning make sure the volume is loud enough so that participants can hear the pre recorded feedback and the presenta
179. is picture E chooses WHITE picture If its BROWN choose that picture E chooses BROWN picture Transition Now you try Keep your eyes on the star Answer as fast as you can without making mistakes If you make a mistake just keep going Put your finger back on Home Base after you answer E reads screen then touches and holds button to continue Color Practice Set 3 4 items sorted by color Test ends if less than 3 out of 4 correct on Set 3 Test item intro Now we re going to play both games together Remember if you see and hear the word SHAPE you choose the picture that s the same SHAPE as the picture in the middle of the screen If you see and hear the word COLOR you choose the picture that s the same COLOR as the picture in the middle of the Screen Remember put your finger back on Home Base after you answer E reads screen then touches and holds button to continue Transition Now you try E reads screen then touches and holds button to continue Return to TOC 92 iPad screen written content Keep your eyes on the star Answer as fast as you can without making mistakes If you make a mistake just keep going Put your finger back on Home Base after you answer Examiner E Actions Test items 30 mixed items C 2 4 4 Dimensional Change Card Sort Test Instructions Ages 12 This table outlines the item con
180. items are presented with the instruction Touch the picture of There are no corrections in this part nor are there questions about whether the child has smelled the item Regardless of the child s performance on the picture identification task the iPad will then move on to odor identification After this section there is a button Touch and Hold Here to Continue at the bottom of the screen Touch and hold that button to continue Part 2 Odor Identification Scratch n Sniff Card Note The odor on the card is strongest immediately after being scratched the examiner may need to remind the participant to smell the card as quickly as possible after scratching it If the child says he she does not smell anything the examiner should scratch the card one more time and place it directly under the child s nose then ask the child to make his her best guess if he she is not sure For this age group the examiner will scratch the card and hand it to the participant saying am going to give you some stickers to smell After you have smelled the sticker touch the picture that shows what you just smelled If you want to change your choice touch the hand also called the GO BACK button Let s begin If the child has difficulty touching the iPad screen the examiner may register the participants choice by touching the screen for him her NOTE The child is not permitted to go back beyond the last item he she attempte
181. ive Affect Parent Report CAT Ages 3 7 v2 0 CAT NIH Toolbox General Life Satisfaction Parent Report FF Ages 3 12 v2 0 5 NIH Toolbox Positive Peer Interaction Parent Report FF Ages 3 12 v2 0 4 NIH Toolbox Social Withdrawal Parent Report FF Ages 3 12 v2 0 4 NIH Toolbox Peer Rejection Parent Report FF Ages 3 12 v2 0 9 NIH Toolbox Empathic Behaviors Parent Report CAT Ages 3 12 v2 0 CAT NIH Toolbox Fear Over Anxious Parent Report FF Ages 3 7 v2 0 6 NIH Toolbox Fear Separation Anxiety Parent Report FF Ages 3 7 v2 0 7 NIH Toolbox Sadness Parent Report FF Ages 3 7 v2 0 7 NIH Toolbox Anger Parent Report FF Ages 3 7 v2 0 9 C 3 3 5 NIH Toolbox Emotion Parent Report Battery ages 8 12 Instrument name CAT or of Items in Fixed Form NIH Toolbox Emotion Instructions Parent Report NIH Toolbox Positive Affect Parent Report CAT Ages 8 12 v2 0 CAT NIH Toolbox General Life Satisfaction Parent Report FF Ages 3 12 v2 0 5 NIH Toolbox Perceived Stress Parent Report CAT Ages 8 12 v2 0 CAT NIH Toolbox Self Efficacy Parent Report CAT Ages 8 12 v2 0 CAT NIH Toolbox Positive Peer Interaction Parent Report FF Ages 3 12 v2 0 4 NIH Toolbox Social Withdrawal Parent Report FF Ages 3 12 v2 0 4 NIH Toolbox Peer Rejection Parent Report FF Ages 3 12 v2 0 9 NIH Toolbox Empathic Behaviors Parent Report CAT Ages 3 12 v2 0 CAT NIH Toolbox Fear Parent Report CAT Ages 8 12 v2 0 CAT NIH Toolbox Sadness Parent Report
182. iven level are incorrect for the second ear the examiner should touch the FINISH button If the participant repeats some words correctly from each of the seven levels after all the levels have been presented the examiner should touch the FINISH button The computer will automatically score the participant s performance we If a participant wears hearing aids they should be removed for the duration of this test soe Before a testing session the examiner should confirm that the iPad volume is turned ON and set to a mid range level i e a comfortable listening level C 5 4 1 NIH Toolbox Words in Noise Test Instructions Ages 6 The test begins with a Title Screen NIH Toolbox Words in Noise Test 6 At the bottom of the screen is a button Touch and Hold Here to Continue Touch and hold that button to begin the test Before placing the headphones on the participant s head the examiner should make sure that he she can see the participant s face and hear his her responses at the same time the participant should not be able to read the iPad screen Since the headphones will block communication between the examiner and the participant the examiner should instruct the participant that if he she does not hear anything in the headphones he she should take them off and the examiner will try to rectify the situation most likely by pressing the button on the side of the iPad to increase the volume The examiner should introduce the task r
183. ld has difficulty dragging the pictures across the screen during the demonstration sequence practice sequences or the actual test sequences he she may point and the examiner will move the pictures in the way the child indicates The examiner should ensure the child completely understands how the process will work and can say something like the following You point to the picture you want to move then point to the gray box where you want to move it I ll move it there for you The test begins with a Title Screen NIH Toolbox PSM 3 4 Form A B or C At the bottom of the screen is a button Touch and Hold Here to Continue Touch and hold that button to begin the test On the next screen read the text Now we are going to play a memory game but first am going to teach you how to move the pictures on this screen When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue The next screen begins the three step demonstration sequence If the steps are not followed the Touch and Hold Here to Continue button will not be active Step 1 Moving Pictures from the Yellow Box to the Gray Boxes Read the text above the yellow box on the screen and demonstrate the actions described Say Here you see some pictures in a yellow box want to show you how to move the pictures to the gray boxes You can move pictures from this yellow box to the gray boxes like this Touch on the picture in the yello
184. le Can never be restarted e Pause perform admin gesture and return to instrument without selecting stop or skip o During Instructions Return to active screen pause not recorded in data o During Practice Return to active screen pause not recorded in data o During Live Items Return to active screen pause not recorded in data e Stop exit the instrument by selecting stop with the intention of resuming at a later time o During instructions Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Practice Participant sees last practice item not responded to o During Live Items Participant sees last live item not responded to NIH Toolbox Visual Acuity Test e Skip o Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted e Pause perform admin gesture and return to instrument without selecting stop or skip o During Instructions Return to active screen pause not recorded in data o During Practice Screening Return to active screen pause not recorded in data o DuringLive Items Return to active screen pause not recorded in data e Stop exit the instrument by selecting stop with the intention of resuming at a later time o During instructions Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Practice
185. ll five words at a given level are incorrect the iPad will begin testing the second ear Second Ear As before a series of five words will appear on the iPad screen along with the current dB level and the ear being tested The associated audio files will play in the participant s earphones The examiner should listen carefully to the participant s responses and touch any word that is said correctly If the participant correctly repeats at least one word at a level the audio files will continue to present words to that ear Incorrect words are not marked If all five words at a given level are incorrect the iPad will stop playing the audio files at which point the examiner should touch the FINISH button If the participant repeats some words correctly from each of the seven levels after all the audio files are presented the examiner should touch the FINISH button The iPad will automatically score the participant s performance C 5 5 NIH Toolbox Regional Taste Intensity Test This activity assesses a participant s sensitivity to bitter and salty solutions in the mouth generally as well as specifically on the tip of the tongue The participants should not have had drinks or food in the 30 minutes prior to the testing All the instructions are shown on the iPad The participant s responses are registered directly on the iPad screen using a calibrated scale that ranges from No sensationto Strongest sensation of any kind Initially t
186. m B v2 0 NIH Toolbox Picture Sequence Memory Test Age 8 Form C v2 0 NIH Toolbox Flanker Inhibitory Control and Attention Test Ages 3 7 v2 0 NIH Toolbox Flanker Inhibitory Control and Attention Test Ages 8 11 v2 0 NIH Toolbox Flanker Inhibitory Control and Attention Test Age 12 v2 0 NIH Toolbox Dimensional Change Card Sort Test Ages 3 7 v2 0 NIH Toolbox Dimensional Change Card Sort Test Ages 8 11 v2 0 NIH Toolbox Dimensional Change Card Sort Test Age 12 v2 0 NIH Toolbox 4 Meter Walk Gait Speed Test Age 7 v2 0 NIH Toolbox 9 Hole Pegboard Dexterity Test Age 34 v2 0 NIH Toolbox Grip Strength Test Age 3 v2 0 NIH Toolbox Standing Balance Test Ages 3 6 v2 0 NIH Toolbox Standing Balance Test Age 7 v2 0 NIH Toolbox 2 Minute Walk Endurance Test Age 34 v2 0 NIH Toolbox Odor Identification Test Age 10 v2 0 Return to TOC Title screen displayed in the Corresponding Instrument Name app NIH Toolbox Odor Identification Test 3 9 NIH Toolbox Words In Noise Test 6 NIH Toolbox Regional Taste Test 12 NIH Toolbox Visual Acuity Test 3 7 NIH Toolbox Visual Acuity Test 8 NIH Toolbox Dynamic Visual NIH Toolbox Odor Identification Test Ages 3 9 v2 0 NIH Toolbox Words In Noise Test Age 6 v2 1 NIH Toolbox Regional Taste Intensity Test Age 12 v2 0 NIH Toolbox Visual Acuity Test Ages 3 7 v2 0 NIH Toolbox Visual Acuity Test Age 8 v2 0 NIH Toolbox Dynamic Visual Acuity Test Ages 3 7 v2 0
187. m and show them back to me in the same way you saw them on the screen When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue The next screen begins the practice sequences There are two practice sequences If the child does not succeed after two trials on first practice sequence of two pictures the test is discontinued The second practice sequence has three pictures if the child succeeds in four or fewer trials the test sequence is started If the child does not succeed on the second practice sequence after four trials the test is discontinued Practice Sequence 1 Say Now you will see how to Eat Ice Cream When finished reading touch and hold the button at the bottom of the screen that says Touch and Hold here to Continue As the pictures are presented an audio recording will say appropriate labels First put a scoop on the cone Then eat the ice cream After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to Eat Ice Cream Now you move the pictures in the same way you saw them on the screen When all pictures have been placed in gray boxes a pop up will appear on the screen Are you finished Ask this of the child If child says YES touch and hold the YES button If the child says NO touch any of the pictures and the pop up will disappear If no picture is moved out of a gray box the pop up
188. me This NIH Toolbox Administrator s Manual and the NIH Toolbox eLearning Course are designed to be used together when learning how to use the NIH Toolbox app After reviewing sections A and B of this Manual an administrator should go through the eLearning course for the NIH Toolbox app Once an administrator has studied the eLearning course and completed practice sessions each instrument is easy to administer Once training is complete this manual should be used for review as needed When used electronically this manual includes hyperlinks that when clicked on or touched take the user directly to the referenced section B 1 NIH Toolbox App Structure Introduction Domain Battery Instrument To better understand the NIH Toolbox structure and to make informed choices as an administrator there are a number of terms that the user needs to understand Domain The NIH Toolbox spans four domains or broad areas of health and function Cognition Emotion Motor and Sensation Each domain includes multiple instruments that can be selected individually or used as part of a preset battery Preset Battery A pre defined set of instruments intended to be administered together in a specific order The order of instruments within a preset battery cannot be changed Individual instruments or additional batteries can be added to an assessment before or after the preset battery Scores are produced for each instrument in the battery as well as
189. meters and feet walking course Any Small plastic Set of 2 cones cones Varies Walking course set up diagram See Appendix 6 Free Colored masking tape to set up the walking Any Varies course Return to TOC 209 NIH Toolbox Sensation instruments additional equipment and materials Instrument Vendor Approximate Cost NIH Toolbox Pain Interference Test Equipment Materials None Suggestion NIH Toolbox Pain Intensity Test None NIH Toolbox Odor Download ordering instructions from Varies by the NIH Toolbox Odor Identification Cards NIH Toolbox size of the order Identification Test Website ids i guitar Any 0 25 Belkin Portable Tablet www cdw com 97 99 Stage or similar Bluetooth Wireless Rape Sion 69 00 Het tebe visaya 1520an Acuity Test Table Any Varies Aculy test Measuring Tape Any Varies Laminated HOTV letters for young Download here Free children Sennheiser HD201 headphones or any others that meet or exceed these specifications Bandwidth Frequency Response Vari NIH Toolbox Words 10 Hz 10 000 Hz Any vendor or A a in Noise WIN Test Isolation 10 dB or Headphone com pproxmately Greater Sensitivity 30 00 96 dB SPL V or greater Standard phone laptop plug 3 5 mm NIH Toolbox Regional Taste Test Please refer to Appendix 7 for the detailed list of materials Return to TOC 210 App
190. miner and the participant can see the screen since all instructions are on the screen and read together by both parties Say Now I am going to test your sense of taste To do this we will be using a salty flavor and a flavor found in tonic water Touch and hold button at the bottom of the screen to move to next screen Demonstration of the scale Say Before the tasting am going to ask you to use this scale to rate how weak or strong some sensations are to you Some of these sensations are things that you will experience Some of these sensations are what you will recall experiencing in the past Continue This scale ranges from no sensation at the bottom to the strongest sensation of any kind at the top The top of the scale Strongest Sensation of Any Kind refers to any kind of experience for example sound brightness of light even those sensations that might be painful Touch and hold button at the bottom of the screen to advance to the next screen Point to the scale on the screen and use one finger to indicate the bottom to the top saying This is how you use this scale Demonstrate how the participant can use his her finger on the scale Then touch and hold button at the bottom of the screen to advance to the next screen Strongest Sensation of Any Kind N Very Strong Strong Moderate Weak Barely Detectable No Sensation At All NY Demonstration continued Show the scale a
191. miological studies along with prevention or intervention trials NIH Toolbox measures have been normed and validated across the lifespan in participants ages 3 85 A 2 Development of the NIH Toolbox In 2004 15 Institutes Centers and Offices at the National Institutes of Health NIH that support neuroscience research formed a coalition called the Blueprint for Neuroscience Research The NIH Blueprint goal was to develop new instruments resources and training opportunities to accelerate the pace of discovery in neuroscience research Because the research community had long sought the development of standard instruments to measure cognitive and emotional health in 2006 the NIH Blueprint awarded a contract to develop an innovative approach to meet this need The NIH Toolbox was intended to include the following domains Cognition Emotion Motor and Sensation Initial literature and database reviews and a Request for Information of NIH funded researchers identified the sub domains for inclusion in the NIH Toolbox along with the criteria affecting instrument selection creation and norming NIH Toolbox validation studies were conducted across the entire age range typically including 450 500 subjects and statistically compared NIH Toolbox against existing gold standard measures whenever available For tests using Item Response Theory IRT approaches to scoring calibration samples generally included several thousand participants ensu
192. n Apple ID Simply tap Continue and then tap Use Existing Account on the following screen Next you ll be asked to enter your billing information To choose a different Credit Card type tap one of the available options and then tap Done You will not be charged until unless you make a purchase After you ve filled out all of the fields for your billing information tap Next You will then see a screen that says Verify Your Account 14 Tap Done and check your email for a verification email from Apple If you need to set up email on your iPhone iPad or iPod touch learn how to add an email account to your iOS device you need to be connected to the Internet for this link to work Open the email and tap the Verify Now link enclosed in the email to activate your account You will then be taken to a secure page to enter your new Apple ID and password After you ve entered your email address and password tap Verify Address To modify or change your account information such as Apple ID payment information or billing address tap your account name located at the bottom of the page once you have signed in to the iTunes Store When prompted tap View Account You might be asked to enter your account password again for verification To sign out of your iTunes Store account simply tap your account name at the bottom of the page in the App Store or iTunes Store Il How to create an Apple ID on your computer Apple or Windows operating
193. n press spacebar An audio recording says That s right When it appears on the screen ask Are you ready When the participant answers affirmatively press the spacebar and the 2 list introduction screen will be presented Incorrect Response If participant does not say PINEAPPLE FROG TIGER press 0 and an audio recording says Let s try that one more time Trial 3 if Trial 2 was incorrect After the pictures are presented and the screen is blank an audio recording says You saw a frog a pineapple and a tiger The pineapple is a food the frog is the smallest animal and the tiger is the biggest animal Now say the food in size order starting with the smallest food and then the animals in size order from smallest to biggest Correct Response If participant says PINEAPPLE FROG TIGER press 1 and then press spacebar An audio recording says That s right When it appears on the screen ask Are you ready When the participant answers affirmatively press the spacebar and presentation of the 2 list introduction screen will be presented If participant answers the question ncorrectly press 0 and then press spacebar Test will be discontinued Return to TOC 9s The 2 list practice items are summarized in the table below P1 Presentation Bear Banana Flashing Question Response Next step Q1 Food first then If Banana Bear press 1 If Bear If 1 goes to P2 If 0 goes to Animal Ba
194. nana press 0 Q2 Q2 Food first then If Banana Bear press 1 If Bear If 1 goes to P2 If 0 goes to Animal Banana press 0 Q3 Q3 Food first then If Banana Bear press 1 If Bear If 1 goes to P2 If 0 test Animal Banana press 0 discontinued P2 Presentation Frog Pineapple Tiger flashing Question Response Next step Q1 Food first then If Pineapple Frog Tiger press 1 If 1 goes to 2 list test items Animals in size order If any other order press 0 If 0 goes to Q2 starting with the smallest Q2 Food first then If Pineapple Frog Tiger press 1 If 1 goes to 2 list test items Animals in size order If any other order press 0 If 0 goes to Q3 starting with the smallest Q3 Food first then If Pineapple Frog Tiger press 1 If 1 goes to 2 list test items Animals in size order If any other order press 0 If 0 test discontinued starting with the smallest 2 List Test Items Read Let s look at some more pictures Remember after you see the pictures you will see a blank screen Once you see this blank screen tell me the foods first in size order from smallest to biggest then the animals in size order from smallest to biggest Are you ready Press the spacebar to continue and the presentation of the 2 List test items will begin As before after the examiner chooses 1 or 0 the question Are you ready appears on the screen Once confirming that the participant is ready and attending the exam
195. nd say You can use your finger to choose a word on the scale that describes what you experience or what you remember You can touch anywhere on the line For example if the sensation you experience is more than moderate but not quite strong you can use your finger to touch a spot between moderate and strong Demonstrate for the participant Then say Move your finger until you think it best represents how you feel and then remove your finger If you like you can fine tune your rating by using the up and down arrows to the right of the scale When you are happy with the position of the mark touch the OK button Once the participant has touched the OK button the practice screens appear preceded by a screen that the examiner reads Let s try some examples The scale on the screen will no longer have instructions on it The examiner should touch and hold button at the bottom of the screen to advance to the next screen Practice Screen 1 Say Use this scale to rate the brightness of a well lit room How strong or intense is the brightness to you When you are finished touch the OK button Practice Screen 2 Say Please remember the brightness of a dimly lit restaurant where the only light is from candles on the table Would you say the intensity of a dimly lit restaurant is less bright or brighter than the light in a well lit room Use the scale to rate the brightness of a dimly lit restaurant When you are finished touch the OK
196. nd the 2 list condition is not administered Return to TOC oe noe Throughout the test the examiner may need to remind the participant It is important to pay attention to the size of the objects on the screen not what they may have experienced when putting things in size order from smallest to biggest If necessary examiners can provide short breaks between items It is also acceptable during the 2 List condition to remind participants of the rules e g tell me the foods first then the animals Return to TOC 59 C 2 3 1 NIH Toolbox List Sorting Working Memory Test Instructions Age 7 Before beginning the test the wireless keyboard should be paired by Bluetooth with the iPad if this has not already been done While administering this measure the examiner needs to be able to view the iPad and have the keyboard and the NIH Toolbox List Sorting Working Memory Test Examiner Answer Sheet easily accessible for scoring participant responses The task is introduced with the Title Screen NIH Toolbox LS 7 To check the Bluetooth connection the examiner is asked at the bottom of the page to Press Spacebar to Continue Touching the spacebar begins the test If the spacebar does not work try repairing the keyboard or changing the batteries in the keyboard REVIEW All the 1 List practice items have the same format First the examiner asks for the names of the pictures in size order from smallest to largest If the participant answers inc
197. nd then score the item using the keyboard 1 or 0 Return to TOC 5 2 List Condition REVIEW The 2 List practice items have the same format First the examiner asks for the food from smallest to largest and then for the animals from smallest to largest If the answer is correct the examiner moves on to the next question If the participant answers incorrectly there are two more opportunities to get a correct answer The first opportunity comes after a verbal explanation and a repeat of the question the second comes after replaying the item on the screen followed by a verbal explanation and then a repeat of the question If after a total of three opportunities the participant continues to answer incorrectly the test will be discontinued and no more items will be presented The practice items are detailed below Say We re going to look at more pictures This time you will see both food and animals in a set of pictures I d like you to tell me the food first and then the animals in size order from smallest to biggest It is important to pay attention to the size of the object on the screen when putting things in size order from smallest to biggest Let s start by looking at some more pictures together Press Spacebar to continue After each answer the examiner should indicate whether it was correct 1 or incorrect 0 on the keyboard Then the question Are you ready appears on the screen When the participant answer
198. ndicators of depression Anger Characterized by attitudes of hostility and cynicism and is often associated with experiences of frustration impeding goal directed behavior 128 Return to TOC Emotion Measure Formats Each emotion measure is administered in either a computerized adaptive testing CAT or fixed form FF format CATs Emotion CATs begin with a standard item specific to that measure and then select items to administer based on a respondents previous answers An algorithm is utilized to determine which item should be administered next NIH Toolbox instruments which use CAT as an administration method are often referred to as Banks CATS are usually 4 6 items long Fixed Forms FFs fixed length form with all items administered in a set Sequential order Self versus proxy report All Emotion items are presented in a self report i e the respondent answers questions about him herself or in a proxy parent report i e the respondent answers questions about someone else format Pediatric self report measures completed by the participant ages 8 17 Adult self report measures completed by adult participants 18 years of age Parent report measures completed by parents for children ages 3 12 Time to administer All individual emotion measures take approximately 1 2 minutes to complete Emotion Batteries The NIH Toolbox App includes 5 preset batteries NIH Toolbox Emotion Battery ag
199. nds You will have a second chance if you cannot hold the position for 50 seconds Between each set of poses you may rest in the chair if needed Please try to do your best will demonstrate how want you to stand before each pose Explain that the iPod on the belt is used to measure balance and ask permission to put on the belt or ask the participant to help The belt should fit tightly around the pelvis and the handles of the belt should be positioned to the back of the participant For ages 7 and older the iPod is placed on the front of the belt A sheet of paper with an attractive picture or large X should be placed on the wall at the participants eye level For the eyes open poses the participant will be asked to focus on this picture The participant is positioned one meter away from the wall directly in front of the picture The examiner should proceed through each of the poses with the participant until the test is completed After each trial or pose is completed the examiner should ask Are you ready for the next one If the participant says NO or otherwise indicates that he she needs to rest say Please sit in this chair to rest The examiner should note the time the participant begins resting a maximum of one minute of rest is permitted Every 15 seconds or so the examiner should ask Are you ready to continue If the participant indicates that he she is ready proceed with the next trial or pose If the participant is not
200. nished this activity The nine odors presented are Lemon Play Doh Bubble Gum Chocolate Popcorn Coffee Smoke Natural Gas and Flower C 5 3 NIH Toolbox Visual Acuity Test This activity is intended to measure visual acuity in adults and children Testing will use different sets of optotypes letters for children and adults For the Visual Acuity Test the participant is seated 3 meters away from the iPad and the display should be at eye level Equipment and materials needed iPad Wireless keyboard with extra AA batteries Tablet stand Table Measuring tape Laminated HOTV letters for young children Detailed information on equipment and materials needed for all tests can be found in Appendix 4 Setting up Bluetooth Wireless Keyboard Go to the Settings app of the iPad and make sure Bluetooth is turned on Make sure the keyboard is in discovery mode by pressing the round button at the top right end of the keyboard and the small green light to the left of the button begins flashing Select the Keyboard when it appears on the My Devices list on the iPad When a pop up window appears on the iPad screen follow the instructions and enter the required code on the keyboard The usual keyboard on the iPad will not work when the external keyboard is working To turn off the external keyboard press the round button at the top right end of the keyboard move atleast 15 meters from the iPad with the keyboard or touch the
201. nning of instrument Previous data are overwritten o During Practice Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Live Items Participant sees first item aka resume at beginning of instrument Previous data are overwritten NIH Toolbox Grip Strength Test e Skip o Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted e Pause perform admin gesture and return to instrument without selecting stop or skip o During Instructions Return to active screen pause not recorded in data o During Practice Return to active screen pause not recorded in data o During Live Items Return to active screen pause not recorded in data e Stop exit the instrument by selecting stop with the intention of resuming at a later time o During instructions Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Practice Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Live Items Participant sees first item aka resume at beginning of instrument Previous data are overwritten NIH Toolbox Standing Balance Test e Skip o Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted e Pause perform admin gesture and return to instrument without s
202. not be administered pose 4 Rule 3 f the participant cannot successfully complete either trial of pose 3 the test will skip ahead to pose 5 noe A re connect button is always enabled should the devices become disconnected Age specific instructions Standing Balance Test Instructions Ages 3 6 Standing Balance Test Instructions Ages 7 C 4 3 1 Standing Balance Test Instructions Ages 3 6 The task is introduced with the following Title Screen NIH Toolbox Standing Balance Test 3 6 At the bottom of the screen is a button Touch and hold here to continue Touch and hold that button to begin the test Participants are to stand in their bare stocking feet no shoes but paper booties can be offered While putting the belt and accelerometer on the participant say This is a test of your balance There are as many as 4 different poses that you will be asked to do During each pose you will be asked to stand as steady as possible for 50 seconds You will have a second chance if you cannot hold the position for 50 seconds Between each set of poses you may rest in the chair if needed Please try to do your best will demonstrate how want you to stand before each pose Explain that the iPod on the belt is used to measure balance and ask permission to put on the belt or ask the participant to help The belt should fit tightly around the pelvis For ages 3 6 the iPod should be placed on the back of the belt and when possible the handles on t
203. not responded to Emotion CAT e Skip o Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted e Pause perform admin gesture and return to instrument without selecting stop or skip o During Instructions Return to active screen pause not recorded in data o During Practice NO PRACTICE IN EMOTION o During Live Items Return to active screen pause not recorded in data e Stop exit the instrument by selecting stop with the intention of resuming at a later time o During instructions Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Practice NO PRACTICE IN EMOTION o During Live Items Participant sees item equivalent to last item shown Motor NIH Toolbox 9 Hole Pegboard Dexterity Test e Skip o Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted e Pause perform admin gesture and return to instrument without selecting stop or skip o During Instructions Return to active screen pause not recorded in data o During Practice Return to active screen pause not recorded in data o During Live Items Return to active screen pause not recorded in data e Stop exit the instrument by selecting stop with the intention of resuming at a later time o During instructions Participant sees first item aka resume at begi
204. nsity consists of one item asking about the participant s level of pain in the past seven days Participants are asked to rate their pain on a scale from 0 no pain to 10 worst imaginable pain NIH Toolbox Pain Interference CAT asks participants about how their experience of pain interfered with or affected their enjoyment of various daily activities in the past seven days The scale is computer adaptive and has a minimum of four questions and a maximum of 12 questions The questions ask for a response on a 5 point scale Some of the items are rated Not at all A little bit Somewhat Quite a bit Very much other items are rated Never Rarely Sometimes Often Always Administration Since there is no specific introduction to the Pain Surveys the NIH Toolbox Emotion Instructions should be selected from the instrument list to introduce them These instructions read On the next screens we will ask you questions about your thoughts feelings and behaviors Read each question carefully and answer as well as you can There is no right or wrong answer only what is true for you and describes your thoughts feelings and behaviors Select an answer by touching your answer choice on the screen After you make your choice the computer will automatically go on to the next question If you want to change your answer touch the GO BACK button to return to the question then touch a different answer choice After this introduction the
205. nt or an existing participant window Participant 2 Gender Birthdate Highest Education Level Completed Mother s Education Handedness Race Ethnicity Assessments Add New Assessment Return to TOC i9 Once Add New Assessment is tapped the app will create a new assessment and offer the user an opportunity to add instruments to that assessment Add Instruments button The name of the assessment defaults to Assessment X where X is a numeral starting at 1 and moving up sequentially depending on how many assessments have been assigned to this participant Tap the name of the assessment to edit it Participant 4 12345 Edit Assessments Add New Assessment N Assessment 1 C Not Started Start Instruments Add Instruments gt Return to TOC ue Step 2 Select batteries or individual instruments to be added to the assessment from the list of Available Batteries or the list of Available Instruments by tapping Select next to the instrument s or battery s name v Selected Instruments Available Batteries Motor v Adult All Types amp NIH Toolbox Motor Battery ages 7 Select v Available Instruments Motor v Adult All Types amp G9 E NIH Toolbox 2 Minute Walk Endurance Test Age 3 v2 0 Select NIH Toolbox 4 Meter Walk Gait Speed Test Age 7 v2 0 Select Users can filter the list of available batteries as well as the list of available instruments by tapping arrows an
206. nue 2A Screen 3 Demonstration Here is a little kitty It goes in the little kitty box E reads screen and touches the little kitty box which makes a clicking sound Touch and Hold Here to Continue button appears then E touches and holds button to continue 2A Screen 4 Now it s going to be your turn Put the little kitties E reads screen then Instruction in the little kitty box and the big kitties in the big touches and holds the kitty box button to continue 2A Screen 5 Can you show me where the little kitties go E reads screen C Rule check touches a box 2A Screens 6a amp 6b Feedback 6a If correct Very good that s right E reads screen Touch and Hold Here to Continue button appears Then E touches and holds button to continue 6b If incorrect Uh oh Remember in this game the big kitties go in the big kitty box and the little kitties go in the little kitty box Touch and Hold Here to Continue button appears after E touches and holds button screen says Can you show me where the little kitties go E reads screen and C touches a box triggering either 6a or 6b Touch and Hold Here to Continue button appears again E touches and holds button to continue Return to TOC 79 2A Screen 7 Rule check Can you show me where the big kitties go E reads screen C touches a box 2A Screens 8a amp 8b Feedback 8a If
207. o don t worry if you have to slow down or rest If you do stop or slow down start walking again as soon as you feel you are ready do so Continue Is there any reason you cannot do the walk Does anything hurt or are you in pain What I would like here is to have you walk as far as you can in this short period of time If participant does not feel he she can do this task note this and continue with another measure Continue You and will not talk while you are walking because this might make you walk more slowly I will however let you know how much time you have to walk and when you are almost done Touch and hold button to go to next screen Demonstration amp Practice Screen While demonstrating the first part of the task say Let me show you what you are going to do You will start with your feet behind this line Point to starting line When I say Go you will walk back and forth around the cones as fast as you can without running or hurting yourself You will begin after say Ready 3 2 1 Go As you pass the cone do not stop or slow down When tell you to stop stop where you are on the path until come to you Demonstrate task and say Watch me as show you You see that am walking fast but not running and that am not slowing or stopping when I pass the cone Do you have any questions Answer questions as necessary Practice Ask participant to walk course once down and back say Now you can pra
208. o other cultural experiences To accomplish this the iPad is paired with a wireless keyboard on which the examiner indicates whether the participant s response is correct or not Equipment and materials needed e iPad e Bluetooth wireless keyboard e Pronunciation guide Detailed information on equipment and materials needed for all tests can be found in Appendix 4 Setting up Bluetooth Wireless Keyboard e Goto the Settings app of the iPad and make sure Bluetooth is turned on e Make sure the keyboard is in discovery mode by pressing the round button at the top right end of the keyboard and the small green light to the left of the button begins flashing e Select the keyboard when it appears on the My Devices list on the iPad e When a pop up window appears on the iPad screen follow the instructions and enter the required code on the keyboard The usual keyboard on the iPad will not work when the external keyboard is working To turn off the external keyboard press the round button at the top right end of the keyboard move at least 15 meters from the iPad with the keyboard or touch the information button on the iPad and touch forget this device Using the Keyboard Once the participant pronounces a letter or word the examiner checks a pronunciation key and types 1 if the pronunciation is correct or 0 if the response is incorrect After choosing 1 or 0 the examiner presses the spacebar to move on to the next word or letter
209. o this place pre measured NaCl crystals in a 1 liter graduated cylinder Make sure all the crystals are emptied from the weigh boat into the graduated cylinder Slowly add distilled or deionized water to the 1 liter mark by bringing the meniscus bottom of the solution to the 1000 ml mark Gently add the stir bar and then stir on a magnetic stirrer until the NaCl is completely dissolved approximately 5 to 10 minutes Once NaCl is fully dissolved turn off the stirrer and use the retrieving rod to remove the stir bar from the solution Transfer the solution to labeled storage bottles Wash and rinse graduated cylinder stir bar and retrieving rod thoroughly before reusing To mix 0 001 M quinine hydrochloride dihydrate dissolve 0 397 grams quinine in purified water To do this weigh out 0 397 grams of quinine HCI dihydrate as described above If you do not have access to an analytical balance that goes to four decimal points weigh out 0 40 grams of quinine HCI on a standard top loading electronic balance Do not use a triple beam balance for quinine Place the pre measured quinine in a 1 liter cylinder add distilled or deionized water to the 1000 milliliter mark gently add the stir bar and then stir on a magnetic stirrer until the quinine is completely dissolved and no visible crystals can be seen at least 15 to 20 minutes Transfer the solution to labeled storage bottles When finished wash and rinse graduated cylinder stir bar and retriev
210. onal Institutes of Health NIH hereinafter referred to as NU NIH and users of any and all aspects or components of the NIH Toolbox hereinafter referred to as You or User Use of the NIH Toolbox measures instruments related materials and services require acceptance of all terms and conditions stated herein You agree to abide by all of NTAC asa condition of reviewing or using the NIH Toolbox No modifications or additions to these terms and conditions are binding upon NU NIH unless previously agreed to in writing by an authorized representative of NU or the NIH NU NIH reserves the right to update the NTAC at any time Changes in the NTAC shall apply to new users new measures and to new projects created by existing users after such changes are posted COPYRIGHT NOTICE NIH Toolbox tests test protocols test items norms norms tables scoring programs scoring keys including scoring algorithms scale definitions scale membership and scoring directions score reports software and other NIH Toolbox related materials are 2015 Northwestern University and the National Institutes of Health Information and materials contributed to the NIH Toolbox by other individuals entities are being used with the permission of the copyright holders Toolbox materials are not to be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying recording or any information storage and retrieval system wi
211. onses with minimal burden on participants and precise evaluation at the individual level NIH Toolbox instrument development has focused on the continuity of assessments throughout the lifespan An expert team of early childhood and older adult assessment consultants was engaged to provide guidelines for administration to offer input on instrument development and to review all NIH Toolbox measures as they relate to the needs of young children and elderly participants A 3 Characteristics of the NIH Toolbox App The use of the NIH Toolbox has grown significantly since public release of the web based version in 2012 Beginning in 2015 the NIH Toolbox is available in the form of an iPad app that presents the following user friendly features and functions Takes advantage of portable easy to use technology e Presents a complete stand alone application internet access is no longer required during test administration e Administering the tests can be easily mastered with practice e Minimizes the use of custom hardware e Features enhanced normative scores for individual Cognition tests and composites e Allows results to be stored locally on the iPad or in iCloud e Provides basic reporting on an individual participant level e Offers email support helo nihtoolbox org 5 Return to TOC B Learning about the NIH Toolbox App Users will find that the NIH Toolbox is a user friendly and effective resource for assessing functioning over ti
212. ooses BALL Return to TOC 72 iPad screen written content Examiner E Actions When you hear the word COLOR choose the E chooses BLUE picture picture that s the same COLOR as the picture in the middle of the screen If it s a BLUE one choose this picture And if it s a YELLOW one choose that picture E chooses YELLOW picture Transition Now you try E reads screen then touches and holds Keep your eyes on the star in the middle of the button to continue Screen Remember Put your finger back on Home Base after you answer Test items 30 mixed items Return to TOC is C 2 4 2 NIH Toolbox Dimensional Change Card Sort Test Ages 3 7 with Developmental Extension DEXT This table outlines the item content read by and the actions to be performed by the examiner and the child Title Screen iPad screen written content NIH Toolbox DCCS 3 7 DEXT Examiner E amp Child C Actions E touches and holds button to continue Practice Intro We re going to play a matching game with colors and shapes E reads screen then touches and holds button to continue Keep your eyes on the star in the middle of the Screen SHAPE Intro We ll play the SHAPE game first In the SHAPE E points to BOAT then game choose the picture that s the same SHAPE demonstrates use of button as the picture in the middle of the screen If it s a BOAT choose this picture If it s a
213. or stopped this information is recorded in the data export along with the reason indicated Stopped assessments can generally be resumed but there are exceptions for specific instruments as for pausing Detailed rules for each test are available in Appendix 3 Return to TOC en View Existing Participants If the participant was previously created using the NIH Toolbox app on this iPad you may also locate him her by tapping Search Participants at the top right corner of the black part of the screen Participants Once the participant is located tap their Identifier or Name to open their record Participant gt 2 1234 Assessments Add New Assessment gt Assessment 1 J Partially Completed Resume y Tap the arrow to the left of the Identifier to view edit participant s information Please note if you edit participant information this change will not be indicated in the data export If you must change participant information after data for that participant has already been collected it is highly recommended that you either a create a new participant with a unique Identifier i e different than the Identifier used for the first assessment or b record the change with the date in another record keeping system i e lab notebook subject tracking software medical record etc Return to TOC 2h Once all the information is complete return to the previous screen by tapping the arrow at the screen s top left R
214. orded in data o During Live Items Return to active screen pause not recorded in data e Stop exit the instrument by selecting stop with the intention of resuming at a later time o During instructions Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Practice Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Live Items Participant sees last live item not responded to Appendix 4 NIH Toolbox Equipment and Materials In most cases when using the NIH Toolbox app all you will need to administer the tests and surveys to participants is an iPad However there are some additional supplies needed for the cognition motor and sensation instruments as outlined below Keep in mind the following guidelines when purchasing additional supplies 1 Unless recommended otherwise all materials and equipment can be purchased from any vendor of your choosing 2 Adhere to the minimum requirements for the materials and equipment where applicable 3 Some materials and equipment can be reused for multiple tests e g Bluetooth wireless keyboard 4 Vendors may provide discounts for educational institutions non profits etc General recommended equipment and materials An iPad case that allows for different viewing angles and provides protection is recommended The links below provide examples of recommended
215. orrectly there are two more opportunities to get a correct answer The first comes after a verbal explanation and a repeat of the question the second comes after replaying the item on the screen followed by a verbal explanation and then repeating the question If after three opportunities the participant continues to answer incorrectly the test will be discontinued and no more items will be presented Both practice items are detailed below 1 List Condition Read the screen You are going to see some pictures one at a time on the screen After each set of pictures you will see a blank screen When you see the blank screen want you to tell me the names of the pictures in size order from smallest to biggest For example if show you a motorcycle a bus and a car you would say motorcycle car bus From now on you will hear most of the instructions from the iPad Do you have any questions Let s practice Press Spacebar to continue 1 List Practice Item 1 Trial 1 After the pictures are presented and the screen is blank an audio recording says Now say the animals in size order Correct Response If participant says DOG HORSE press 1 and then press spacebar An audio recording says That s right When it appears on the screen ask Are you ready When the participant answers affirmatively press the spacebar and 1 List Practice Item 2 will be presented Incorrect Response If participant does not say DOG HORSE pr
216. ot required to complete the test it is OK if the child does not correctly name each letter Encourage the child s efforts without providing negative feedback Then say Let s do some more Press Spacebar to continue Say You are going to look on this screen point to iPad then you will see a picture or letter for children who clearly know the alphabet it is OK to say letter instead of picture Each time want you to tell me or point on this card what you saw on the screen If you are not sure it is OK to guess Are you ready to start Press Spacebar to continue Practice The iPad will present one set of practice visual acuity trials four letters at a large size Rules a If the child gets three or more correct the program will continue automatically to visual acuity testing b If the child misses two or more of four review the laminated pointing chart and ask him her to identify either orally or by pointing the four letters HOTV If all are done correctly see step c below If child cannot correctly identify the optotypes on the HOTV set repeat the training above one more time C Proceed to a second practice trial set If three or more of four are done correctly proceed to live visual acuity testing d If not repeat third practice trial set If three or more are correct on the third practice trial begin visual acuity testing If two or more are incorrect stop the test since this is the third practice
217. ox app is available through the app store and can be downloaded for free However to use the instruments you will be asked to purchase a 6 month subscription for 9 99 special introductory pricing This subscription may be used on any iPad on which you install the NIH Toolbox app as long as you enter the same Apple ID used for purchase After your 6 month subscription expires we will offer a 12 month subscription for purchase at regular pricing 100 200 range if you choose to continue administering the instruments After expiration you will still have access to your data on the iPad but you will no longer be able to create new participants patients or collect new data Return to TOC 10 B 3 NIH Toolbox Support To access a copy of this manual or view more resources about the NIH Toolbox please visit www nihtoolbox org Resources NIHToolboxiPadapp Contact help nihtoolbox org with questions or to report technical problems The NIH Toolbox is more than a set of measures we are a community of users and NIH Toolbox continues to evolve Help us make this product the best it can be f you have suggestions for changes or corrections please share them here info nihtoolbox org Return to TOC B 4 Using the NIH Toolbox App B 4 1 NIH Toolbox App at a Glance Ni ls ia Koyo ole Tap one of these four buttons to pi r1 Participants change the app passcode view subscription info view FAQs view the app T amp C
218. pant know the trial has ended Choose STOP FAIL if the participant did not successfully complete the trial for any reason If a second trial is needed start the second trial of this pose the examiner should say Let s try that one again Please stand with your feet together heels and balls of feet touching and as still as possible with your eyes open and with your arms crossed on your chest like this demonstrate Focus on the X shown on the wall in front of you Ready The examiner touches the START button and says Go Again choose STOP FAIL if the participant did not successfully complete the trial for any reason After 50 seconds of elapsed trial time a tone will sound After a few more seconds the examiner will be able to touch the PASS or STOP FAIL button Whenever the PASS or the STOP FAIL button is touched a pop up window asking for confirmation of the choice will appear The examiner must confirm his her choice to move on to the next trial Note If a participant fails both trials of Pose 1 the test will be terminated Once the participant successfully completes a trial say Are you ready for the next one Proceed with the next pose or allow the participant to rest following the procedures noted above If participant fails trial 2 the discontinue rule is invoked say We are done with this activity Pose 2 Screen Flat surface feet together eyes closed the same as Pose 1 except this time the participant s eye
219. pant is allowed to go back to the last item he she attempted If either a child or adult participant has difficulty touching the pictures on the iPad screen he she may point and the examiner may touch the iPad When this happens the examiner should say something like the following to the participant You can point to the picture you want and then I will touch it for you Similarly if a participant has trouble reading picture labels the examiner may read the labels for him her Age specific Instructions NIH Toolbox Odor Identification Test Ages 3 9 NIH Toolbox Odor Identification Test Ages 10 C 5 2 1 NIH Toolbox Odor Identification Test Instructions Ages 3 9 The task is introduced with the following Title Screen NIH Toolbox Odor Identification Test 3 9 At the bottom of the screen is a button Touch and Hold Here to Continue Touch and hold that button to begin the test For this age group there are two parts to the instructions picture identification and odor identification Part 1 Picture Identification The child is presented with a screen that shows eight pictures Popcorn Flower Lemon Play Doh Bubble Gum Chocolate Coffee and Cinnamon A voice on the iPad asks the child to Touch the picture of The examiner should read the screen Now we are going to look at some pictures want to see if you know what they are At the bottom of the screen is a button Touch and Hold Here to Continue Touch and hol
220. pears E touches and holds button to continue Return to TOC 81 2B Screen 6 Here is a big kitty Where does it go E reads screen C Live trial 2 touches a box 2B Screen 7 If it s a little kitty then it goes in the big kitty box If E reads screen After 5 Rule reminder 3 its a big kitty then it goes in the little kitty box Text appears above reversed boxes seconds Touch and Hold Here to Continue button appears E touches and holds button to advance to next screen 2B Screen 8 Here is a little kitty Where does it go E reads screen C Live trial 3 touches a box 2B Screen 9 Little kitties go here Big kitties go here Text E reads screen After 3 Rule reminder 4 appears above reversed boxes seconds Touch and Hold Here to Continue button appears Then E touches and holds button to advance to next screen 2B Screen 10 Live Trial 4 Here is a little kitty Where does it go E reads screen C touches a box 2B Screen 11 Rule reminder 5 If it s a little kitty then it goes in the big kitty box If its a big kitty then it goes in the little kitty box Text appears above reversed boxes E reads screen After 5 seconds Touch and Hold Here to Continue button appears Then E touches and holds button to advance to next screen 2B Screen 12 Live Trial 5 Here is a big kitty Where does it go E reads screen C touches a box
221. picture that s the same SHAPE as the picture in the middle of the screen If its a BOAT choose this picture E chooses BOAT If it s a RABBIT choose that picture E chooses RABBIT Transition Now you try Keep your eyes on the star Answer as fast as you can without making mistakes If you make a mistake just keep going Put your finger back on Home Base after you answer E reads screen then touches and holds button to continue Return to TOC 90 iPad screen written content Examiner E Actions Shape Practice Set 2 4 items sorted by shape More practice if less than 3 out of 4 correct on Set 2 Let s practice that some more In the SHAPE game choose the picture that s the same SHAPE as the picture in the middle of the screen If it s a BOAT choose this picture E chooses BOAT If it s a RABBIT choose that picture E chooses RABBIT Transition Now you try Keep your eyes on the star Answer as fast as you can without making mistakes If you make a mistake just keep going Put your finger back on Home Base after you answer E reads screen then touches and holds button to continue Shape Practice Set 3 4 items sorted by shape Test ends if less than 3 out of 4 correct on Set 3 COLOR intro We can also match by COLOR In the COLOR game E points to then choose the picture that s the same COLOR as the c
222. pointing different ways But first we are going to learn about Home Base This is your Home Base Put your finger on Home Base and wait for the next picture E reads screen and points to the home base then touches and holds button to continue Practice Introduction You will see a row of arrows You should choose the button that matches the way the MIDDLE arrow is pointing E points to left arrow and demonstrates touching the correct arrow If the MIDDLE arrow is pointing this way choose this button E demonstrates touching arrow button If the MIDDLE arrow is pointing this way choose this button E demonstrates touching arrow button Sometimes all the arrows will point the same way Sometimes the middle arrow will point a different way like this You should always choose the button that matches the way the MIDDLE arrow is pointing You will see the word MIDDLE to remind you E reads screen points to the arrows and demonstrates touching arrow button Transition to practice items Now you try Keep your eyes on the star Answer as fast as you can without making mistakes If you make a mistake just keep going Remember put your finger back on Home Base after you answer E reads screen then touches and holds button to continue Practice Items set 1 4 practice items More practice if less than 3 out of 4 correct on set 1 Let s practice some more If the MIDDL
223. quently on the papillae of the tongue throughout the oral cavity It is measured by the NIH Toolbox Regional Taste Test Time to Sensation amp Pain Instruments Ages Administer minutes NIH Toolbox Pain Interference Survey NIH Toolbox Pain Intensity Survey 18 85 1 NIH Toolbox Odor Identification Test 3 85 4 5 NIH Toolbox Visual Acuity Test 3 85 3 NIH Toolbox Words in Noise WIN Test 6 85 6 NIH Toolbox Regional Taste Intensity Test 12 85 6 Return to TOC L2 wr The Time to Administer minutes column gives users an idea of how long each test might take however please note that testing times could vary based on how prepared the test administrator is going into the session individual differences among participants as well as other unplanned activities that may occur during testing nore Only the individual Sensation instruments listed above are available through the NIH Toolbox App at this time The Sensation Battery will be released later in 2015 C 5 1 NIH Toolbox Pain Interference Survey 18 amp NIH Toolbox Pain Intensity Survey 18 Equipment and materials needed e iPad Two instruments NIH Toolbox Pain Interference CAT Age 18 and NIH Toolbox Pain Intensity FF Age 18 make up the measurement of this construct Each is self administered for each instructions are presented on the iPad screen Each instrument is presented separately to the participant Pain Inte
224. r explains the walk Let me show you what I want you to do Put both your feet together behind this line point to starting line Walk all the way past the cone on the other end before you stop Before the demonstration say 3 2 1 Go Examiner should demonstrate the walk After returning examiner presses Touch and hold button for next screen Practice Screen After demonstration have the participant stand with both feet touching the start line say Now you try Remember to walk at your usual speed and keep walking until you pass the cone When I want you to start will say 3 2 1 go Do you have any questions Answer any questions Ready 3 2 1 Go When the participant passes the cone say That s good Do you have any questions Answer any questions Touch and hold that button for next screen After practice is completed the following screens will then be presented As below each shows what the examiner is to say and do Test Intro Screen Begin timing press start stop button when the participant steps over first footfall the starting line Stop timing when one of the participant s feet is completely across the end finish line the line at 4 0 meters not the line at 5 0 meters Position yourself so that you can easily see when the participant steps across each line If necessary walk behind and to the side of the participant as he she walks If the participant stumbles or tries to run void that trial an
225. r hand to hold the board in place At the bottom of the screen it says Right or Left as appropriate Hand Practice and there is a timer with START and RESET buttons Say Are you ready 3 2 1 Go Make sure to touch the START button as soon as you say GO As participant is placing the final peg say And take them out Touch the STOP button as soon as the final peg is placed back in the cup After timer stops touch the NEXT button and confirm your choice in the pop up window There is a RESET button if for some reason the participant needs to start again If this happens the examiner should touch RESET and confirm his her choice in the pop up window Start the trial over again removing all the pegs before starting Test Trial dominant hand Say Now I will time how fast you can do this Pick up the pegs one at a time using only your RIGHT or LEFT as appropriate hand Put them in the holes one at a time until all 9 holes are filled Then take them all out one at a time The pegs can be put in the holes or taken out in any order Remember to work as fast as you can Have participant start with his her hand flat on table beside pegboard At the bottom of the screen it says Right or Left as appropriate Hand Trial and there is a timer with START and RESET buttons Say Are you ready 3 2 1 Go Make sure to touch the START button as soon as you say GO As participant is placing the final peg say And
226. r two trials on two practice items 3 7 testing will automatically be discontinued and iPad will move on to the next test Test Items Read the screen Now you ll do some more Remember touch the SMILEY face if the pictures look alike or are the same and touch the FROWN face if they do not look alike and are NOT the same Make a choice as quickly as you can Are you ready When ready touch and hold button that says Touch and hold here to continue For both test and practice items if participant does not respond within 10 seconds audio recording asks Are these the same When either 130 items appear or 85 seconds of testing time has occurred the test will end if a participant is working on an item when time is up he she will be permitted to complete it C 2 5 2 Pattern Comparison Processing Speed Test Instructions Ages 7 The task is introduced with the Title Screen NIH Toolbox PC 7 At the bottom of the screen is a button Touch and Hold Here to Continue Touch and hold that button to begin the test Handedness If this was not entered during registration the iPad app will not allow this test to be administered Instead the examiner will need to ask a set of questions to ascertain handedness and to enter it in the participant registration screen Please refer to Appendix 2 for details Once handedness is entered in the participant registration screen it will automatically update the instructions on the
227. re required to order a series of objects either food or animals in size order from smallest to largest The test begins with a two object item The participant must succeed at one of the first two object items to continue See the discontinue rules below In the 2 List condition participants are presented both food and animals and are first asked to say the food objects in size order and then the animal objects in size order In each condition participants ages 7 85 have two practice items both items are presented in a flashing mode Because the participant answers orally this measure cannot be self administered An examiner must record on a wireless keyboard whether each response is correct specifically after the participant answers gives the list of objects the examiner types 1 if the response list is correct or 0 if the response list is incorrect For the practice items after choosing 1 or 0 the examiner presses the spacebar to move on to the next item list of objects There is feedback presented by a prerecorded voice and there are repeated trials for errors For the test items after the examiner chooses 1 or 0 the question Are you ready appears on the screen Once confirming that the participant is ready and attending the examiner presses the spacebar to move on to the next item list of objects For the examiner there is a code at the bottom right side of the iPad screen to indicate which item is being adminis
228. ree symbols or to identify a specific letter in an array of four letters In such cases an audio file will play instructing the participant to point out the answer on the iPad screen the examiner will score the item accordingly using the keyboard as with all other items C 3 Emotion Domain Emotion refers to any strong feeling as of joy sorrow or fear Emotion is an affective state of consciousness in which joy sorrow fear hate or the like is experienced as distinguished from cognitive and volitional states of consciousness Emotions can be negative and distressing or positive emotions can be reflections of well being in our lives and positive social relationships can buffer stress and enhance health Emotion Domain Framework NIH Toolbox Emotion consists of four subdomains Psychological Well Being Social Relationships Stress amp Self Efficacy and Negative Affect Each subdomain includes narrower constructs that are measured through appropriate versioned surveys for Adults over 18 ages 13 17 ages 8 12 self and parent report and ages 3 7 parent report only Social Social Distress Positive Social Development Psychological Well Being PWB includes both hedonic and eudaimonic components Hedonic constructs are more subjective and experiential and emphasize pleasure and positive affect happiness serenity and cognitive engagement Eudaimonic well being is more evaluative and emphasizes fulfillment
229. reen and demonstrate the actions described Say Here you see some pictures in a yellow box want to show you how to move the pictures to the gray boxes You can move pictures from this yellow box to the gray boxes like this Touch on the picture in the yellow box then drag the picture you touched to the gray box where you want to move it Now you try with this picture After the participant demonstrates understanding of this step touch the button at the bottom of the screen that says Touch and Hold Here to Continue Step 2 Moving Pictures from the Gray Boxes to the Yellow Box Read the text above the yellow box on the screen and demonstrate the actions described Say You can also move pictures from the gray boxes back to the yellow box like this Touch the picture you want to move Then drag that picture to the yellow box Now you move the other picture back to the yellow box After the participant demonstrates understanding of this step touch the button at the bottom of the screen that says Touch and Hold Here to Continue Step 3 Moving Pictures between the Gray Boxes Read the text above the yellow box on the screen and demonstrate the actions described Say You can also move the pictures from one gray box to another like this First you touch the picture in one gray box Then drag that picture to the gray box where you want the picture to go Now you try it move the picture from here to here After the participant demonstrat
230. required If unknown please refer to Appendix 2 for a brief survey to determine handedness e Race e Ethnicity Please note that some of these fields may be required for some instruments Examiners will be alerted when launching an assessment if one or more required fields are missing based on the selection of instruments Error and Warning messages are described below in more detail If a participant is less than 18 years old and his her Mother s Education is unknown examiners will be asked to complete additional fields related to other family members education If the NIH Toolbox Picture Vocabulary Test or the NIH Toolbox Oral Reading Test is selected examiners will also see a Starting Education Level Override field If an examiner feels that a participant should begin the test at a level higher or lower than what would be appropriate for his her grade education level the examiner should use this feature Using the override will affect the difficulty of the initial items presented on these tests this may be appropriate in cases where the participant is expected to be at a significantly higher or lower functioning level than would be expected by his her grade level education This function should be used judiciously and only in cases where the examiner has prior evidence of lower or higher participant functioning Return to TOC 14 Assign batteries or instruments to a participant Step 1 Tap Add New Assessment either from a new participa
231. responding full name of the instrument as it appears for selection elsewhere in the app vr A detailed list of equipment and materials needed to administer the entire NIH Toolbox can be found in Appendix 4 Return to TOC oe C 1 NIH Toolbox Touch Screen Tutorial NIH Toolbox Touch Screen Tutorial 3 is available and recommended for anyone not familiar with using an iPad or similar device It is particularly useful for young children and older adults who may need reassurance that they are able to complete the assessment competently If used it should be added as the very first instrument in the assessment Description This series of screens is designed to help participants to use the iPad and specifically the touch screen To help the participant get comfortable with the touch screen the examiner may want to demonstrate move the participant s finger or in other ways encourage the participant to do the required actions The task is introduced with the Title Screen NIH Toolbox Touch Screen Tutorial 3 At the bottom of the screen is a button Touch and Hold Here to Continue Touch and hold that button to begin the tutorial Read the next screen to the participant First you will practice touching pictures on the screen When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue Read Touch the flower on the screen After participant touches the flower the next screen appears
232. rial over again removing all the pegs before starting Test ends C 4 2 NIH Toolbox Grip Strength Test This is a measure of upper extremity muscle strength that makes use of a dynamometer It was originally adapted from the protocol of the American Society of Hand Therapy The results are recorded on the iPad screen Equipment and materials needed e iPad e Jamar Plus or Rolyan Digital Hand Dynamometer Detailed information on equipment and materials needed for all tests can be found in Appendix 4 Set up Before beginning be sure the dynamometer is turned on The handle for gripping the dynamometer is adjustable but should be initially set at the notch second closest to the unit touch information button for picture Before each trial press RESET button and then TEST button on the dynamometer to record the grip strength force Support the dynamometer for the participant and ensure the participant is holding the arm bein tested next to but not touching his her side with elbow bent at 90 degrees Procedure The testing involves one practice trial with each hand followed by one test trial with each hand The alternation allows the hand to recover strength between exertions Return to TOC Lu C 4 2 1 Grip Strength Test Instructions Ages 3 The task is introduced with the Title Screen NIH Toolbox Grip Strength Test 3 At the bottom of the screen is a button Touch and Hold Here to Continue Touch an
233. ring robust models In total data were collected from more than 16 000 subjects as part of field testing calibration and validation activities The NIH Toolbox project conducted a large national norming study in both English and Spanish languages A sample of 4 859 participants ages 3 85 representative of the U S population based on gender race ethnicity and socioeconomic status was administered all of the NIH Toolbox measures at sites around the country NIH Toolbox normative scores are now available for each year of age from 3 through 17 as well as for ages 18 29 30 39 40 49 50 59 60 69 70 79 and 80 85 allowing for targeted accurate comparisons for any research study participant groups against the U S population In 2012 the web based version of NIH Toolbox was released to the general public and in 2015 the iPad app version was released NIH Toolbox measures utilize several advanced approaches in item development test construction and scoring Two of these are Item Response Theory IRT and Computer Adaptive Testing CAT which are used in a subset of instruments IRT allows tests to be brief 4 Return to TOC yet precise and valid Using IRT methodology sets of items are calibrated along a continuum that covers the full range of the construct to be measured This calibrated set of items enables the creation of CAT a specialized type of computer based testing that enables administration of items based on individuals resp
234. rm A Play in the Park Form B Go to the Fair Form C Work on the farm e Open a picnic basket e Take the pony out of the barn e Dig a hole e Lay out the blanket e Putthe saddle on the pony e Plant the tomatoes e Sit on the blanket e Go for a pony ride e Water the e Puta coin in the duck food e Put the hot dog in a bun tomatoes machine e Spread mustard on the hot dog e Put up a fence e Get the duck food e Eat the hot dog e Getsome paint e Feed the ducks e Paint the fence After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to Play in the Park Form A Go to the Fair Form B Work on the Farm Form C Now you move the pictures in the same way you saw them on the screen When all pictures have been placed in gray boxes a pop up will appear on the screen Are you finished Ask this of the child If child says YES touch and hold the YES button If the child says NO touch any of the pictures and the pop up will disappear If no picture is moved out of a gray box the pop up will continue to be on the screen The pop up will close if a picture is moved back to the yellow box and will reappear each time all pictures have been placed in gray boxes Read the screen Now you will see again how to Play in the Park or Go to the Fair or Work on the Farm Everyone has to do this more than once When finished reading touch the button at the bottom of the screen that says Touch
235. rs above relevant boxes Touch and Hold Here to Continue button appears E touches and holds button to continue 4A Screen 10 Live Trial 1 Here is a red one Where does it go E reads screen C touches a box 4A Screen 11 Rule reminder 2 Red ones go here Blue ones go here Text appears above relevant boxes E reads screen After 3 seconds Touch and Hold Here to Continue button appears E touches and holds button to continue 4A Screen 12 Live Trial 2 Here is a blue one Where does it go E reads screen C touches a box 4A Screen 13 Rule reminder 3 If it s a red one then it goes in the red box If it s a blue one then it goes in the blue box Text appears above relevant boxes E reads screen After 5 seconds Touch and Hold Here to Continue button appears E touches and holds button to continue 4A Screen 14 Live Trial 3 Here is a blue one Where does it go E reads screen C touches a box 4A Screen 15 Rule reminder 4 Red ones go here Blue ones go here text above relevant boxes E reads screen After 3 seconds Touch and Hold Here to Continue button appears E touches and holds button to continue 4A Screen 16 Live trial 4 Here is a red one Where does it go E reads screen C touches a box 4A Screen 17 Rule reminder 5 If it s a red one then it goes in the red box If it s a blue one then it goes
236. rt the second trial of this pose the examiner should say Let s try that one again Please step onto the foam and put your feet together heels and balls of feet touching and stand as still as possible with your eyes open and your arms crossed on your chest like this demonstrate Focus on the X shown on the wall in front of you Ready The examiner touches the START button and says Go Again choose STOP FAIL if the participant did not successfully complete the trial for any reason After 50 seconds of elapsed trial time a tone will sound After a few more seconds the examiner will be able to touch the PASS or STOP FAIL button Whenever the PASS or the STOP FAIL button is touched a pop up window asking for confirmation of the choice will appear The examiner must confirm his her choice to move onto the next trial After participant completes one or both trials say Are you ready for the next one Proceed with the next pose or allow the participant to rest following the procedures noted above Pose 4 Screen Foam surface feet together eyes closed is the same as Pose 3 except that the participant s eyes are closed The examiner should demonstrate the pose describing what he she is doing as it is being done The participants turn is next the examiner should ask the participant to stand in the desired position saying Please step onto the foam and put your feet together heels and balls of feet touching and stand as still
237. rticipant says YES touch and hold the YES button If the participant says NO touch any of the pictures and the pop up will disappear If no picture is moved out of a gray box the pop up will continue to be on the screen The pop up will close if a picture is moved back to the yellow box and will reappear each time all pictures have been placed in gray boxes Logic 1 If participant gives correct response Test Item will be presented 2 If participant gives incorrect response Go Camping will be repeated with an audio recording saying Let s try that again After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to Go Camping Now you move the pictures in the same way you saw them on the screen 3 If participant gives incorrect response again 2 above is repeated up to two additional times or a total of 4 trials 4 If participant fails all 4 trials test will discontinue Test Sequences Participants ages 8 will be presented with two trials one with a 15 step sequence and the other with an 18 step sequence Read the screen Now we are going to play the game with more pictures This time you will see how to Play in the Park Form A Go to the Fair Form B Work on the Farm Form C When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue Test Item Trial1 As the pictures are presented an audio recording will say appropr
238. s Participants should not do this walk in bare feet high heeled or open back shoes sandals or flip flops Paper booties may be offered Equipment and materials needed e iPad e Measuring tape with meters and feet e Set of two cones e Walking course set up diagram Detailed information on equipment and materials needed for all tests can be found in Appendix 4 Detailed information on setting up the walking courses for the NIH Toolbox 4 Meter Walk Gait Speed Test and 2 Minute Walk Endurance Test can be found in Appendix 6 C 4 4 1 4 Meter Walk Gait Speed Test Instructions Ages 7 The task is introduced with the following Title Screen NIH Toolbox 4 Meter Gait Speed Test 7 At the bottom of the screen is a button Touch and Hold Here to Continue Touch and hold that button to begin the test The examiner should observe how participants walk normally If they use a cane or other walking device and feel they need it for the walking test they may use it If the participant uses such a device the examiner should note its use First Screen The examiner should show the participant the walking course and say This activity involves walking from one place to another This is our walking course point to the course want you to walk to the other end of the course at your usual speed just as if you were walking down the street to go to the store Touch and hold button for next screen Demonstration Screen The examine
239. s affirmatively the examiner should press the spacebar to continue 2 List Practice Item 1 Trial 1 After the pictures are presented and the screen is blank an audio recording says Say the food then the animal Correct Response If participant says BANANA BEAR press 1 and then press spacebar An audio recording says That s right When it appears on the screen ask Are you ready When the participant answers affirmatively press the spacebar and 2 List Practice Item 2 will be presented Incorrect Response If participant does not say BANANA BEAR press 0 and then press spacebar An audio recording says Let s try that again Trial 2 if Trial 1 was incorrect An audio recording continues The BEAR is an animal the BANANA is a food Now say the food first and then the animal Correct Response If participant says BANANA BEAR press 1 and then press spacebar An audio recording says That s right When it appears on the screen ask Are you ready When the participant answers affirmatively press the spacebar and 2 List Practice Item 2 will be presented Incorrect Response If participant does not say BANANA BEAR press 0 and then press spacebar An audio recording says Let s try that once more Trial 3 if Trial 2 was incorrect After the pictures are presented and the screen is blank an audio recording says The BEAR is an animal the BANANA is a food Now say the food first and then the animal If participant says BANANA
240. s are closed The examiner should demonstrate the pose describing what he she is doing as it is being done The participant s turn is next the examiner should ask the participant to stand in the desired position saying Please stand with your feet together heels and balls of feet touching and as still as possible with your eyes closed and with your arms crossed on your chest like this demonstrate Ready After the participant assumes the position the examiner touches the START button and says Go The examiner should check the participant s posture and that the eyes remain closed The iPad screen will display the elapsed time of the trial so the examiner can easily see it while assuring the safety of the participant Choose STOP FAIL if the participant did not successfully complete the trial for any reason If the first trial is failed for any reason start the second trial of this pose the examiner should say Let s try that one again Please stand with your feet together heels and balls of feet touching and as still as possible with your eyes closed and with your arms crossed on your chest like this demonstrate Ready The examiner touches the START button and says Go Again choose STOP FAIL if the participant did not successfully complete the trial for any reason After 50 seconds of elapsed trial time a tone will sound After a few more seconds the examiner will be able to touch the PASS or STOP FAIL but
241. say That s how to Have a Birthday Party Now you move the pictures in the same way you saw them on the screen 3 If child gives incorrect response again 2 above is repeated up to two additional times or a total of 4 trials 4 If child fails all 4 trials test will discontinue Practice Sequence 2 Say That s right Now you will see how to Go Camping When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue As pictures are presented an audio recording will say the appropriate labels First put up the tent Then go for a hike Then catch a fish And last roast a marshmallow After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to Go Camping Now you move the pictures in the same way you saw them on the screen When all pictures have been placed in gray boxes a pop up will appear on the screen Are you finished Ask this of the child If child says YES touch and hold the YES button If the child says NO touch any of the pictures and the pop up will disappear If no picture is moved out of a gray box the pop up will continue to be on the screen The pop up will close if a picture is moved back to the yellow box and will reappear each time all pictures have been placed in gray boxes Logic 1 If child gives correct response Test Item will be presented 2 If child gives incorrect r
242. set for the NIH Toolbox app 3 Requiring the administrator to enter the app passcode at the end of an assessment before returning to the home screen iCloud Security and Privacy policies can be found here https support apple com en us HT202303 Internet connection is required to use this link Return to TOC BY B 4 5 NIH Toolbox App Settings e View subscription information e g how much time is left on the subscription e View NIH Toolbox app Terms amp Conditions e Change the app data security settings enable disable data export via email and iCloud e View FAQs e View diagnostic information that may be needed when contacting Support e Change the app passcode Subscription Information Subscription Status 104 Days Remaining Terms and Conditions O Security Data Security Help Frequently Asked Questions Diagnostic Information App Version NIH Toolbox 1 1 Build 440 Return to TOC 2 To change the data security settings tap on Data Security then update the settings Data Security Allow Data Export To Use Email Allow Data Export To iCloud Drive To return to Data Export instructions tap click here Return to TOC on C Administering NIH Toolbox This section contains information about each of the four NIH Toolbox domains Cognition Emotion Motor and Sensation as well as descriptions of individual instruments the equipment and materials needed for their administration and age specifi
243. should only be added if the user is not selecting a preset emotion parent report battery NIH Toolbox Emotion Instructions should also be used with NIH Toolbox Pain instruments Return to TOC 1H Step 3 Reorder selected instruments if desired by dragging them up or down using the mmm Symbol to the right of the instrument name Tap Done in the upper right corner of the screen or tap the arrow in the upper left corner to save your selections and to return to the previous screen v Selected Instruments gt NIH Toolbox Motor Battery ages 7 NIH Toolbox Odor Identification Test Age 10 v2 0 v Available Batteries Motor Adult All Types amp v Available Instruments Sensation w Adult All Types E NIH Toolbox Pain Intensity FF Age 18 v2 0 Sen Select E NIH Toolbox Pain Interference CAT Age 18 v2 0 Sen Select Return to TOC 1 Start an Assessment Upon completing instrument selection tap Start to launch the assessment Participant gt E Edit Assessments Add New Assessment M Assessment 1 e C Not Started Start Instruments Edit Instruments gt gt NIH Toolbox Cognition Battery Age 12 Cog At this time users will be presented either with the assessment launch screen The assessment will now begin Please make sure the participant is ready then touch the Start button to continue Return to TOC 20 or with one or more Error or Warning messages alerting users a
244. source test publisher and copyright notice PERMISSION TO USE COPYRIGHTED TEST NORMS NU NIH have the sole right to authorize reproductions of any portion of their published tests including test norms Copying of test norms without authorization is a violation of federal copyright law The term copying includes but is not limited to entry of test NIH Toolbox norms into a computer s memory for purposes of test processing scoring or reporting Any person or organization wanting to use NU NIH test norms must submit a written request through the NU NIH Contact Us page on the website at www nihtoolbox org Please enter request details in the message box If permission is granted a fee may be charged Permission from NU NIH for use of test norms does not imply endorsement of or responsibility for the accuracy or adequacy of any test processing scoring or reporting service MODIFICATION OF NIH TOOLBOX COMPONENTS NU NIH recognizes the importance of continued scientific development of the NIH Toolbox measures to meet the needs of researchers but emphasizes the importance of maintaining rigorous measurement standards Therefore User may make modifications to NIH Toolbox tests and test items if and only if the following conditions are met 1 Specific modification plans must be enumerated and submitted in writing to NU NIH for approval This request must include the specific changes to be made and the rationale for the changes This writ
245. st live item not responded to NIH Toolbox List Sorting Working Memory Test e Skip o Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted e Pause perform admin gesture and return to instrument without selecting stop or skip o During Instructions Return to active screen pause not recorded in data o During Practice Participant sees last live item not responded to o During Live Items Participant sees last live item not responded to e Stop exit the instrument by selecting stop with the intention of resuming at a later time o During instructions Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Practice Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Live Items Participant sees last live item not responded to This restart will also always play the list s introduction screen before showing the screens again NIH Toolbox Dimensional Change Card Sort Test e Skip o Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted e Pause perform admin gesture and return to instrument without selecting stop or skip o During Instructions Return to active screen pause not recorded in data o During Practice Return to active screen pause not recorded in data o During
246. subtract one lap Below is the test trial screen EXAMINER SAYS This time will be timing you Remember when say Go walk back and forth around the cones as fast as possible for 2 minutes without running or hurting yourself Ready 3 2 1 Go Timer 02 00 tome o cm Each time the participant makes a turn press the Lap button to record it If you make a mistake press the or button to add or subtract one lap Next Continue by saying This time I will be timing you Remember when I say Go walk back and forth around the cones as fast as possible for 2 minutes without running or hurting yourself Ready 3 2 1 Go Start the timer and keep track of the laps as described above At the same time examiner should provide the following feedback 1 minute You are doing well You have 1 minute to go If participant is resting at one minute reminder encourage him her to continue and change statement to You have only 1 minute left Rest as long as you need start walking again as soon as you feel able to do so When time reads 0 15 tell the participant In a moment I m going to ask you to stop When do just stop right where you are and will come to you When five seconds remain examiner should count down 5 4 3 2 1 stop Please stay where you are and rest The examiner put a piece of tape on the floor to mark where participant stopped the tape should be placed behind the participant s heel
247. surveys are automatically presented first with the question from the Pain Intensity survey followed by the questions from the Pain Interference survey C 5 2 NIH Toolbox Odor Identification Test This task assesses the ability to identify various odors Before identifying the odors the child participants ages 3 9 years are asked to identify the eight pictures that are used as answer choices Having identified the pictures they are asked if they have smelled the objects or foods depicted The examiner needs to have an iPad scratch n sniff cards and a scratcher e g guitar pick to administer this measure Equipment and materials needed e iPad e NIH Toolbox Odor Identification Cards e Scratcher Detailed information on equipment and materials needed for all tests can be found in Appendix 4 For the test items all participants ages 3 85 years use scratch n sniff cards These cards are numbered to match not only the order in which they are presented but the number on the iPad screen as well After scratching them participants are asked to identify which of four pictures on the screen matches the odor they have just smelled Children ages 3 to 9 are handed cards that the examiner scratched and are asked to identify five odors participants ages 10 and above are asked to scratch and identify nine odors There are two versions of the instructions one for ages 3 9 and one for ages 10 and above In both versions the partici
248. t look alike The practice items are not timed If a participant child or adult continues to make an error after being corrected on two practice items the test will discontinue For both test and practice items if there is no response in 10 seconds the pre recorded audio asks Are these the same During practice items only an audio recording will follow each item presentation If the item is correct an audio recording will say That s right If the item is incorrect an audio recording will say why the item is incorrect The item will appear a second time and the participant will be asked to respond again If a participant child or adult continues to make an error after being corrected two times on two different practice items the test will discontinue Test items There are a maximum of 130 items or a maximum response time of 85 seconds Prompts Some participants need reminders to stay on task The examiner may give prompts although fewer are better as this is a timed task Each prompt should be succinct Examples are look at the screen are these the same yes or no remember to choose a button remember to choose as quickly as you can Return to TOC is Handedness If this was not entered during registration the iPad app will not allow this test to be administered Instead the examiner will need to ask a set of questions to ascertain handedness and to enter it in the participant registration screen Please refer to App
249. t on the e Smell a flower e Milk a cow horse e Plant the tomatoes After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to Play in the Park Form A Go to the Fair Form B Work on the Farm Form C Now you move the pictures in the same way you saw them on the screen When all pictures have been placed in gray boxes a pop up will appear on the screen Are you finished Ask this of the child If child says YES touch and hold the YES button If the child says NO touch any of the pictures and the pop up will disappear If no picture is moved out of a gray box the pop up will continue to be on the screen The pop up will close if a picture is moved back to the yellow box and will reappear each time all pictures have been placed in gray boxes Read the screen Now we re going to do the same pictures with some more pictures added Everyone is asked to do this more than once When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue Test Item Trial 2 As the pictures are presented an audio recording will say appropriate labels Form A Play in the park Form B Go to the fair Form C Work on the farm Fly a kite Play in the sand Go down the slide Pull the wagon Swing on the monkey bars Lay out the blanket Play catch Catch a butterfly Ride a bike Row the boat Read a book Kick the b
250. t wears lenses but indicates he she has forgotten them or does not have them for any reason the examiner may choose to continue testing or not it is at the examiner s discretion However if the participant requires a very strong correction testing without corrective lenses will not likely be valid The examiner should note any such irregularities and if testing is completed should interpret results with caution iPad on stand Visual Acuity set up showing 3 meters distance Return to TOC Lis The examiner records the participant s response on the wireless keyboard specifically once the participant names for young children points on the HOTV sheet the letter on the screen the examiner types that letter into the keyboard After typing the letter the examiner presses the spacebar to move on to the next letter The iPad software automatically scores the response and displays the next letter accordingly Age Specific Instructions NIH Toolbox Visual Acuity Test Instructions Ages 3 7 NIH Toolbox Visual Acuity Test Instructions Ages 8 C 5 3 1 NIH Toolbox Visual Acuity Test Instructions Ages 3 7 Before beginning the testing set up the iPad on a stand that sits on a table such that the iPad is 3 meters from the participant Pair the wireless keyboard by Bluetooth with the iPad if it has not already been paired The task is introduced with the Title Screen NIH Toolbox Visual Acuity Test 3 7 At the bottom of the screen is a
251. ten request must be signed by the lead researcher 2 User may not make modifications to any component of NIH Toolbox without written consent of NU NIH 3 All modifications should be fully validated against the existing NIH Toolbox measure s on which they were based Plans for a concurrent validation study must be included in the written request for modifications If no validation study is planned this must be noted in the written request along with an explanation 4 User must send validation study results to NU NIH for review prior to publication citing any results of said study or any results citing use of NIH Toolbox 5 NU NIH will review validation study data and will inform User if modification to NIH Toolbox measure s constitute an Approved Adaptation or a Non Validated Adaptation of NIH Toolbox NU NIH will update NIHToolbox org accordingly to inform other users and prospective users of these modifications along with contact information for the lead researcher 6 User must cite NIH Toolbox in any and all presentations publications or other third party sharing of research data indicating whether any measures used constitute Approved Adaptations or Non Validated Adaptations The citation must include the following statement All NIH Toolbox related materials are 2015 Northwestern University and the National Institutes of Health 7 NU NIH maintains all rights to all translations Approved Adaptations as well
252. tent read by as well as the actions for the examiner iPad screen written content Examiner E Actions Practice set 1 Title Screen NIH Toolbox DCCS 12 E touches and holds button to continue Home Base We re going to play a matching game with colors and shapes E reads screen and Intro But first we are going to learn about Home Base This is your points to Home Base Home Base Put your finger on the Home Base and wait for then touches and the next picture holds button to continue SHAPE intro We ll play the SHAPE game first In the SHAPE game E points to BOAT choose the picture that s the same SHAPE as the picture in then demonstrates the middle of the screen If it s a BOAT choose this picture use of button If its a RABBIT choose that picture E points to RABBIT then touches and holds button to continue Transition Now you try E reads screen then Keep your eyes on the star Answer as fast as you can touches and holds without making mistakes button to continue If you make a mistake just keep going Put your finger back on Home Base after you answer Shape 4 items sorted by shape More practice if less than 3 out of 4 correct on set 1 Let s practice that some more In the SHAPE game choose the picture that s the same SHAPE as the picture in the middle of the screen If it s a BOAT choose this picture E chooses BOAT If its a RABBIT choose that picture E chooses R
253. tep 3 Moving Pictures between the Gray Boxes Read the text above the yellow box on the screen and demonstrate the actions described Say You can also move the pictures from one gray box to another like this First you touch the picture in one gray box Then drag that picture to the gray box where you want the picture to go Now you try it move the picture from here to here After the child demonstrates understanding of this step touch the button at the bottom of the screen that says Touch and Hold Here to Continue Introduction to the Practice Items Read the screen Now we re going to play the game You will see some pictures on the screen You should remember them and show them back to me in the same way you saw them on the screen When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue The next screen begins the two practice sequences The child has four trials to complete each sequence If the child succeeds in four trials or less the next practice sequence or test sequence is presented If the child fails all four trials of either practice sequence the test is discontinued Practice Sequence 1 Say Now you will see how to Have a Birthday Party When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue As pictures are presented an audio recording will say the appropriate labels First bake the cake Next
254. tered The examiner should use this code to look up the correct response on the NIH Toolbox List Sorting Working Memory Examiner Answer Sheet and then score the item using the keyboard 1 or 0 and pressing the spacebar Introduction For an item to be marked correct the participant must name all the stimuli in the correct order without any intrusions A participant may change his her response It is also acceptable for a participant to give a synonym for either a food item or an animal For example in English responses such as these should be marked as correct puppy for dog bunny for rabbit and lamb for sheep Several discontinue rules are embedded in the software e f a participant does not complete a practice item correctly the test itself is not administered e lfaparticipanthas incorrect responses on both parts of a test item the test condition being administered 1 List or 2 List is discontinued e If the participant has a score of 1 point as the sum of the two sets of 2 stimulus items pig mouse and bird cow banana watermelon and apple blueberry and a score of 0 points on the set of 3 stimulus items pumpkin strawberry banana and dog horse rabbit in the 1 list condition the test is discontinued and the 2 list condition is not administered e f the participant has a score of 0 points as the sum of the two sets of 2 stimulus items pig mouse and bird cow banana watermelon and apple blueberry the test is discontinued a
255. tes touching arrow button More test items arrows Now you try Keep your eyes on the star in the middle of the screen Try to answer as fast as you can Remember Put your finger back on Home Base after you answer E reads screen then touches and holds button to continue 20 test items arrows Return to TOC DEXT Screen 1 Demo Trial 1 Let s try some more Here is a Fish This Fish is HUNGRY To feed the HUNGRY Fish we have to touch the button pointing the same way that the HUNGRY Fish is swimming Right button is flashing after 5 seconds E reads screen and then E touches right arrow Screen won t advance until correct arrow is touched When correct arrow is touched bubbles sound plays and iPad says Mmm thank you Touch and hold here to continue screen appears E touches and holds button to continue DEXT Screen 2 Practice Trial 1 Now it s your turn Feed the HUNGRY Fish by touching the button that points the same way the HUNGRY Fish is swimming E reads screen Child touches an arrow If incorrect iPad says Let s try again Repeats until correct arrow is touched If correct bubbles sound plays and iPad says Mmm thank you Touch and hold here to continue appears on screen E touches and holds button to continue DEXT Screen 3 Transition Let s try some more E reads screen then E touches and holds button to continue DEX
256. the iPad screen The examiner reads them to and or with the participant and points out the relevant aspects of the stimuli on the screen The next screen appears when either the examiner or participant makes a choice There are two versions of this measure for ages 3 7 The first is the standard NIH Toolbox DCCS test for ages 3 7 The second is an experimental version with developmental extension or DEXT that was designed to extend the range of assessment downward for those participants who have difficulty understanding the standard task Both versions yield a score for the standard measure and the DEXT version provides simple raw scores and percentages for the experimental items Standard administration Practice items Participants of all ages are given four practice trials with each dimension color and shape If the participant responds incorrectly an audio recording prompts him her to choose the correct image Similarly a separate audio file plays each time the participant gets a practice item correct Rules e Participants must get at least three out of four practice trials correct to advance to the practice trials for the next dimension and then to the test trials e f a participant of any age gets fewer than three out of four practice trials correct he she will complete up to two more sets of four practice trials with the same cutoff to advance to the test trials e f a participant of any age does not meet the cu
257. the instrument by selecting stop with the intention of resuming at a later time o During instructions Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Practice Return to active screen pause not recorded in data o During Live Items Participant sees item equivalent to last item shown Dichotomous engine will find the un administered item whose difficulty setting is closest to the user s theta which will be used for restarting On restart the engine is provided with the user s existing theta score instead of the starting theta value NIH Toolbox Flanker Inhibitory Control and Attention Test e Skip o Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted e Pause perform admin gesture and return to instrument without selecting stop or skip o During Instructions Return to active screen pause not recorded in data o During Practice Return to active screen pause not recorded in data o During Live Items Return to active screen pause not recorded in data e Stop exit the instrument by selecting stop with the intention of resuming at a later time o During instructions Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Practice Participant sees last practice item not responded to o During Live Items Participant sees la
258. thout permission in writing from NU NIH The reproduction of any part of NU NIH s copyrighted tests and related materials in any way whether the reproductions are sold or furnished free for use is a violation of federal copyright law No adaptations translations modifications or special versions may be made without permission in writing from NU NIH moreover users are advised that such adaptations translations modifications or special versions may affect the validity of the tests even if permission is granted PERSONAL AND NON COMMERCIAL USE LIMITATION Any publication or presentation of results obtained from studies conducted using NIH Toolbox measures should include a statement that NIH Toolbox version 2 0 measures instruments were used and reference the NIH Toolbox website www NIHToolbox org for further information TERMS AND CONDITIONS OF USE CONFIDENTIALITY User acknowledges and agrees that the contents of the NIH Toolbox may constitute trade secrets which include confidential and proprietary material information and procedures User will not resell or otherwise distribute materials or authorize or allow disclosure of the contents of a test instrument protocol including test questions and answers or normative data except under the limited circumstances described in the section titled Maintenance of Test Security and Test Use or as otherwise contemplated in the published manual associated with the test User acknowledges
259. tion of the words 4 f the participant says he she does not understand the word after several repetitions the examiner if present may say the word one more time If there is an examiner present and a participant has difficulty touching the screen the participant may point and the examiner can touch the screen In this case the examiner should say something like the following to the participant You can point to your choice and then I will touch the screen for you Return to TOC eo C 2 1 1 NIH Toolbox Picture Vocabulary Test Instructions Age 3 The task is introduced with the Title Screen NIH Toolbox PVT 3 At the bottom of the screen is a button Touch and Hold Here to Continue Touch and hold that button to begin the test The next screen is slightly different for participants ages 3 6 and those ages 7 The two screens are printed below Ages 3 6 Say Let s look at some pictures You ll hear a word and see four pictures on the screen Touch the picture that means the same as the word that was said Some words will be easy and some will be harder Answer as best as you can If you need to hear a word again can play it again If you think you made a mistake and want to change your last answer can bring back that word and pictures Are you ready to play When participant is ready touch button that says Touch and Hold Here to Continue Ages 7 Say You are going to be asked the meaning of some words For
260. toff the task will automatically discontinue Return to TOC P If the participant does not respond after five seconds the examiner should prompt him her saying Choose one of the pictures Test Trials The examiner should not prompt the participant to respond during the test trials If the participant does not respond after ten seconds the program will automatically advance to the next test trial Ages 3 7 During the test trials participants 3 7 years of age first complete a set of five trials to sort according to color If these young participants succeed in four of the five test trials the program advances to a set of five trials to sort according to shape If the young participants do not get four out of five test trials correct on either color or shape the test ends If participants ages 3 7 meet the criterion on the second set of test trials i e post switch they will complete the mixed block consisting of 30 shape color trials Because the mixed trials are scored for reaction time these young participants need to be trained in the use of Home Base where the participant places his her index finger between trials Training for Home Base precedes the introduction of the mixed trials for 3 7 year olds Age 8 Participants age 8 receive training for Home Base before learning about the test The test trials for participants 8 years of age consist of a mixed block of 30 shape color items Developmental Extension DEX
261. tom of the screen to advance to the test itself Pose 1 Screen Flat surface feet together eyes open The examiner should demonstrate the pose describing what he she is doing as it is being done The participant s turn is next the examiner should ask the participant to stand in the desired position saying Please stand with your feet together heels and balls of feet touching and as still as possible with your eyes open and with your arms crossed on your chest like this demonstrate Focus on the X shown on the wall in front of you Ready After the participant assumes the position the examiner touches the START button and says Go The examiner should check the participant s posture The iPad screen will display the elapsed time of the trial so the examiner can easily see it while assuring the safety of the participant In addition an audible tone will play when 50 seconds has elapsed alerting both the examiner and the participant that the trial has ended Choose STOP FAIL if the participant did not successfully complete the trial for any reason If the first trial is failed for any reason start the second trial of this pose the examiner should say Let s try that one again Please stand with your feet together heels and balls of feet touching and as still as possible with your eyes open and with your arms crossed on your chest like this demonstrate Focus on the X shown on the wall in front of you Ready The e
262. ton Whenever the PASS or the STOP FAIL button is touched a pop up window asking for confirmation of the choice will appear The examiner must confirm his her choice to move onto the next trial After participant completes one or both trials say Are you ready for the next one Proceed with the next pose or allow the participant to rest following the procedures noted above Pose 3 Screen Foam surface feet together eyes open The examiner should pick up the blue pad and place it on the floor one meter in front of the icture on the wall The examiner should demonstrate the pose describing what he she is doin as it is being done The participant s turn is next the examiner should ask the participant to stand in the desired position saying Please step onto the foam and put your feet together heels and balls of feet touching and stand as still as possible with your eyes open and your arms crossed on your chest like this demonstrate Focus on the X shown on the wall in front of you Ready After the participant assumes the position the examiner touches the START button and says Go The examiner should check the participant s posture The iPad screen will display the elapsed time of the trial so the examiner can easily see it while assuring the safety of the participant Choose STOP FAIL if the participant did not successfully complete the trial for any reason If the first trial is failed for any reason sta
263. touches and holds button to screen continue Color items 5 items sorted by color If less than 4 out of 5 correct iPad screen written content Examiner E amp Child C Actions Post switch Now we re going to play the SHAPE game E chooses TRUCK intro Remember the SHAPE game In the SHAPE game choose the picture that s the same SHAPE as the picture in the middle of the screen If it s a TRUCK choose this picture And if i s a BALL choose that picture E chooses BALL Transition Now you try E reads screen then Keep your eyes on the star in the middle of the touches and holds button to screen continue Shape items 5 items sorted by shape If less than 4 Moves to developmental extension DEXT Phase 3 out of 5 correct Home Base We can also play both games together But first we E reads screen and points before Mixed Items are going to learn about Home Base This is your Home Base Put your finger on Home Base and wait for the next picture In this new game put your finger back on Home Base after each answer to the home base then touches and holds button to continue Transition to Mixed Trials Now we are ready to play both games together Remember when you hear the word SHAPE choose the picture that s the same SHAPE as the picture in the middle of the screen If it s a TRUCK choose this picture E chooses TRUCK And if it s a BALL choose that pictur
264. trument as completed go to next instrument if applicable Can never be restarted e Pause perform admin gesture and return to instrument without selecting stop or skip o During Instructions Return to active screen pause not recorded in data o During Practice Return to active screen pause not recorded in data o During Live Items Return to active screen pause not recorded in data e Stop exit the instrument by selecting stop with the intention of resuming at a later time o During instructions Participant sees first item aka resume at beginning of instrument Previous data are overwritten o During Practice If the user stops during the first practice item they will return to the start of the instrument If the user stops during the second practice item they will return to the last sequence they did not respond to this includes that sequence s introduction o During Live Items If the user stops during a live item they will return to the last sequence they did not respond to this includes that sequence s introduction NIH Toolbox Oral Reading Recognition Test e Skip o Resume not allowed mark instrument as completed go to next instrument if applicable Can never be restarted Pause perform admin gesture and return to instrument without selecting stop or skip o During Instructions Return to active screen pause not recorded in data o During Practice NO PRACTICE IN OR
265. tteries button Preset Batteries Cognition v Age3 v Q Deme ammi Co gt NIH Toolbox Early Childhood Cognition Battery Ages 3 4 NIH Toolbox Picture Vocabulary Test Age 3 v2 0 NIH Toolbox Flanker Inhibitory Control and Attention Test Ages 3 7 v2 0 NIH Toolbox Dimensional Change Card Sort Test Ages 3 7 v2 0 NIH Toolbox Picture Sequence Memory Test Ages 3 4 Form A v2 0 Custom Batterie All Domains v All Ages v Pos EES I NIH Toolbox 2 Minute Walk Endurance Test Age 3 v2 0 NIH Toolbox Odor Identification Test Ages 3 9 v2 0 You can filter which batteries you want displayed If no custom battery has ever been created on this iPad the Custom Batteries list will be empty Return to TOC Create a New Custom Battery Step 1 Tap Create New Battery in the upper right corner of the screen Step 2 Enter the new battery s name required and select instruments to be included in this battery from the list of Available Instruments Battery Information Battery Name v Selected Instruments v Available Instruments Motor AllAgesw AllTypesw amp NIH Toolbox 2 Minute Walk Endurance Test Age 3 v2 0 E NIH Toolbox 4 Meter Walk Gait Speed Test Age 7 v2 0 Selected instruments will move to the upper part of the screen and be listed under Selected Instruments Return to TOC s emp Step 3 Reorder the selected instruments by dragging them up or down using the symbol to the right of the instrument name
266. v2 0 NIH Toolbox Picture Sequence Memory Test Ages 3 4 Form B v2 0 Return to TOC 212 Title screen displayed in the app NIH Toolbox PSM 3 4 Form C Corresponding Instrument Name NIH Toolbox Picture Sequence Memory Test Ages 3 4 NIH Toolbox PSM 5 6 Form A NIH Toolbox PSM 5 6 Form B NIH Toolbox PSM 5 6 Form C NIH Toolbox PSM 7 Form A NIH Toolbox PSM 7 Form B NIH Toolbox PSM 7 Form C NIH Toolbox PSM 8 Form A NIH Toolbox PSM 8 Form B NIH Toolbox PSM 8 Form C NIH Toolbox FL 3 7 NIH Toolbox FL 8 11 NIH Toolbox FL 12 NIH Toolbox DCCS 3 7 NIH Toolbox DCCS 8 11 NIH Toolbox DCCS 12 NIH Toolbox 4 Meter Walk Gait Speed Test 7 NIH Toolbox 9 Hole Pegboard Dexterity Test 3 NIH Toolbox Grip Strength Test 3 NIH Toolbox Standing Balance Test 3 6 NIH Toolbox Standing Balance Test 7 NIH Toolbox 2 Minute Walk Endurance Test 3 NIH Toolbox Odor Identification Test 10 Form C v2 0 NIH Toolbox Picture Sequence Memory Test Ages 5 6 Form A v2 0 NIH Toolbox Picture Sequence Memory Test Ages 5 6 Form B v2 0 NIH Toolbox Picture Sequence Memory Test Ages 5 6 Form C v2 0 NIH Toolbox Picture Sequence Memory Test Age 7 Form A v2 0 NIH Toolbox Picture Sequence Memory Test Age 7 Form B v2 0 NIH Toolbox Picture Sequence Memory Test Age 7 Form C v2 0 NIH Toolbox Picture Sequence Memory Test Age 8 Form A v2 0 NIH Toolbox Picture Sequence Memory Test Age 8 For
267. w box then drag the picture you touched to the gray box where you want to move it Now you try with this picture After the child demonstrates understanding of this step touch the button at the bottom of the screen that says Touch and Hold Here to Continue Step 2 Moving Pictures from the Gray Boxes to the Yellow Box Read the text above the yellow box on the screen and demonstrate the actions described Say You can also move pictures from the gray boxes back to the yellow box like this Touch the picture you want to move Then drag that picture to the yellow box Now you move the other picture back to the yellow box After the child demonstrates understanding of this step touch the button at the bottom of the screen that says Touch and Hold Here to Continue Step 3 Moving Pictures between the Gray Boxes Read the text above the yellow box on the screen and demonstrate the actions described Say You can also move the pictures from one gray box to another like this First you touch the picture in one gray box Then drag that picture to the gray box where you want the picture to go Now you try it move the picture from here to here After the child demonstrates understanding of this step touch the button at the bottom of the screen that says Touch and Hold Here to Continue Introduction to the Practice Items Read the screen Now we re going to play the game You will see some pictures on the screen You should remember the
268. will continue to be on the screen The pop up will close if a picture is moved back to the yellow box and will reappear each time all pictures have been placed in gray boxes Logic 1 Ifchild gives correct response Practice sequence 2 Have a Birthday Party will be presented 2 If child gives incorrect response Eat Ice Cream will be presented again with an audio recording that says Let s try that again After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to Eat Ice Cream Now you move the pictures in the same way you saw them on the screen The examiner may have to explain that the child made a mistake on the first trial If child fails both trials of Practice Sequence 1 test will discontinue Practice Sequence 2 Say That s right Now you will see how to have a Birthday Party When finished reading touch and hold the button at the bottom of the screen that says Touch and Hold Here to Continue As the pictures are presented an audio recording will say appropriate labels First bake the cake Next frost it And last put on the candles After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to have a Birthday Party Now you move the pictures in the same way you saw them on the screen When all pictures have been placed in gray boxes a pop up will appear on the screen Are you finished
269. wood Collect the eggs Put the blanket on the horse Plant the tomatoes After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to Play in the Park Form A Go to the Fair Form B Work on the Farm Form C Now you move the pictures in the same way you saw them on the screen When all pictures have been placed in gray boxes a pop up will appear on the screen Are you finished Ask this of the child If child says YES touch and hold the YES button If the child says NO touch any of the pictures and the pop up will disappear If no picture is moved out of a gray box the pop up will continue to be on the screen The pop up will close if a picture is moved back to the yellow box and will reappear each time all pictures have been placed in gray boxes Read the screen Now you will see again how to how to Play in the Park Form A Go to the Fair Form B Work on the Farm Form C Everyone has to do this more than once When finished reading touch the button at the bottom of the screen that says Touch and Hold Here to Continue Test Item Trial 2 As the pictures are presented an audio recording will say appropriate labels same as Trial 1 see above After the pictures are presented and as the pictures are scrambled an audio recording will say That s how to Play in the Park Form A Go to the Fair Form B Work on the Farm Form C Now you move the pictur
270. x 1A Screen 10 Rule reminder 3 If it s a fish then it goes in the fish box Appears above the fish box E reads screen and points to fish box then E touches and holds button to advance to next screen 1A Screen 11 Live Trial 3 Here is a fish Where does it go E reads screen C touches a box 1A Screen 12 Rule reminder 4 Fish go here Appears above the fish box E reads screen and points to fish box then E touches and holds button to advance to next screen 1A Screen 13 Live Trial 4 Here is a fish Where does it go E reads screen C touches a box 1A Screen 14 Rule reminder 5 If it s a fish then it goes in the fish box Appears above the fish box E reads screen and points to fish box then E touches and holds button to advance to next screen 1A Screen 15 Here is a fish Where does it go E reads screen C touches Live Trial 5 a box If less than 4 of 5 correct the test is discontinued If 4 or more correct the test continues to Phase 1B 1B Screen 1 Now we re going to play a different game Look E reads screen and points Instructions what have here have an elephant I m going to put the elephant in the elephant box because that s where it belongs out the relevant aspects After 8 seconds the Touch and Hold Here to Continue button appears Then E touches and holds the button to continue 1B Screen 2
271. xaminer touches the START button and says Go Again choose STOP FAIL if the participant did not successfully complete the trial for any reason After 50 seconds of elapsed trial time a tone will sound After a few more seconds the examiner will be able to touch the PASS or STOP FAIL button Whenever the PASS or the STOP FAIL button is touched a pop up window asking for confirmation of the choice will appear The examiner must confirm his her choice to move onto the next trial Note If a participant fails both trials of Pose 1 the test is terminated Once the participant successfully completes a trial say Are you ready for the next one Proceed with the next pose or allow the participant to rest following the procedures noted above If participant fails trial 2 the discontinue rule is invoked say We are done with this activity Pose 2 Screen Flat surface feet together eyes closed is the same as Pose 1 except this time the participant s eyes are closed The examiner should demonstrate the pose describing what he she is doing as it is being done The participant s turn is next the examiner should ask the participant to stand in the desired position saying Please stand with your feet together heels and balls of feet touching and as still as possible with your eyes closed and with your arms crossed on your chest like this demonstrate Ready After the participant assumes the position the examiner touches th
272. y Examiner Answer Sheet For more information about access to cognition instruments please contact cognition nihtoolbox org Return to TOC ao Cognition Battery Constructs Definition Executive Function The capacity to plan organize and monitor the execution of behaviors that are strategically directed in a goal oriented manner The NIH Toolbox focuses on two components 1 Inhibition of automatic response tendencies that may interfere with achieving a goal which is measured by the NIH Toolbox Flanker Inhibitory Control and Attention Test and 2 Set shifting or the capacity for switching among multiple aspects of a strategy or task which is measured by the NIH Toolbox Dimensional Change Card Sort Test Attention The allocation of one s limited capacities to deal with an abundance of environmental stimulation It is measured by the NIH Toolbox Flanker Inhibitory Control and Attention Test Episodic Memory The acquisition storage and retrieval of new information It involves conscious recollection of information learned within a context It is measured by the NIH Toolbox Picture Sequence Memory Test Language A set of mental processes that translate thought into symbols words gestures that can be shared among individuals for purposes of communication The NIH Toolbox focuses on two aspects of language 1 Vocabulary knowledge measured by the NIH Toolbox Picture Vocabulary Test and 2 Oral reading
273. y good that s right E reads screen Touch and Hold Here to Continue button appears E touches and holds button to advance to next screen 5b If incorrect Uh oh Remember in the shape game hearts go in the heart box and flowers go in the flower box Touch and Hold Here to Continue button appears after E touches and holds button screen says Can you show me where the hearts go E reads screen and C touches a box triggering either 5a or b When Touch and Hold Here to Continue button appears again E touches and holds button to advance to next Screen 3A Screen 6 Rule check Can you show me where the flowers go in the shape game E reads screen C touches a box 3A Screens 7a amp b Feedback 5a If correct Very good that s right E reads screen Touch and Hold Here to Continue button appears E touches and holds button to advance to next screen Return to TOC 83 5b If incorrect Uh oh Remember in the shape game hearts go in the heart box and flowers go in the flower box Touch and Hold Here to Continue button appears after E touches and holds button screen says Can you show me where the flowers go E reads screen and C touches a box triggering either 5a or b When Touch and Hold Here to Continue button appears again E touches and holds button to advance to next screen 3A Screens 8 Now let s do more like that E
274. y the file s from the iPad to the computer This list is updated in real time So without leaving iTunes while plugged into the computer you can run the app on the iPad generate files on the Export Data screen and immediately see the files in the File Sharing list E oe G 1 Select your iPad NCS Test 25 NCS Test 25 16GB 53 m 4 p Page 1 Summary Extras A Apps lt q J Music 2 Select Apps of gt Movies a TV Shows Automatically install new iPad ps Select apps to install on your iPad or drag apps to a specific screen Drag to rearrange apps screens and pages en 3 Scroll down AA Books Sha to see File Sharing Photos ae Shang The apps listed below can transfer documents between your iPad and this computer Info Apps NIH Toolbox Documents 2015 09 14 12 5 cipant Report txt Music n Me 2015 09 16 10 2 cipant Report txt Rentals 2015 09 16 10 2 cipant Report txt Movies NCS_PSM_Scores sqlite 4 Click on the 7 is _ TV Shows NCS_PSM_Scores sqlite shm NIH Toolbox App iTunes U NCS_PSM_Scores sqlite wal AA Books RI Audi 5 Select the files to download ee 6 Use the Save To button Tones to save files tbe Add Save to Return to TOC es Data Safeguards Data stored on this iPad are protected by a number of safeguards These include 1 The passcode set for this iPad 2 The passcode
275. your eyes on the star Answer as fast as you can without making mistakes If you make a mistake just keep going Remember put your finger back on Home Base after you answer E reads screen then touches and holds button to continue Test items 20 items arrows Return to TOC 57 C 2 3 NIH Toolbox List Sorting Working Memory Test This task assesses working memory and requires the participant to recall and sequence different visually and orally presented stimuli Pictures of different foods and animals are displayed with both an accompanying audio recording and written text that name the item The participant is asked to say the items back to the examiner in size order from smallest to largest Equipment and materials needed e iPad e Bluetooth wireless keyboard e NIH Toolbox List Sorting Working Memory Examiner Answer Sheet Detailed information on equipment and materials needed for all tests can be found in Appendix 4 Setting up Bluetooth Wireless Keyboard e Goto the Settings app of the iPad and make sure Bluetooth is turned on e Make sure the keyboard is in discovery mode by pressing the round button at the top right end of the keyboard and the small green light to the left of the button begins flashing e Select the Keyboard when it appears on the My Devices list on the iPad e When a pop up window appears on the iPad screen follow the instructions and enter the required code on the key
276. zziness vertigo Fallen in the last 6 months more than one time not as a result of an accident Multiple sclerosis Macular degeneration Glaucoma Cataracts Pregnancy Equipment and materials needed e iPad e iPod Touch 5 generation or later e The BalancePod app installed on the iPod Touch BalancePod is available at no additional cost through the App Store Get BalancePod here e Griffin Survivor protective case or similar e AIREX Balance Pad Elite e Scott Gait Belt w Velcro e Sanitary booties Detailed information on equipment and materials needed for all tests can be found in Appendix 4 Set up This task requires the examiner to set up the equipment before the participant arrives Upon launching the BalancePod App the iPod will display a dashboard with two buttons at the bottom of the screen One button Standing Balance Test Info directs the user to an informational screen that includes a single text file that scrolls up and down The second button Start a Standing Balance Test directs the user to the connection server that communicates between the iPod accelerometer and the iPad test administration The screen is illustrated below Camer 2 38PM NIH Toolbox BalancePod Standing Balance Test Info Start a Standing Balance Test iPod iPad synchronization A participant s movement sway is measured by an iPod that is enclosed in a protective case The iPod is attached to the gait belt by

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