Dement Neuropsychol 2015 June;9(2):156-164 Original Article

DOI 10.1590/1980-57642015DN92000010

Brazilian adaptation of the Hotel Task

A tool for the ecological assessment of executive functions
Caroline de Oliveira Cardoso1, Nicolle Zimmermann1, Camila Borges Paraná2,
Gigiane Gindri1, Ana Paula Almeida de Pereira2, Rochele Paz Fonseca1

ABSTRACT. Over recent years, neuropsychological research has been increasingly concerned with the need to develop
more ecologically valid instruments for the assessment of executive functions. The Hotel Task is one of the most widely
used ecological measures of executive functioning, and provides an assessment of planning, organization, self-monitoring
and cognitive flexibility. Objective: The goal of this study was to adapt the Hotel Task for use in the Brazilian population.
Methods: The sample comprised 27 participants (three translators, six expert judges, seven healthy adults, ten patients
with traumatic brain injuries and one hotel manager). The adaptation process consisted of five steps, which were repeated
until a satisfactory version of the task was produced. The steps were as follows: (1) Translation; (2) Development of new
stimuli and brainstorming among the authors; (3) Analysis by expert judges; (4) Pilot studies; (5) Assessment by an expert in
business administration and hotel management. Results: The adapted version proved adequate and valid for the assessment
of executive functions. However, further research must be conducted to obtain evidence of the reliability, as well as the
construct and criterion validity, sensitivity and specificity, of the Hotel Task. Conclusion: Many neurological and/or psychiatric
populations may benefit from the adapted task, since it may make significant contributions to the assessment of dysexecutive
syndromes and their impact on patient functioning.
Key words: neuropsychology, executive functions, adaptation, Hotel Task.

ADAPTAÇÃO BRASILEIRA DA TAREFA DO HOTEL: UMA FERRAMENTA PARA A AVALIAÇÃO ECOLÓGICA DAS FUNÇÕES EXECUTIVAS
RESUMO. A busca por validade ecológica dos instrumentos neuropsicológicos vem recebendo uma atenção especial
nos últimos anos, especialmente daquelas ferramentas que avaliam funções executivas. A Tarefa do Hotel é uma das
tarefas ecológicas de exame executivo mais reconhecida internacionalmente, por examinar planejamento, organização,
automonitoramento e flexibilidade cognitiva. Objetivo: O objetivo deste estudo é apresentar o processo de adaptação da
Tarefa do Hotel para uma versão brasileira. Método: A amostra constitui-se de 27 indivíduos (três tradutores, seis juízes
especialistas, sete adultos saudáveis, dez pacientes pós traumatismocranioencefálico e um gerente de hotel). Cinco etapas
foram conduzidas, replicadas ao longo do processo: (1) tradução, (2) desenvolvimento de novos estímulos e brainstorming
entre os autores, (3) análise de juízes especialistas em neuropsicologia, (4) estudos pilotos e (5) julgamento de expert
em administração e hotelaria. Resultado: A versão adaptada mostrou-se adequada e válida para avaliar componentes
executivos, sendo necessários estudos futuros em busca de evidências de fidedignidade, validades de construto e de
critério, sensibilidade e especificidade, considerando-se as particularidades de uma ferramenta ecológica. Conclusão:
Muitas populações clínicas neurológicas e/ou psiquiátricas poderão se beneficiar do exame com a Tarefa do Hotel, por
esta auxiliar no diagnóstico de síndrome disexecutiva relacionada à demanda de componentes executivos no cotidiano.
Palavras-chave: neuropsicologia, função executiva, adaptação, Tarefa do Hotel.

INTRODUCTION the ability to engage in goal-oriented, volun-

O ver recent years, considerable research

and clinical attention has been dedicated
to the associations and dissociations between
tary and independent behaviors.1 However,
researchers have not yet agreed on a theoreti-
cal model of EF, nor is there a consensus on
executive functions (EF). This term refers to which specific components comprise EF. One
This study was conducted at the Department of Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
1
Department of Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre RS, Brazil. 2Department of Psychology, Universidade Federal do
Paraná, Curitiba PR, Brazil.

Caroline de Oliveira Cardoso. Programa de Pós-Graduação em Psicologia (Cognicao Humana, Pontificia Universidade Catolica do Rio Grande do Sul – Av.
Ipiranga, 6681 / Prédio 11 / Sala 932 – 90619-900 Porto Alegre RS – Brasil. E-mail: carolineocardoso@yahoo.com.br

Disclosure: The authors report no conflicts of interest.

Received January 02, 2015. Accepted in final form March 27, 2015.

156 Brazilian adaptation of the Hotel Task     Cardoso CO, et al.

 Dement Neuropsychol 2015 June;9(2):156-164

of the greatest challenges posed by the absence of suffi- ensure the quality of the final product of the adaptation
ciently consolidated models of EF is the difficulty in op- process.
erationalizing assessment procedures and rehabilitation
programs for executive functioning. Although several Participants. The sample comprised 27 participants, con-
instruments have been designed in an attempt to pro- sisting of three translators, six expert judges, 17 partici-
vide an accurate assessment of EF, given the complex- pants in the pilot study, and one hotel manager, whose
ity of these abilities and the extent of the controversy contributions to the study will be explained in the Pro-
as to their nature, even traditional assessment instru- cedures section. Table 1 presents the characteristics of
ments have been criticized for their lack of specificity. each sample.
Although they tend to be sensitive for detecting execu- Control subjects were recruited using convenience
tive impairments, they are not always accurate in pre- sampling within university and community-based set-
dicting and evaluating the impact of these impairments tings. A group of patients with TBI was also recruited
on daily functioning.2-4 As a result, researchers and clini- from the patient records of public hospitals in the cities
cal practitioners have been increasingly concerned with of Porto Alegre and Curitiba.
the need to develop more ecologically valid instruments
for the assessment of EF.5-7 Procedures and instruments. In accordance with ethical
The term “ecological validity” refers to the function- guidelines for human research, participation was vol-
al and predictive relationship between performance on untary and all participants provided written informed
neuropsychological assessments and impairments in consent. The present study was also approved by the Re-
daily living tasks.8,9 Neuropsychological research has search Ethics Committee of the Pontifical Catholic Uni-
been increasingly concerned with the development and versity of Rio Grande do Sul. Participants were assessed
adaptation of ecologically valid measures of EF. Some of in a single session lasting approximately one hour, dur-
these instruments include the Behavioral Assessment ing which the Hotel Task, as well as sample character-
of the Dysexecutive Syndrome (BADS),10 the Multiple ization measures and screening instruments, were ad-
Errands Task,11 the Iowa Gambling Task12 - adapted to ministered. Patient characteristics were assessed using
Brazilian Portuguese13,14 and the Hotel Task.15 a sociodemographic and cultural questionnaire.19 The
The Hotel Task focuses on the assessment of the goal of this procedure was to test the instrument in a
following executive components: planning, organiza- real data collection scenario, so as to estimate its dura-
tion, self-monitoring and cognitive flexibility.15 The tion, and verify the comprehensibility of its instructions
task simulates a real-life situation which requires the in- and stimuli. Both the adapted and original versions of
volvement of multiple executive resources for its correct the Hotel Task comprise five activities involved in ho-
resolution. It is an ecologically valid and standardized tel management. The materials required to perform the
task which has proved to be sensitive in the assessment task were laid out on a table in front of the subjects, who
of several clinical conditions such as frontotemporal de- were provided the following instructions:
mentia,16 multiple sclerosis,17 attention deficit/hyperac- “In this task you are asked to imagine that you are
tivity disorder,18 and bipolar disorder.18 working in a hotel. Your manager would like to see how
There is also a pronounced lack of ecologically valid you perform each of these five activities in the next 15
measures of EF adapted and ‘normed’ for use in Brazil. minutes as part of the hiring process for working at the
Therefore, to address this gap in assessment tools, the hotel. Your main goal is to do at least some of these five
present study aimed to adapt the Hotel Task15 for use tasks over the next 15 minutes. Each of the tasks may
in Brazilian Portuguese, ensuring its adequacy for the well take longer than 15 minutes alone to complete.
social, cultural, linguistic and cognitive characteristics Therefore, it is impossible to complete all the tasks with-
of the target population. in the time limit. The most important thing is to try and
do something from each task within the available time
METHOD period, while keeping track of the time with this clock.
The adaptation process involved the following stages: Did you understand the instructions? I will now explain
[1] Translation; [2] Development of new stimuli and each of the tasks. Please pay close attention!”
brainstorming among the authors; [3] Analysis by ex-
pert judges; [4] Pilot studies; [5] Assessment by an ex- The following tasks were included in the instrument:
pert in business administration and hotel management. Compiling individual bills task – Participants are
Each stage was performed as many times as required to asked to post guest charges on bills, writing down the

Cardoso CO, et al.     Brazilian adaptation of the Hotel Task 157

 Dement Neuropsychol 2015 June;9(2):156-164

total amount of money spent by each individual as well Proof reading the hotel brochure – Participants were
as the value of each service or product purchased. asked to identify and rectify errors (words with double
Sorting the charity collection task – The goal of this letters) in the new hotel brochure.
task is to separate foreign currency coins from Brazilian
Real (R$) coins. In addition to these tasks, the participant was asked
Looking for promotions in menu task – Participant to make two wake-up calls to hotel guests by pressing
was given a menu from the hotel restaurant, and a list two buttons on a telephone at two different time points.
of the 20 promotions of the month. They were asked to
locate each of these dishes or drinks in the menu, and Instruments and procedures per adaptation step. Each version
write down their prices in the promotion list. of the task produced throughout the adaptation proce-
Sorting conference labels task – Participant was dure was analyzed by the authors. The details of each
asked to organize 80 nametags into alphabetical order. version of the task are described in Table 2.

Table 1. Sample characteristics by adaptation phase of the Hotel Task.

Phase Phase Descriptive Task
number name Participants data version
1 Direct translation 02 translators Bilingual neuropsychologists with background in
EF* neuropsychology and proficiency in English
and native Brazilian Portuguese
Compared translation 01 expert translator for consensus Neuropsychologist and speech therapist
with proficiency in English and native
Brazilian Portuguese
2 Author brainstorm – phase 1 06 – Discussion of semantic adjustments to 05 Neuropsychologists and 01 speech therapist VERSION 1
instructions and task stimuli proficient in neuropsychology and
instrument adaptation
3 Expert judge analysis – phase 1 04 expert judges – Evaluation of instructions 03 Neuropsychologists and
and task stimuli adequacy 01 Speech therapist
4 Author brainstorm – phase 2 06 – Discussion of adjustments to instructions 05 Neuropsychologists and VERSION 2
and task stimuli after suggestions by expert 01 speech therapist proficient in
judges neuropsychology and instrument adaptation
5 Pilot study 1 01 healthy adult Age (years): 20
Education (years): 13
Sex: Female
6 Author brainstorm – phase 3 06 – Discussion of adjustments to instructions, 05 Neuropsychologists and VERSION 3
task stimuli and scoring after observations in 01 speech therapist proficient in
Pilot study 1 neuropsychology and instrument adaptation
7 Expert judge analysis – phase 2 02 expert judges 02 Neuropsychologists
Pilot study 2 05 healthy adults Age in years, mean: 25.02
Education in years, mean: 16.2
Sex: 03 Male and 02 Female
8 Author brainstorm – phase 4 06 – Discussion of adjustments to instructions, 05 Neuropsychologists and VERSION 4
task stimuli and scoring 01 speech therapist proficient in
neuropsychology and instrument adaptation
9 Pilot study 3 01 healthy adult Age in years: 54
Education in years: 18
Sex: Female
10 Author brainstorm – phase 5 06 – Discussion of adjustments to instructions, 05 Neuropsychologists and VERSION 5
task stimuli and scoring 01 speech therapist proficient in
neuropsychology and instrument adaptation
11 Appraisal of expert judge analysis 01 Professional expert 01 Expert in business administration with
emphasis in hotel management and 11 years of
experience as hotel manager
12 Pilot study 4 10 TBI** patients Age in years, mean (SD#): 37.09 (10.29)
Education in years, mean (SD#): 9.36 (5.73)
Sex: 08 male and 02 Female
*Executive function; **Traumatic brain injury; #Standard deviation.

158 Brazilian adaptation of the Hotel Task     Cardoso CO, et al.

 Dement Neuropsychol 2015 June;9(2):156-164

Data analysis. All stages of the adaptation process were Phases 2. Stimuli were created and adapted based on par-
descriptively analyzed, and any changes made to the ticipant familiarity, and with the aim of making the task
task were carefully described. The agreement between ecologically valid and as close as possible to the reality of
judges was descriptively assessed using the methods de- a hotel. The number of coins in the sorting task was re-
scribed by Fagundes20 and Andres and Marzo.21 duced, as was the number of pages and typing errors in
the brochure used in the proofreading task (in the origi-
nal Hotel Task, the brochure had nine pages containing
RESULTS 130 errors, while the adapted brochure was three pages
Each stage in the process of adapting the Hotel Task to long and contained 17 errors, maintaining the page-to-
Brazilian Portuguese is described below. The versions error ratio of the original instrument). The version of
of the task produced after each phase are presented in the Hotel Task produced after this stage of the adapta-
Table 3. tion process is described in Table 3.

Phases 1. The task instructions and stimuli were indepen- Phases 3. The tasks were descriptively analyzed by the
dently translated from English to Brazilian Portuguese expert judges, who agreed as to the adequacy of the
by two translators. Differences between the translations activities and the executive abilities assessed by each.
were resolved by a third professional, who adapted the However, changes were made to the task instructions,
wording of the task for the social and linguistic charac- its scoring system and to the Compiling Customer Bills
teristics of the Brazilian population. and Telephone Book tasks, as shown in Table 3.

Table 2. Phases for Hotel Task adaptation.

Phases Specification
1 – Translation Instructions and stimuli were translated and adapted to the Brazilian social and cultural context.
The overall procedure was divided into two sub-steps: a) direct translation by two English-proficient
translators; and b) translation comparison by an expert in the assessed constructs and knowledge in
the languages involved.
2 – Development of new stimuli and Authors developed stimuli and performed semantic adjustments to instructions from the original version
author brainstorm - phase 1 (Manly et al., 2002) and the study of the applicability of the Hotel Task by Torralva et al. (2012). The first
version of the Hotel Task was developed (Version 1).
3 – Expert judge analysis – phase 1 Professionals analyzed the adapted stimuli from the previous step and instructions for each task. At
first, each judge was required to individually verify whether each stimulus was appropriate for the
respective instruction, suggesting changes where necessary.
4 – Development of new stimuli and Based on expert analysis and suggestions, the authors modified several stimuli and a new version was
author brainstorm – phase 2 developed (Version 2).
5 – Pilot study The first pilot study was conducted with the second version of the task in order to test the instrument
in a real assessment situation, as well as to analyze potential faults and stimuli adequacy. A healthy
young adult participated.
6 and 7 – Development of new stimuli The authors made further adjustments after observations from the first pilot study (Version 3).
and author brainstorm – phase 3; and Furthermore, a second expert judge analysis was concurrently conducted via a pilot study with Version
Expert judge analysis – phase 2 and 3 and five healthy adults.
Pilot study 2
8 and 9 – Development of new stimuli The authors made further adjustments after suggestions by the expert judges and observations from
and author brainstorm – phase 4; and the pilot study (Version 4). The fourth version of the instrument was utilized with a healthy adult in
Pilot study 3 phase 9.
10 and 11 – Development of new Further adjustments were made after observations and analysis of the third pilot study (Version 5). A
stimuli and author brainstorm – phase professional in business administration with emphasis in hotel management analyzed the proposed
5; and assessment by expert judge activities. Each task was explained and the judge evaluated whether instructions and stimuli were
analysis consistent with the reality of Brazilian hotels.
12 – Pilot study 4 The fifth version was utilized with 10 patients with traumatic brain injury (TBI). This population was
selected for having a high prevalence of executive dysfunction.

Cardoso CO, et al.     Brazilian adaptation of the Hotel Task 159

 Table 3. Versions of the Hotel Task through adaptation phases.
Compiling Looking for
individual bills Sorting the charity promotions in Sorting conference Proof reading the
Version task collection task menu task labels task hotel brochure Waking up guests Instructions Scoring
VERSION 1 Development of Selection of 50 coins Development of a list Development of 100 A hotel folder was A box was used as the A general instruction Variables: Number of tasks
two billing lists: one of Brazilian currency of local companies name tags with the developed. It comprised garage remote control and further instructions started; task time; Number
with the costs of and 50 coins of foreign selected from a public name and surname 509 words, 17 for each task of times garage button was
services provided currency telephone list. The from participants of a orthographic errors, font pressed; Time deviations in
to all guests participant was required meeting size 12, in color opening and closing garage
and another for to search the public doors; Correct responses
individual guest list for companies’ versus number of tries on
billing telephone numbers each task
Dement Neuropsychol 2015 June;9(2):156-164

VERSION 2 An example was No modification Task was maintained, No modification No modification No modification Instructions were Qualitative analyses were
added to task however each Brazilian all modified; in the included
instructions state were required to adapted version,
create its own list of instructions were

160 Brazilian adaptation of the Hotel Task     Cardoso CO, et al.

companies only read aloud to the
patient, with no written
version available for
further consultation
VERSION 3 No modification Number of coins was No modification No modification No modification No modification No modification No modification
modified to 45 each.
Besides sorting foreign
from Brazilian coins,
participants had to
sort Brazilian coins
according to their value
into predefined spaces
VERSION 4 We increased Number of coins was We modified task We opted to insert the Font size was increased Instead of using a box Participants also No modification
font size altered to 100 Brazilian stimuli. A restaurant first name followed by and writing was as remote control, received a written
coins and 10% target menu with promotional the surname. Number printed in black font. participants were version to follow during
coins (foreign coins) meals was developed. of tags was reduced to The amount of errors required to press two reading of instructions.
Task objective was to 80 and font size was corresponded to around telephone buttons For each task, an
find the promotional increased. 10% the number of in order to wake up instruction chart was
meals words (539 words and guests. available
62 errors)
VERSION 5 Same version was Number of coins was The Promotional meals Version 4 was Version 4 was The idea of waking up No modification No modification
maintained, with an increased to 198 task was officially maintained maintained guests was maintained
increase in font size Brazilian and 22 foreign established
to 16 coins. Number of coins
by value and nationality
was stimulated
 Dement Neuropsychol 2015 June;9(2):156-164

Phases 4 and 5. The authors revised and modified the task look up each dish or drink on a menu and write down
based on the analysis and suggestions made by the ex- its price. In the conference label task, participants were
pert judges, and the following two changes were made: also instructed to order the nametags alphabetically by
inclusion of an example in the Compiling Customer first rather than last name, a more common procedure in
Bills task and creation of a separate telephone book for Brazil. The sizes of the labels were also changed to ensure
each location in which the instrument was used. The that participants had no trouble handling or reading the
instructions for the tasks were also made clearer and cards. The coin and brochure tasks were changed so that
more precise. These changes resulted in the production the target-to-distractor ratio was 1:10, as is commonly
of a second version of the adapted Hotel Task (Table 3), adopted in canceling tasks. Due to the complexity and
which was used in a pilot study. The participant was able length of the Hotel Task instructions, a written copy of
to perform all tasks and remembered to press the garage the directions was provided to participants so they could
door buttons as requested. The pilot study revealed that follow these while the researcher read them out prior to
the number of coins in the sorting task was too small, the administration of the task, as in its original English
such that the task could be completed in a very short pe- version. Additionally, a card with the instructions for
riod of time. The participant also had trouble handling each task was laid out next to its corresponding materi-
the telephone book, which led him to spending longer als, to be consulted by participants whenever necessary.
on this task than expected. After completing the Hotel
Task, the participant mentioned his unfamiliarity with Phases 9 and 10. The participant who was administered
telephone books, to which he attributed his difficulties the Hotel Task in the third pilot study displayed satis-
in the aforementioned task. factory performance, and was able to distribute his time
among the five tasks. The coin task was found to be
Phases 6 and 7. After the first pilot study, some changes too easy for participants, who were able to complete it
were made to the task stimuli and instructions. The within three minutes. Therefore, the only change made
number of coins in the sorting task was increased, and to the task in stage 10 of the adaptation process was an
after two expert judges had reevaluated the task, a sec- increase in the number of coins to 198 Real coins and 22
ond pilot study was conducted. The judges suggested foreign coins, as described in Table 5.
that the telephone book task be replaced so as to assure
the ecological validity and practicality of the Hotel Task. Phases 11. A hotel manager assessed the similarity of the
For the same reason, the garage door task was replaced stimuli and instructions of the Hotel Task with those
by the two wake-up calls, which the participant was in his workplace, and reported a similarity of 100% be-
instructed to make by pressing two buttons on a tele- tween the task and the objects found in a real-world ho-
phone. In the second pilot study, most healthy subjects tel setting.
were able to perform all five tasks, and remembered to
call the two hotel guests. However, they still had diffi- Phases 12. This was the last stage in the adaptation pro-
culty handling the telephone book. The fact that, in the cess, since the version of the Hotel Task produced after
conference label task, participants were asked to alpha- stage 11 was considered by the authors to be appropri-
betically order the nametags by last name also led to ate both for healthy individuals and for patients with
some problems in this activity. Furthermore, the font neurological conditions. Table 4 shows the performance
size in some of the tasks interfered with participant per- of patients who took part in the last pilot study. Table 5
formance, as did the length of the instructions. describes the original version of the Hotel Task and the
latest adapted version.
Phases 8. Based on the suggestions made by the expert
judges and on the analysis of the results obtained in the The scores of patients with TBI varied widely, as
second pilot study, further modifications were made to shown in Table 4. On average, patients engaged in three
some of the tasks in the instrument. The telephone book out of the five tasks available. There were no floor or
task was replaced by the “Looking for monthly promo- ceiling effects. Healthy participants were administered
tions in the hotel menu” task, whose underlying proce- a similar version of the task, and were also able to per-
dure was similar to that of the telephone book task. In form all five tasks within the 15 minutes provided. A
this activity, the participant was given a list of the month- comparison between the first and final versions of the
ly promotions in the hotel restaurant, and was asked to task is given in Table 5.

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 Dement Neuropsychol 2015 June;9(2):156-164

Table 4. Participant performance in the Pilot study with the Hotel Task.
Performance of TBI* patients
Task M** (SD#)
Number of tasks performed 3.10 (1.66)
Total time in the Compiling customer bills task, in seconds 143.90 (207.40)
Total correct responses in the Compiling customer bills task 7.00 (12.42)
Total number of attempts in the Compiling customer bills task 7.20 (13.00)
Total time in the Sorting the charity collection task, in seconds 210.10 (187.37)
Total correct responses in the Sorting the charity collection task 122.80 (187.39)
Total number of attempts in the Sorting the charity collection task 126.90 (102.57)
Total time in the Proof reading the hotel brochure, in seconds 51.50 (78.74)
Total correct responses in the Proof reading the hotel brochure 6.30 (9.44)
Total number of omissions in the Proof reading the hotel brochure 6.80 (14.63)
Total time in the Sorting conference labels task, in seconds 368.30 (244.73)
Total correct responses in the Sorting conference labels task 22.50 (22.69)
Total number of attempts in the Sorting conference labels task 34.20 (29.74)
Total time in the Looking for promotions in menu task, in seconds 71.30 (101.85)
Total correct responses in the Looking for promotions in menu task 2.00 (4.13)
Total number of attempts in the Looking for promotions in menu task 2.20 (4.13)
Time for waking up the first guest, in seconds 205.20 (245.70)
Time for waking up the second guest, in seconds 365.80 (387.44)
*Traumatic Brain Injury; **Mean; #Standard deviation;

Table 5. Description of the original Hotel Task and of the final Brazilian adapted version.
Version by Manly et al. (2002) Adapted version
Compiling individual bills. Two types of material are presented: The first rep- Compiling customer bills. The task was identical to the origi-
resents the till roll from the hotel register listing services provided to the guests nal version, except for the inclusion of an example before start-
and their costs. The second are individual bill forms for each of the guests. The till ing the task.
roll needed to be scanned for services used by a particular guest and then these
items transferred to individual bills. Eight guest bills each featuring 10 separate
items would need to be compiled.
Sorting the charity collection. One box containing 196 coins, of which 21 are of Sorting the charity collection task. A total of 198 Brazilian
foreign origin. The goal in this task is to sort the British from the foreign coins. The coins and 22 of foreign currency. The goal is to sort foreign
British coins comprised: 5×1p, 4×2p, 96×5p, 46×l0p and 24×20p. coins from Brazilian coins. Brazilian coins available are: 7x1.00,
16x0.50, 45x0.25, 65x0.10 and 65x0.05.
Looking up telephone numbers. Participants are provided with a list of 34 local Looking for promotions in menu task. A list of 20 monthly
companies and asked to find and note down their telephone numbers using the promotions is provided and the participant is asked to search
regional Yellow Pages phone directory. for matching prices in the menu.
Sorting conference labels. Participants are provided with a pile of 100 labels, Sorting conference labels task. Eighty labels are provided
each with the name of a guest attending a conference. Prior to each administra- and should be arranged in alphabetical order according to the
tion, the pile is shuffled and participants are asked to sort the cards into alpha- first name of the respective guest.
betical order based on the surname of each guest.
Proof Reading the hotel leaflet. A leaflet of nine pages with specific typos rep- Proof reading the hotel brochure. A two-page brochure with
etition of letters. A total of 130 (4%) is presented. Participants are asked to mark specific typos repetition of letters. A total of 62 errors (10%) is
the errors with a pen. presented. Participants are asked to identify and rectify errors.
Opening and closing the garage doors. At two pre-defined times (6 and 12 min Waking up guests. Participants are asked to perform two
after beginning the task), the participants are asked to remember to open and wake-up calls to hotel guests by pressing two buttons on a
close the hotel garage doors, in order to allow deliveries. The door is opened by telephone at two different time points (6 and 12 min after start-
pressing a red button and closed by pressing a black button, both mounted on a ing the task).
single button box placed on the desk.

162 Brazilian adaptation of the Hotel Task     Cardoso CO, et al.

 Dement Neuropsychol 2015 June;9(2):156-164

DISCUSSION cation Assessment Battery,26 the Brief Montreal Com-

The present study described the adaptation of the Ho- munication Assessment Battery – MAC-B,25 and of the
tel Task for use in the Brazilian population. This was the WAIS-III and WISC-III28 for use in Brazil. The judges
first stage in the instrument’s validation process, and an may suggest changes to the task which can be evaluated
extremely important source of evidence of the adequacy and implemented by its authors. Due to the complexity
of this instrument for use in research and clinical prac- of the task used in the present study, expert judges had
tice in Brazil. to be consulted more than once in the adaptation pro-
There is no consensus in the literature as to the ideal cess and, as previously mentioned, the pilot investiga-
method to be used in the cross-cultural adaptation of tion was crucial for assessing the need for modifications
neuropsychological assessment instruments. However, to the task. A total of six pilot studies were conducted in
Fonseca et al.22 found that, in the case of non-verbal the present investigation. According to Fonseca et al.,22
measures, the adaptation process consisted mostly of the neuropsychological literature does not specify an
the translation and back-translation of instructions of ideal sample size for pilot studies. In the present study,
the original task.14,23,24 Fonseca et al.22 suggested that healthy individuals with different ages and educational
these procedures be followed by analysis by expert and levels as well as patients with TBI were recruited for the
non-expert judges as well as pilot studies. After each pilot studies.
stage of this process, the authors of the instrument The small number of participants in the pilot study
should analyze the task and make any necessary adjust- may constitute a limitation of the present study. How-
ments. All of these phases were followed in the present ever, as there is no consensus in the literature as to the
study, as the hotel manager, who had no professional ideal sample size for pilot studies of adapted neuropsy-
experience with neuropsychology, contributed to the chological instruments, we had no way of assessing the
process as a non-expert judge. Since there are no clear adequacy of our sample size. Additionally, the length
descriptions of the Hotel Task in the literature, the fo- and complexity of Hotel Task instructions may have
cus of the adaptation process was the pilot study rather influenced the performance of patients with low edu-
than the analysis by expert and non-expert judges. cational levels or severe neurological conditions on the
A similar phenomenon occurred in the adaptation task. Impairment in EF associated with these features
of the Iowa Gambling Task for use in Southern Brazil: may impair comprehension of task instructions as well
in this case, the task instructions were translated by an as performance on the Hotel Task, since the activities
English-speaking professional before being evaluated by involved in the instrument rely on the use of multiple
two judges with a background in neuropsychology and EF for their successful completion.
knowledge of the English language, who ensured the so- In spite of these limitations, the adaptation of the Ho-
ciocultural adequacy of the stimuli; the last step in the ad- tel Task for use in the Brazilian population was successful,
aptation process was a pilot study of the adapted task.13 and all recommended stages for the cross-cultural adap-
In the present study, two translators worked inde- tation of neuropsychological instruments were closely
pendently on the instructions of the Hotel Task.15 How- followed. We suggest that further research be conducted
ever, translation alone may not be able to guarantee the to assess the psychometric properties and applicability
equivalence between an adapted task and its original of this instrument in other clinical populations, as well
version,25,26 and therefore may not always lead to suc- as its ability to differentiate between clinical conditions
cessful cross-cultural adaptations of assessment instru- such as dementias. The Hotel Task may be especially
ments.22 Acevedo et al.27 suggested that adapted transla- sensitive to patients with frontotemporal dementia, for
tions may be more adequate than literal ones, where the instance, since executive impairments are a hallmark
latter do not involve the adjustment of terms to the lo- of this disorder.29 Furthermore, we also suggest that a
cal culture, compromising the comprehensibility of task more concise and less complex version of the Hotel Task
stimuli and instructions. Adapted translations involve be developed, so that it can be used in patients with low-
modifications to the terminology and semantic struc- er educational levels and more severe neurological con-
ture of instructions and stimuli to ensure their compre- ditions. Further research should also look more deeply
hensibility and familiarity. into the development of shorter ecologically valid tasks
Analyses by expert judges are a commonly used which could, for instance, be used in bedridden patients.
method for the cross-cultural adaptation of assess-
ment instruments. Such procedures were involved, for Author contributions. Caroline de Oliveira Cardoso: litera-
instance, in the adaptation of the Montreal Communi- ture search, study design; preparation and writing of the

Cardoso CO, et al.     Brazilian adaptation of the Hotel Task 163

 Dement Neuropsychol 2015 June;9(2):156-164

manuscript, data acquisition and collection; statistical da Pereira: scientific contribution and critical content
analysis. Nicolle Zimmermann: literature search; prepa- review; approval of the final version to be sent to the
ration and writing of the manuscript; scientific con- journal. Rochelle Peace Fonseca: study design; scientific
tribution; survey data and statistical analysis. Camila contribution and critical content review; approval of the
Borges Paraná: literature search; scientific contribution; final version to be sent to the journal
data collection and writing of the manuscript. Gigiante
Gindri: literature search; scientific contribution; prepa- Acknowledgments. We thank CAPES for the doctoral fel-
ration and writing of the manuscript. Ana Paula Almei- lowship awarded to Caroline Cardoso

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164 Brazilian adaptation of the Hotel Task     Cardoso CO, et al.