Assessing executive performance during cognitive rehabilitation

Abstract

Executive functioning influences a host of other cognitive processes and people who attend neuropsychological services are more likely to display executive dysfunction than any other cognitive deficit (Stuss & Levine, 2002). Impairment in executive functioning disrupts a person's ability to effectively employ their intact areas of functioning, and undermines effective self-management of other areas of dysfunction, hampering attempts to employ compensatory strategies. Therefore, assessment of a person's executive functioning is a high priority as part of a comprehensive neurorehabilitation plan. Guided by the International Classification of Functioning, Disability, and Health model (ICF model; Peterson, 2005), we suggest that an important development in the field is moving to formal assessment of executive performance in functional contexts, in addition to more traditional assessment of executive impairment. We outline a number of existing studies in this area, review current measures that can provide clinicians with useful information on these issues, and discuss how this research could be further advanced.

Dysexecutive symptoms and carer strain following acquired brain injury: Changes measured before and after holistic neuropsychological rehabilitation

“…The use of standardised questionnaires have become widespread allow patients and carers to communicate everyday problems, providing opportunities to identify personally relevant goals for rehabilitation, (Hart & Evans, 2006;Lewis, Babbage & Leathem, 2011). The Dysexecutive Questionnaire was developed as an informant (DEX-I) and self-rating scale (DEX), sampling everyday problems commonly associated with executive dysfunction, (Wilson, Alderman, Burgess, Emslie & Evans, 1996).…”

Rehabilitation of Executive Functions in Patients with Chronic Acquired Brain Injury with Goal Management Training, External Cuing, and Emotional Regulation: A Randomized Controlled Trial

“…Since EF is crucial in managing new situations, and a test can only be new once, tests of EF might face particular test-retest reliability issues (Burgess, Alderman, Evans, Emslie & Wilson, 1998). Neuropsychological measures typically capture only certain aspects of EF, and may thus not accurately reflect dysfunction in everyday life (Lewis et al, 2011;Spikman et al, 2010). It has been suggested that performance-based measures and subjective ratings of EF assess different aspects of cognitive and behavioural functioning that independently contribute to clinical problems (Toplak et al, 2012).…”

“…Executive dysfunction (ED) is common following acquired brain injury (ABI) (Stuss & Levine, 2002;Novakovic-Agopian et al, 2011), and may disrupt the ability to effectively use intact functions or compensatory strategies, undermine efficient self-management (Lewis, Babbage & Leathem, 2011), hamper the rehabilitation process (Robertson & Murre, 1999), and is also associated with long-term negative psychosocial and vocational outcome (Draper & Ponsford, 2008; Ylvisaker & Feeney, 2000). Thus, techniques for reducing ED might significantly impact functional outcome (Manly & Murphy, 2012).…”

Response to Goal Management Training in Veterans with blast-related mild traumatic brain injury

“…Krasny-Pacini et al [14] and Lewis et al [4] described the lack of ecological validity in many executive function measures and the limitations of measures that are more functionally based. Functional measures often lack standardization, norms, and adequate test-retest reliability.…”

“…In fact, disorganization as a result of executive dysfunction is the most common complaint in individuals with traumatic brain injury (TBI) [2]. Executive deficits may be expected to lead to functional deficits in a broad range of cognitive, emotional, and social skills [3], though more data are needed about how laboratory-based measures of executive dysfunction map onto real-life skills [4].…”