Executive dysfunction in chronic brain-injured patients: Assessment in outpatient rehabilitation

Abstract

In this study 81 chronic brain-injured patients referred for outpatient rehabilitation, who complained of executive impairments in daily life situations and were observed by proxies and therapists to have such problems, were assessed using various tests and questionnaires of executive functioning, such as the BADS and the DEX Questionnaire. The main purpose was to examine the sensitivity of these instruments in this particular group of patients. The tests and the DEX were also administered to healthy controls to investigate which of the instruments discriminate optimally between patients and controls. The results indicate that the tests as well as the questionnaires were sensitive to the executive problems of the patients. There were no significant differences between DEX ratings of patients, proxies and therapists. This suggests that patients who were eligible for outpatient rehabilitation showed relatively intact awareness into their executive problems. A specific combination of three "open-ended" tests and the DEX contributed significantly to the prediction of group membership.

Who benefits from treatment for executive dysfunction after brain injury? Negative effects of emotion recognition deficits

“…We found distinct impairments in facial affect recognition in the group of brain injured patients with executive deficits (Boelen et al, 2009;Spikman et al, 2010). Given that we investigated this problem in patients with lesions not confined to prefrontal areas, this suggests that problems with social cognition can be found in subjects with impaired EF and damage outside prefrontal circuits.…”

“…Although emotion recognition deficits are most extensively documented in TBI patients, they are also found in other neurological conditions, for instance in stroke (Harciarek & Heilman, 2009;Kucharska-Pietura, Phillips, Gernand, & David, 2003) and in survivors of paediatric brain tumours (Bonner et al, 2008). This is similar to executive function deficits, that are also found across different brain injury groups (Boelen, Spikman, Rietveld, & Fasotti, 2009). However, to our knowledge, deficits in emotion recognition in brain injured patients with executive deficits have not been specifically investigated.…”

“…Although these patients were selected on the basis of executive deficits (Boelen et al, 2009), it is plausible that in part of this group social cognition might also be affected. Associated questions concern aetiology and gender-related differences in emotion recognition.…”

Executive Functions Deficits After Severe Traumatic Brain Injury

“…Nevertheless, previous studies using other comparable behavioral questionnaires, such as the Dysexecutive Questionnaire 62 for example, found that proxies' ratings were more accurate than patients' ratings 63 or that they did not significantly differ from therapists' ratings. 64 Further research should look at the differences between patient's, proxy's, and therapist's rating to control for sources of bias, such as lack of awareness, denial, or overestimation due to burden. Finally, the control group included only healthy participants.…”

Temporal dysfunction in traumatic brain injury patients: primary or secondary impairment?

“…While frontally mediated cognitive processes (i.e., attention, working memory, executive functions, etc.) play an important role in temporal processing (Rao et al, 2001; Perbal et al, 2002; Baudouin et al, 2006a,b; Mioni et al, 2013a,b), frontally mediated cognitive deficits are well-documented in traumatic brain injury (TBI) patients (Azouvi, 2000; Leclercq et al, 2000; Boelen et al, 2009; Stuss, 2011). …”