Executive functions

What is executive function?

A complex neuropsychological construct that is critical for goal-directed and purposeful behavior (correct)

selective concentration; ability to prioritize one type of information over some other type.

processing and interpretation of sensory information

finding solutions to obstacles; understanding the components of a problem, breaking down or reframing problems, gathering resources to solve them, identifying optimal solutions

The regulation of one’s thoughts, emotional responses, actions, and motivations in order to behave in an expected way for a given situation.

Problem-solving

Planning

Reasoning

Self-regulation (correct)

The action of beginning a goal-directed task.

Initiation (correct)

Problem-solving

Mental flexibility

Inhibition

Awareness and understanding of one’s own thoughts and skills and how you learn information

Meta-cognition Signup and view all the answers

Identifying the problem, generating potential solutions, choosing a solution, and evaluating the outcome.

Problem solving Signup and view all the answers

The process of forming conclusions, judgments, or inferences from facts or premises

Reasoning Signup and view all the answers

The ability to change a course of action or thought based on the shifting demands of a situation

Mental flexibility Signup and view all the answers

The ability to select appropriate responses and suppress unwanted actions

Inhibition Signup and view all the answers

Setting objectives and determining a course of action for achieving those actions

Planning Signup and view all the answers

Being able to discern the potentially good and harmful aspects of a situation, and act in a way that makes sense

Judgement Signup and view all the answers

The more automatic the task, the fewer resources it requires.

True Signup and view all the answers

Automatic responses can be overwritten/inhibited by conscious cognitive control

True Signup and view all the answers

Information receiving attention can be held in a temporary storage space and manipulated. What is this known as?

Working memory Signup and view all the answers

What anatomic correlates are associated with executive function?

The frontal lobes and their connections Signup and view all the answers

What are the 5 subdivisions of the pre-frontal cortex?

Dorsolateral Ventrolateral Orbitofrontal Dorsomedial Ventromedial Signup and view all the answers

There are 4 factors to consider when choosing an assessment approach for treating executive functions. What are these 4 factors?

Clinical setting Patient’s stage of recovery Purpose of the assessment Resources available Signup and view all the answers

The evaluating therapist is more likely to obtain reliable results from executive function tests during later stages of recovery

True Signup and view all the answers

For individuals with TBI the Ranchos Los Amigos (RLA) may help guide assessment decision for the evaluation of executive functioning. The RLA is scale-based. True or False: Executive dysfunction can be more reliably diagnosed if a patients score is higher on the scale

False Signup and view all the answers

What is the paradox between structured assessment vs. spontaneous activity?

Testing protocols typically provide structure and cues for initiation, maintenance of on-task behavior, and explicit goals, reducing the likelihood of exposing executive dysfunction Signup and view all the answers

_____ may provide information on the specific components affected and the severity.

Impairment-based measures Signup and view all the answers

_____ are helpful in determining the impact of the executive function impairment on the patient’s ability to carry out daily tasks at home and the prognosis for returning to work or school.

Activity/participation-based tools Signup and view all the answers

Current guidelines for cognitive communication assessment after TBI recommend using only standardized assessments. What other factors need to be considered?

False Signup and view all the answers

Selection of a therapy approach depends on several factors. Name 3.

Clinician’s theoretical belief on the nature of executive functioning Time since injury Severity of the dysexecutive symptoms Co-occurrence of other cognitive deficits Client’s level of awareness Rehabilitation priorities of patient, family, and staff Support available in the environment Signup and view all the answers

There are five treatment guiding principles. This principle focuses on how instruction is designed and delivered. It emphasizes error control, task analysis, pre-instruction, modeling, faded support, high amounts of correct practice, and immediate corrective feedback.

Systematic instruction Signup and view all the answers

This treatment guiding principle focuses on self-awareness, self-monitoring, and self control of cognition while performing an activity.

Metacognitive instructions Signup and view all the answers

This treatment guiding principle focuses on creating an organizational plan, including anchors, scaffolding, strategies, use of reminders, prompts, encouragement, reinforcement to develop systems to maintain or establish anchors, and behaviors to increase independent use of aids.

Structure Signup and view all the answers

Provide 3 examples of how to modify task demands.

Break task into smaller tests, remove or minimize stimuli that may elicit inappropriate behavior, provide breaks, allow extra time to complete tasks, reduce environmental distractions Signup and view all the answers

Having designated areas for items, centralized space for calendar, schedules, etc., and creating filing system for bills and other important items are examples of this type of environmental support

Organization of physical space Signup and view all the answers

Monitoring nutrition, sleep, activity level, and medications, implementing specific routines (e.g., taking medication with meals), and monitoring levels of fatigue by “checking in” during completion of challenging activities is what type of environmental support?

Manipulation of physiologic factors Signup and view all the answers

This environmental support involves lists of tasks to be completed, steps in specific routines, and creating schedules

Cueing and prompting Signup and view all the answers

Group therapy can be beneficial for some patients. There are many activities that can be done in a group format. Please provide 3 examples.

Discussion Modeling Role-playing Verbal or visual (videotaped) feedback Self-monitoring Social reinforcement Signup and view all the answers

Match the location of lesions to its consequences.

Orbitofrontal = Emotional lability Disinhibition Distractibility Social inappropriateness Dorsomedial = Apathy Decreased drive/awareness Akinetic-abulic syndrome Mutism Ventromedial = Impaired judgment Inappropriate social behavior Dorsolateral = Executive function deficit Disinterest/emotional reactivity Decreased attention to relevant stimuli Signup and view all the answers

Executive functions

Questions and Answers

What is executive function?

The regulation of one’s thoughts, emotional responses, actions, and motivations in order to behave in an expected way for a given situation.

The action of beginning a goal-directed task.

Awareness and understanding of one’s own thoughts and skills and how you learn information

Identifying the problem, generating potential solutions, choosing a solution, and evaluating the outcome.

The process of forming conclusions, judgments, or inferences from facts or premises

The ability to change a course of action or thought based on the shifting demands of a situation

The ability to select appropriate responses and suppress unwanted actions

Setting objectives and determining a course of action for achieving those actions

Being able to discern the potentially good and harmful aspects of a situation, and act in a way that makes sense

The more automatic the task, the fewer resources it requires.

Automatic responses can be overwritten/inhibited by conscious cognitive control

Information receiving attention can be held in a temporary storage space and manipulated. What is this known as?

What anatomic correlates are associated with executive function?

What are the 5 subdivisions of the pre-frontal cortex?

There are 4 factors to consider when choosing an assessment approach for treating executive functions. What are these 4 factors?

The evaluating therapist is more likely to obtain reliable results from executive function tests during later stages of recovery

For individuals with TBI the Ranchos Los Amigos (RLA) may help guide assessment decision for the evaluation of executive functioning. The RLA is scale-based. True or False: Executive dysfunction can be more reliably diagnosed if a patients score is higher on the scale

What is the paradox between structured assessment vs. spontaneous activity?

_____ may provide information on the specific components affected and the severity.

_____ are helpful in determining the impact of the executive function impairment on the patient’s ability to carry out daily tasks at home and the prognosis for returning to work or school.

Current guidelines for cognitive communication assessment after TBI recommend using only standardized assessments. What other factors need to be considered?

Selection of a therapy approach depends on several factors. Name 3.

There are five treatment guiding principles. This principle focuses on how instruction is designed and delivered. It emphasizes error control, task analysis, pre-instruction, modeling, faded support, high amounts of correct practice, and immediate corrective feedback.

This treatment guiding principle focuses on self-awareness, self-monitoring, and self control of cognition while performing an activity.

This treatment guiding principle focuses on creating an organizational plan, including anchors, scaffolding, strategies, use of reminders, prompts, encouragement, reinforcement to develop systems to maintain or establish anchors, and behaviors to increase independent use of aids.

Provide 3 examples of how to modify task demands.

Having designated areas for items, centralized space for calendar, schedules, etc., and creating filing system for bills and other important items are examples of this type of environmental support

Monitoring nutrition, sleep, activity level, and medications, implementing specific routines (e.g., taking medication with meals), and monitoring levels of fatigue by “checking in” during completion of challenging activities is what type of environmental support?

This environmental support involves lists of tasks to be completed, steps in specific routines, and creating schedules

Group therapy can be beneficial for some patients. There are many activities that can be done in a group format. Please provide 3 examples.

Match the location of lesions to its consequences.

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