SP-LPC 223 Executive Functions PDF

Executive Function(s) Miguel Don S. Baluyut, RSLP Adapted the lecture slides of Kathy B. Reyes-Brander, MS, RSLP Objectives Describe higher level cognition Explain the implications of frontal lobe lesions and executive dysfunction (ED) Identify the characteristics of verbal...

Executive Function(s) Miguel Don S. Baluyut, RSLP Adapted the lecture slides of Kathy B. Reyes-Brander, MS, RSLP Objectives Describe higher level cognition Explain the implications of frontal lobe lesions and executive dysfunction (ED) Identify the characteristics of verbal communication in ED Discuss treatment options for clients with ED Higher-Level Cognition: Executive Functions (EF) (Balasubramanian, 2015, Purves, 2013) EF is responsible for control of cognition, and the regulations of flexible, goal-directed behavior Intact EF is critical in everyday life to initiate, monitor and terminate behavior In the absence of EF, behavior is determined by the default mode of brain operation (automatic, reflexive) Executive processes are conscious and effortful and poorly understood (Fodor, 1983). EF consists of interconnecting control processes “EF represents a complex set of cerebral processes that operate in non-routine situations and exert top-down, volitional control over cognition and behavior” (Daffner & Searl, 2008, p. 249)  3 AREAS OF EXECUTIVE FUNCTION (Carungcong, 2020) Cognitive flexibility Working memory Inhibitory control (Image from The Understood Team 2019) Components of Executive Function (Balsubramanian, 2015) First Order EF: Working memory Monitoring Inhibition Initiation Second Order EF: Planning Organization Resisting interference Set-shifting Affect regulation context appropriate behavior (Daffner & Searl, 2008) CORE EXECUTIVE SKILLS (Barkley, 2011) Planning and Organization Working Memory Initiation Task Monitoring Self-Monitoring Inhibition Emotional Control Shifting Planning andPLANNING Organization (Barkley, 2011) AND ORGANIZATION (Barkley, 2011) The ability to impose order on thoughts, tasks, play and storage spaces Impact – difficulty with breaking down a task into smaller steps to reach a goal; difficulty creating a cognitive schema to organize information Working Memory (Barkley, 2011) WORKING MEMORY (Barkley, 2011) Memory in the service of action; reviewing new information, and retrieving, holding and manipulating old information for the purpose of completing a cognitive task Impact – weak working memory will result to difficulties to hold on to little bits of information long enough to complete a task Initiation (Barkley, 2011) The ability to begin a task or activity and to independently generate ideas, responses or problem solving strategies Impact – procrastinate about doing tasks Task Monitoring (Barkley, 2011) Ability to monitor one’s own performance and to measure it against a standard of what is needed for any given task Task monitoring allows someone to consider his own progress towards a goal and to adjust his plans if he is going off course Self-Monitoring (Barkley, 2011) Ability to observe one’s behavior and to determine whether it conforms to explicit behavioral expectations and unwritten social rules Impact – good self monitoring allows someone to fluidly adjust their behavior in response to overt environmental feedback and more subtle social cues, such as facial expressions and modeling of peers Inhibition (Barkley 2011) The ability to “put on brakes” or to stop a behavior at an appropriate time Impact – without good ability to inhibit behaviors and thoughts children are impulsive and unfocused, they tend to take actions before thinking about the consequences Emotional Control (Barkley 2011) The ability to reflect on one’s own feelings and then to use that understanding to guide one’s emotional responses Impact – weak emotional control tend to have strong, immediate, poorly controlled emotional reactions Shifting (Barkley 2011) The ability to “change gears” to move freely from one situation to another and to think flexibly in order to respond appropriately to a new or unexpected situations Impact – people with the weak ability to shift tend to get locked into behaviors or expectations and they have trouble making transitions from one activity or pattern of thought to another The Neural Control of Executive Functions (Purves, 2013) Several interrelated brain systems combine to support the flexible goal-directed control of behavior: Dorsolateral prefrontal control systems: initiating and shifting behavior, inhibiting behavior Ventromedial prefrontal control systems: inhibition of socially inappropriate behavior, sensitivity to the consequences of actions Posterior parietal cortex control systems: Visual attention or intentionality? Cingulate control systems: conflict monitoring function? Basal ganglia control systems The Neural Control of Executive Functions (Purves, 2013) Purves, 2008 Purves, 2008  Components of the Faculty of Language (Broad) (Balasubramanian, 2015) I. Signal (speech or sign) II. Structure (phonology and syntax) - Phonology: - Sequencing - Duality of patterning - Combinatorial phonology/hierarchical chunking - Syntax: - Hierarchical phrase structure - Structure dependent rules - Self-embedding - Mapping to meaning and phonology III. Semantics or meaning: Formal semantics & pragmatics - Semantics: Formal & lexical semantics, propositionality, referential stance, constraints on induction of word meanings - Pragmatics: context-driven (pragmatic) inference, Theory of Mind (TOM), the drive to share meanings (Mitteilungsbedürfnis) - The faculty in the broad sense (FLB) includes perceptual-articulatory systems (for sound and sign) and conceptual-intentional systems (for meaning). - Hauser et al.(2002) unambiguously defined FLN as the “computational core” of the language faculty: the cognitive subsystem responsible for generating the discrete infinity of linguistic expressions. Dysexecutive Syndromes: Causes (Balasubramanian,2015) Neurodegenerative Diseases CNS Infections Traumatic Brain Injury Neurodevelopmental Conditions Vascular Diseases Tumors Multiple Cclerosis Etc. Frontal Lobe Lesion and Executive Dysfunction (ED) (Purves, 2013) ED and frontal lobe syndrome Rylander (1939): - increased distractibility - disturbed attention - difficulty learning new tasks - able to work along routine lines Shallice (1982): - Impairment in attentional control (Supervisory Attentional System, or SAS) Adelman & Ward (1991): - Impulsive - Distractible - Have problems using feedback - Inappropriate pragmatic skills Areas of Communication Affected by ED (Purves, 2013) Prefrontal functions and inference: - PFC: no role in perception or movement - PF functions are critical to the goal directed control of all cognitive processes (executive functions) - Research points to the role of PFC in determining how the context alters the meaning (Mesulam, 2002) - Frontal Lobe Syndrome: poor inferential reasoning linked to poor understanding of sarcasm  Areas of Communication Affected by ED (Purves, 2013) Executive Functions of PFC include: Working Memory, Inhibition, Flexible Attentional Focus Deficits in each of these processes may interfere with inferential reasoning. Examples: 1. WM is pivotal to the computation of inferences in written text (Calvo, 2005) & pragmatic understanding (McDonald et al., 2006) 2. Poor inhibitory control prevents the suppression of irrelevant associations, thus adding to the working memory demands 3. The ability to shift one’s focus of attention flexibly between relevant attributes of the environment is also fundamental to efficient executive processing Disorders of 2 & 3 are likely to disrupt conversational inference.  Areas of Communication Affected by ED (Purves, 2013) Social nature of conversational inference: Conversational inference requires making judgments that are unique to social tasks like sarcasm, irony - Less to do with making statements, and more to do with speaker’s attitude toward the state of affairs Other kinds of conversational inference may also allude to issues that are on the speaker’s MIND rather than in the patient context. Social information processing is functionally & even neuroanatomically distinct from non-social processing  Areas of Communication Affected by ED (Purves, 2013) Social Cognition Social intelligence: ability to interact with others in a complex and flexible manner - Social information processing system may have evolved as a separate processing system within the human brain (Adolphs, 2001). Three major constructs that characterize social cognition: Theory of Mind (ToM) Emotion Processing Social Knowledge Schemas Neural substrates underlying these three constructs appear to overlap & include the PFC - Dorsolateral PFC (tested by many conventional executive tests) - Orbitomedial PFC (Social cognitive task) - Ventral PFC (social cognition) How does TOM, emotion processing & social knowledge influence inferencing? Areas of Communication Affected by ED (Purves, 2013) Discourse production Measured by the use of various theoretical approaches: - Polite utterances - Narratives: coherence (local, global) measures - Conversations Areas of Communication Affected by ED (Purves, 2013) Neuropsychological underpinnings of disordered discourse production Continuous monitoring is essential for coherent discourse production Monitoring requires the WM processing Inhibition is important for socially appropriate language use Social problem solving is involved in socially appropriate usage Ability to plan and sequence (executive function) may be important for global coherence Story generation vs story recall tasks Mild Traumatic Brain Injury (Purves, 2013, Balasubramanian, 2015) Mild Traumatic Brain Injury (Purves, 2013, Balasubramanian, 2015) Cognitive Rehabilitation for TBI (Purves, 2013, Balasubramanian, 2015) Cognitive Rehabilitation Therapy attempts to enhance functioning and independence in patients with cognitive impairments as a result of brain damage (TBI) or disease (stroke) CRT vs Cognitive Behavior Therapy(CBT) CRT may be sometimes confused with cognitive behavioral therapy (CBT) These are not mutually exclusive and can be delivered conjointly CRT- used to rehabilitate impaired domains of cognition CBT - used for a variety of emotional and psychiatric disorders (mood, anxiety & psychotic), PTSD, distorted negative thoughts The breadth of treatment of CRT mirrors WHO-ICF: impairment, disability, handicap (limitation in activities and participation in interacting with the physical and social environments) (Purves, 2008, Balasubramanian, 2015)  References Balasubramanian,V (2015). Executive Disfunction. Seton Hall University Balasubramanian,V (2016). Traumatic Brain Injury Treatment. Seton Hall University Barkley R. (2011). ADHD, Self – Regulation And Executive Functioning: Implications For Management And Life Course Outcomes Presentation. Rockville, MD. Carlson, S. M., Zelazo, P. D., & Faja, S. (2013). Executive function. In P. D. Zelazo (Ed.), Oxford library of psychology. The Oxford handbook of developmental psychology (Vol. 1): Body and mind (pp. 706-743). New York, NY, US: Oxford University Press. Hunter S.J. and Sparrow E.P., Executive Function and Dysfunction: Identification, Assessment and Treatment, (2012), Cambridge University Press Purves, D Et al. (2013). Principles of cognitive neuroscience. Sunderland, Massachusetts: Sinauer Associates, Inc. Publishers. Understood Team (2017). 3 Areas of Executive Function. https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/ex ecutive-functioning-issues/3-areas-of-executive-function