13: Executive Function Management

Question 1

What is the goal of executive function management?

Answer 1

reinforce the use of conscious and deliberate strategies to reestablish external structure and/or improve a patients ability to exercise control over his/her behaviors

Question 2

What are the required steps of executive function management?

Answer 2

1) identify demands associated with the task
2) plan appropriate sequence of responses
3) predict outcomes
4) implement plan
5) self monior performance with strategies
6) compare actions with predicted effects and consequences
7) evaluate performance

Question 3

How do you do executive func management with severe deficits?

Answer 3

1) task specific approach

2) external strategies with cueing and assistance

Question 4

How do you do exec func managmenet with mild deficits?

Answer 4

1) internal and external strategies

Question 5

What are treatement ideas?

Answer 5

1) increases/decreaseing structure of common tasks
2) applying external support
3) follow therapy scheudle
4) map reading
5) completing homeowkr
6) goal setting, task prediction, self eval
7) avoid contributing to learned helplessness
8) computer based planning tasks

Question 6

What are the 4 parts of task analysis?

Answer 6

1) take a task where client has trouble
2) breakdown into smallest sequential parts
3) determine where the breakdown is
4) determine what part of exec func system is breaking down

Question 7

What are compensatory treatment strategies?

Answer 7

1) goal setting/planning: write them out
2) initiation: create a checklist
3) planning: pick optimal times and give reminders (alarms, sticky notes)
4) time management: watch, timer, etc + give extra time for harder tasks
5) self-monitoring: recheck work
6) awareness: review limits, goals, skills, changes

Question 8

What are some homework treatment ideas?

Answer 8

1) household chores
2) developing monthly budget
3) using the internet

Question 9

What are 4 EBPs that can be used for exec func management?

Answer 9

1) metacognitive skill training
2) social skills training
3) self-regulation scripts
4) communication partner training

Question 10

What is metacognition?

Answer 10

ability to think about thinking

Question 11

What does metacognition allow us to do?

Answer 11

know when a straegy will help us and how to use it effectivey and if we do

Question 12

What is the goal of metacognitive skill training?

Answer 12

teach individuals how to regulate and control their thoughts and behaviors and their learning

Question 13

What are 4 metacogntive skills traning strategies?

Answer 13

1) setting goals
2) comparing performance with goals
3) making decisions to changes ones behaviors and how to
4) implementing behavior change`

Question 14

What is self talk procedures?

Answer 14

overt verbalizations that fade to whipser and htne inner talk

Question 15

What are the steps of self talk procedures?

Answer 15

1) performa task while talking aloud about each step
2) step down = clinician helps them break it down and make a list
3) list is removed
4) task performed with verbal script
5) task performed with whispering
6) task performed with inner talk

Question 16

What is the basic framework for making a problems solving plan? (5)

Answer 16

1) what is the problem
2) set goal
3) plan solution
4) execute solution
5) monitor feedback and make changes

Question 17

What are problem solving frameworks?

Answer 17

1) Ylsivaker and Feeny (1998)
2) Kennedy (2008)
3) SWAPS

Question 18

What is SWAPS?

Answer 18

S: stop! is there a problem?
W: what is the problem?
A: alternatives to solve problem
P: pick and plan chosen option
S: satisfied with outcome?

Question 19

What is goal-plan-do-review?

Answer 19

Goal: waht do i want to accomplish
Plan: how will it be accomplished? list steps
Do: execute plan
Review: how did I do? What worked? What didn’t?

Question 20

What are pts encouraged to do in Goal Management Training?

Answer 20

stop and think about their goals before, during, and after tasks

Question 21

Who is the primary population for Goal Managment Training?

Secondary?

Answer 21

mild to mod TBI

CVA, MCI, and s/p tumor resection

Question 22

What is the procedure for Goal Managmenet Trraining? (5)

Answer 22

Stage 1: STOP, what am I doing?
Stage 2: DEFINE the main task
Stage 3: LIST the steps
Stage 4: LEARN the steps
Do the task
Stage 5: CHECK - am I doing what I planned?

Question 23

What are 6 strengths of Goal Management Training?

Answer 23

1) highly research supported
2) personally relevant
3) general problem sovling formula
4) repeition
5) low cost/few materials
6) can be taught to fam/caregivers

Question 24

What are 5 weaknesses of Goal Managment Training?

Answer 24

1) only for exec func deficits
2) abstract concepts
3) difficult to monitor/data
4) relatively samll sample sizes in research
5) research inconsistent regarding gneralaizaiton

Question 25

What are regulation scripts/self talk?

Answer 25

scripts for clients everyday life that typically apply to multiple situations and can be used repeatedly and become automatic
regulate behavior and emotion

Question 26

What pt types should regulation scripts/self talk be used with?

Answer 26

1) pt with exec func deficits
2) behavioral issues
3) social comm issues
4) TBI and rt CVA

Question 27

What is the treatment procedure for regulation scripts/self talk? (4)

Answer 27

1) introduce scripts to client
2) implement scripts in therapy
3) practice scriptsi n therapy
4) use scripts independently in therapy and natrual enviornments

Question 28

What are 5 strengths of regulation scripts/self talk?

Answer 28

1) personalized
2) clincian and pt work together to set goals/palns
3) easily applied to multiple settings
4) for all ages
5) easy for family

Question 29

What are weaknesses of regulation scripts/self talk?

Answer 29

1) small sample sizes
2) no standardized approach to follow
3) use of caregiver can put pt at risk for learned helplessness

Question 30

What is the focus of time pressure management training?

The reason?

Answer 30

Focus: monitoring the passage of time
Reason: increased processing time needed with brain injury

Question 31

What is the procedure for time pressure training? (3 stages)

Answer 31

Stage 1: increase awareness of mental slowness and its consequences are a problem
Stage 2: Inform that speed of processing may not return to previous levels but strategies can be used for management (give themselves enough time)
Stage 3: strategy application and generalization

Question 32

How is time pressure training management implemented?

Answer 32

provide client a time limit for multiple takss, and an auditory reminder (beep), when pt hears beep should consider what they should be doing

Question 33

Time pressure management training auditory reminders have been found to do what?

Answer 33

have positive outcomes with increasing time management performance levels

Question 34

What is communication partner training used for?

Answer 34

increase social communication skills through cooperative training of comm. partners

Question 35

How is communication partner training done?

Answer 35

behavioral technique like role playing, video feedback, cues for slef monitoring, training appropraite bheaviors, and possitive collaborate strategies to give feedback adn scaffolding

Question 36

Communication partner training uses the benefits of _____ _________, trains the _____________ ________ rather then the person with __, and maximizes opportunities for what?

Answer 36

peer pressure
communication
TBI
practice and functional application

Question 37

What is the CPT procedure?

• weeks?
• sessions weekly?
• how long
• with who?

Answer 37

• 10 weeks
• 1 session weekly
• 2.5 hours
• with 3-4 other pairs

Question 38

What types of pts is CPT used with?

Answer 38

TBI
Aphasia
AD
Rt CVA (not explored much in research)

Question 39

What are 4 strenghts of CPT?

Answer 39

1) family involvement/team approach
2) support group for individuals with TBI and caregivers
3) increased potential for generalization/carryover
4) can be customized to target problem behaviors

Question 40

What are 3 weaknesses for CPT?

Answer 40

1) emerging evidence
2) requires reliability and commitment from caregiver for success
3) difficult to standardize protocol