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Cognition Final > Executive Function Module 4 > Flashcards

Executive Function Module 4 Flashcards

1
Q

What is Executive Function?

When is it developed?

A

It is the cognitive functions needed to plan an activity, problem solve the issues that arise, and determine when the activity is completed.

**It is the latest to develop in our development and there is a lot of overlap between all sub components

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2
Q

What is Metacognition?

A

The cognitive functions needed to determine how well your plan went and what needs to be changed in the future to improve performance

**Basically reflecting on how to do things

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3
Q

List the components of Executive Function?

A
  1. Self-awareness
  2. Goal setting
  3. Planning
  4. Initiation
  5. Problem Solving
  6. Self-monitoring
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4
Q

What is “Self-Awareness”

A

-Goal directed intentions
“I want to bring something to the party that everyone will enjoy”

-Appreciation of strengths and weaknesses
“I am not good at cooking but I am a great baker”

-Recognition of oneself within a social context
“I am the quiet person in the corner who tends to help with setting things up”

What factors affect your actions and responses
“I tend to be a people pleaser so whatever I am asked to bring I tend to bring”

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5
Q

What is “Goal Setting”

A

-Identifying elements of a problem
“I’d like to make my famous cheesecake brownies but they take a long time”

-Identifying criteria for solutions
“I need something with fewer steps or pre-made”

-Recognizing potential constraints to solutions
“I have a meeting in the afternoon so I will need to shop and cook before the meeting”

-Comparing problems to previous solutions
“Last time I had to get a last minute treat I bought that ice cake from ShopRite that everyone seemed to love”

(have you experienced a similar issue in the past? what did you do? Did it work?)

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6
Q

What is “Planning”

A

-Organizing thoughts and actions
“First shopping then go home to cook then go to work”

-Ability to control impulses
“These chips look goof but it isn’t what im here for”

-Awareness of appropriate planning sequences
“I need to know what ingredients I need before I go to the store”

-Deciding about locations and time frames
“Ill go to shoprite at 9:30 am and be back home by 9:45”

-Choosing necessary materials to achieve goals
“I am going to make the cheesecake and here are the ingredients”

  • Predicting Outcomes
  • Tracking Progress
  • Evaluating Solutions
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7
Q

What is “Initiation”

A

-Ability to persevere
“I want to text my friends about the party, but I have to get shopping done first”

  • Mental flexibility (change things around as needed)
  • Behavioral flexibility (being able to substitute one component for another)
  • Ability to complete actions within a time frame
  • Ability to avoid premature actions (impulse control)
  • Ability to follow rules (with mental flexibility)
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8
Q

What is “Self-Monitoring”

A
  • Ability to make good judgements
  • insight
  • social sensitivity (awareness of rules and structures as they apply to social structures)
  • self-inhibition (impulse control)
  • Self-evaluation (did I do well/not well?)
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9
Q

EF assessments -

“Simulated Tasks and Self-Report”

-Name each one

A
  1. Behavioral Assessment of Dysexecutive Syndrome (BADS) - Simulated Task Performance
  2. Behavioral Rating Inventory of Executive Function (BRIEF) - Frequently used in school system (Observation/Self-report)
  3. Dysexecutive Questionnaire - (part of the BADS) (Self-Report)
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10
Q

Behavioral Assessment of Dysexecutive Syndrome (BADS)

A
  • Simulated Task Performance & Self-Report Questionnaire
  • A test kit that is largely paper and pencil
  • Completed in a quiet clinic environment which does not approximate the EF needs posed by complex real life environments

Time: 40 minutes (extensive time to score)

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11
Q

Dysexecutive Questionnaire

A

Two scales completed:

  • Self-report
  • Caregiver Report
  • Part of the BADS system but often given as a stand-alone assessment

-20 questions that focus on difficulties experienced in everyday tasks

Time: 10 minutes

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12
Q

Behavioral Rating Inventory of Executive Functions (BRIEF)

A
  • Several Versions: Self Report and Caregiver/Teacher Report
  • at home and at school
  • examines EF, attention, & memory
  • *For CHILDREN
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13
Q

BADS - Modified Six Elements Test

A
  • Client has 10 minutes to do 6 sub-tasks
  • client needs to try all of them within the time limit
  • Six Elements sometimes given alone as the most predictive subtest
  • Requires planning, task switching, and processing speed
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14
Q

Executive Function Assessment - Functional Task Performance

-Name each one

A
  1. Executive Function Route Finding Task
  2. Multiple Errands Test
  3. MET-Hospital Version
  4. Executive Function Performance Test (EFPT)
  5. Kettle Test
  6. Hotel Task
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15
Q

Executive Function Route Finding Task

A

**Oldest Test

  • real life functional performance
  • client is asked to find a given location as quickly and efficiently as possible (How do you get to the student center?)
  • Therapist scores client’s performance in terms of PLANNING (this isn’t about motor performance, vision, etc.)

**How did you plan to find your route in a 3D spatial environment

Time: ~10 minutes

**This is a DYNAMIC assessment = therapist provides cues to see if route finding performance improves. Standardized scoring used to assess performance and cue use.

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16
Q

Multiple Errands Test (MET)

A
  • Client is instructed to complete several activities (errands) which include buying items, gathering information, and interacting with others to complete the activities
  • Route finding is part of this test (scored on moving through locations most efficiently)
  • Specific to location of assessment

Scoring:

  • Inefficiencies - where a more effective strategy could have been used
  • Rule breaks - if any one of the given task rules or social/pragmatic rule was broken
  • Interpretation failure - errands were misunderstood
  • Task failures - one of the 12 errands not completed

**more complex than route finding and also more ecologically valid for common everyday problems

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17
Q

MET - Hospital Version

A

specific to hospital, similar tasks as MET

18
Q

Executive Functional Performance Test (EFPT)

A

Actual Task Performance in Constrained Environment

  • Hand-washing - used as a screening to determine if client can participate in the assessment
  • oatmeal preparation
  • telephone use
  • taking medication
  • paying bills

Time: ~45 minutes
Cost: Free (OT assembles supplies)

Scoring:
Cues needed - include rating of what type of cue needed

EF skills assessed

  • Initiation
  • Execution
  • Completion
19
Q

Kettle Test

A

Actual Task Performance in Constrained Environment

Only assesses performance in one specific KITCHEN task, given over-familiarity with this task may not represent client functioning in other tasks

Scoring: errors and performance

0=intact performance
4 = physical demonstration or assistance

20
Q

Hotel Task

A

Functional Task in Constraint Environment (functional version of the Modified Six Elements test from BADS)

  • Pretend you work at a hotel front desk
  • 6 functional Tasks

-individual is given 15 minutes to complete assessment

21
Q

FOR: Dynamic Interactional Approach (DIA)

What is the focus on?
What are the components?

A

It is an OCCUPATION FOCUSED approach

PERSON

  • current stage of life, emotional/motivational factors that influence treatment
  • Client’s current AWARENESS of performance and abilities

OCCUPATION
-Generalizability and potential for transfer of skills

ENVIRONMENT
-Focus on zone of proximal development (match between abilities and what the environment provides/requires

22
Q

DIA Treatment Focus

  • Main cognitive areas
  • Treatment Focus
A

Main areas of cognitive functions:

  • Meta-cognition
  • Awareness
  • Monitoring
  • Planning
  • Ability to generalize

Focus: Occupation Based Activities

  • use dynamic occupations as primary method of treatment delivery
  • therapist must systematically develop upgrades/downgrades to each activity
  • Have client participate in selecting the occupations (COPM –> select from valued occupations checklist or just have client say let’s work on “this” and “not that” today)
23
Q

Generalization DIA

A

Teach strategy (self compensatory approach)

  • select one strategy to use (self-instruction, self-questioning)
  • Have the client practice using the strategy in a number of different occupations
  • generalization occurs as the client tries the same technique in multiple different environments with different needs
Make Modifications (environmental compensatory approach)
-for a selected occupation modify the task so client can be more successful using the strategy
24
Q

Why choose DIA approach?

What is the goal?

A
  • Client lacks awareness and insight into deficits and you want to improve it
  • client has executive impairments
  • client has enough basic cognitive functions (memory, attention, etc.) to work on higher level problem solving

GOAL: develop new strategies that the client can use for information processing

25
Q

Formal Assessments in DIA

A

Any test that allows you to observe the explicit effects of cueing on performance

  • Contextual Memory Test
  • Toglia Category Assessment (EF)
  • Deductive Reasoning Test (EF)
  • Dynamic Object Search Task (VP)
  • Executive Function Performance Test (EFPT)
  • Route Finding Test
  • *- Prospective/Retrospective Memory Questionnaire (because you can examine the effect of self vs environmental cueing)
26
Q

FOR: Cognitive Orientation to Daily Occupational Performance (CO-OP)

Client Selected Goals

A

Client Selected Goals

  • they identify problem areas
  • they identify activity based goals
  • goals designed to maximize engagement
27
Q

CO-OP: Dynamic Performance Analysis (DPA)

A

Dynamic Performance Analysis (DPA)

  • therapist observes client performance of selected activities
  • therapist identifies “breakdowns” in task performance, where cues or assistance are needed
  • Therapist observation often leads to changes in client goals
28
Q

CO-OP: Cognitive Strategy Training

A

“Goal-Plan-Do-Check” metacognitive strategy is taught to the client

  • helps client develop a plan to improve performance in daily activities
  • develop a method for evaluating the activity (Knowledge of results and knowledge of performance )
29
Q

CO-OP: Guided Discovery

A

Therapist assists with self-monitoring, error awareness, and self-instruction of performance
-client is helped to learn about their performance, use the metacognitive strategy, and problem solving ability

**NOTE: This model is very client involved –> Therapist role is in selecting and modifying activities

30
Q

When is CO-OP used and what is the goal of CO-OP?

A
  • Client has some AWARENESS of their deficits
  • Client has EF deficits and primary focus of therapy (problem solving, planning, and organization)
  • Client has the ability to engage in mutual goal setting (requires basic skills in memory, learning, attention, and motivation)

GOAL: Teach client a strategy they can use independently to solve future problems

31
Q

EF Interventions

Strategy Training Goal

A 
Strategy Training Techniques 
GOAL: increase self-awareness and control of cognitive processes
-self-instruction training 
-problem solving training 
-goal management training
-time pressure management

Specific for dealing slowed processing speeds = one of the most common complaints in CVA, TBI, MS, PD, and other neurological disorders

32
Q

EF Interventions

Strategy Training Steps

A

Step 1: Teach client about executive functions that are impaired

Step 2: Teach the client strategies to improve functions (practice with strategies)

Step 3: Teach the individual methods to promote transfer of skills across context (practice with the strategies)

33
Q

EF Interventions

Practice Settings

A

Extensive training in EF likely in OUTPATIENT settings

  • outpatient cognitive rehabilitation setting
  • home health care
  • vocational training and rehabilitation
  • outpatient day programs

OTHERS:

  • Introduce strategies in inpatient, subacute settings (limited opportunity to practice with step 2, and a little opportunity to practice with step 3 due to time and facility constraints)
  • -Self-instruction is easier to introduce, focus on BADL and simple IADLs
  • GOAL-PLAN-CHECK-DO with simple IADL tasks
34
Q

EF Interventions

Self-Instruction Training Goal

A
  • Client verbalizes the action plan before and during the execution of the task
  • GOAL: gradually fade verbalization

**over verbalization –> whispering –> internal talk

35
Q

EF Interventions

Self-Instruction Training Levels of Support

A

Levels of Support
-Self-verbalization - talk through a script of the entire activity (high support)

  • Self-guidance - talk through key reminders of plan (medium support)
  • Self-questioning - pose a series of questions to double check performance (least support)
36
Q

EF Interventions

Problem Solving Training (PST)

A

Teach clients to break down problems into smaller steps and use a step-wise approach to problem solving

5 steps:
1. Problem Orientation - recognize situations where a problem exists that needs to be solved

  1. Problem Definition - identify the main relevant information versus irrelevant information
  2. Generating Alternatives - generate as many possible solutions to problem as possible
  3. Decision Making - weight pros and cons of potential solutions
  4. Solution Verification - recognize bad solutions, self-correct errors, try other solutions
37
Q

EF Interventions

Goal Management Training

A
  • Use across multiple tasks
  • provide cues and prompts to begin with –> gradually fade over time
  • Journaling - client keeps track of perceived deficits in task performance before and after training (looks at self-awareness changes)
38
Q

EF Interventions

PST vs GMT

A

Problem Solving Training (PST)

  • Focus on the problem (I forget things when going grocery shopping)
  • Focus is on developing multiple ways of addressing this problem
  • More appropriate if the client has awareness about when problems occur but does not know how to prevent or solve the problems
  • *More appropriate if the client doesn’t have awareness of has limited awareness about all the situations
  • *where a problem occurs (works on increasing awareness)

Goal Management Training (GMT)

  • Focus is on the occupation (getting dressed, going to the store)
  • Focus is on predicting potential problems that could occur
39
Q

EF Interventions

Time Pressure Management

A

-A structure problem solving strategy designed to deal with decreased processing speed
(address the problem of slow processing in multiple occupational areas)

3 Levels of decision making:

  • strategic (long-term plans)
  • Tactical (short-term, moment to moment adjustments in plans)
  • Operational (if tactical fail, rapid decisions under time pressure, during task performance)

GOAL: To use task analysis and modification to reduce daily time demands so that client can complete tasks despite slow processing speed

40
Q

EF Interventions
Compensatory Strategies

Environmental Modifications

A
  1. Reduce # of distractors in environment

More structure/less distraction –> less structure/more distraction

GOAL: achieve mastery in less demanding environment before moving to more demanding

  1. Cognitive scheduling/fatigue management to balance load of fatiguing decision making
41
Q

EF Interventions
Compensatory Strategies

External Cueing Devices

A
  1. Checklists - self-instructional strategy
  2. Pagers
  3. Organizers/notebooks

Cognition Final (4 decks)

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