A systematic review of assessments for identifying executive function impairment in adults with acquired brain injury

Profiles of executive functioning following traumatic brain injury and stroke using the assessment of participation and executive functions: combined cross-sectional and longitudinal designs

OBJECTIVES

The Assessment of Participation and Executive Functions (A-PEX) evaluates executive functioning through daily participation in complex daily activities. This study examines its ability to discriminate between executive functioning profiles post-traumatic brain injury and post-stroke and its sensitivity to changes.

DESIGN

Cross-sectional with a longitudinal component.

PATIENTS

Adults with post-traumatic brain injury (n = 28) and post-stroke (n = 26) in a rehabilitation facility.

METHODS

Patients were administered the A-PEX, Multiple Errands Test-Hospital version and Color Trail Test at 2 time-points 1 month apart. The Montreal Cognitive Assessment was administered at the first time-point, and Executive Functions Performance Test's Internet-based Bill Payment subtest at the second. The analysis used Mann-Whitney and Wilcoxon signed-rank tests.

RESULTS

The stroke group's A-PEX scores were higher than the traumatic brain injury group's at the first time-point (p < 0.05). No differences were found in the other assessments. Within-group differences in both groups were significant in the A-PEX (-3.7 < r < - 2.3, p < 0.05) and Multiple Errands Test-Hospital version (-3.4 < r < -3.3, p < 0.01).

CONCLUSION

The A-PEX may provide valuable information about the uniqueness of executive functioning profiles and patients' progress.

Response inhibition in Veterans with a history of mild traumatic brain injury: The role of self-reported complaints in objective performance

INTRODUCTION

Although objective deficits in response inhibition (RI) have been detected in civilians with mild traumatic brain injury (mTBI), it remains unclear whether objective RI is worse in military Veterans with mTBI despite the prevalence of self-reported disinhibition. Assessing RI in Veterans is critical due to their unique characteristics, including combat and blast exposure, in addition to the prevalence of psychiatric comorbidity. Therefore, the aims of this study were to (1) examine RI performance in Veterans with mTBI compared to non-mTBI Veterans and (2) compare RI performance in well-defined subgroups of mTBI Veterans with and without self-reported complaints of disinhibition to non-mTBI Veterans.

METHOD

53 mTBI Veterans and 37 non-mTBI Veterans completed a Go/No-Go RI task and measures of self-reported disinhibition (Frontal Systems Behavior Scale) and psychiatric symptoms. ANCOVAs covarying for mood and demographics compared RI performances of the non-mTBI Veterans to (1) the total sample of mTBI Veterans (n= 53) and to (2) mTBI Veterans with elevated (t-score ≥ 60; mTBI-SubjDis; n= 23) and low (t-score < 60; mTBI-NoSubjDis; n= 30) levels of self-reported disinhibition.

RESULTS

There were no significant differences in RI between the mTBI group as a whole and the non-mTBI Veterans group. However, when Veterans with mTBI were divided into groups by clinically-significant concern about their disinhibition, the mTBI-SubjDis group demonstrated significantly worse RI than the mTBI-NoSubjDis and non-mTBI Veteran groups. No significant differences in RI performance were observed between the mTBI-NoSubjDis and non-mTBI Veteran groups.

CONCLUSIONS

Results indicate that mTBI Veterans with elevated levels of self-reported disinhibition show diminished performance on objective measures of RI, independent of mood. Findings highlight the unique contribution of subjective complaints on executive functioning in mTBI, and they underscore the importance of assessing cognitive complaints in order to identify those most at risk for poor-long term outcomes.

The inter-relationship between acquired brain injury, substance use and homelessness; the impact of adverse childhood experiences: an interpretative phenomenological analysis study

PURPOSE

Acquired Brain Injuries, caused by a range of illnesses and injuries, can lead to long-term difficulties for individuals; mental health problems, cognitive and executive impairment and psychosocial problems including relationship breakdown, substance abuse and potentially homelessness. The study aimed to seek and gain a more definitive understanding of the inter-relationship of Acquired Brain Injury, substance abuse and homelessness by identifying key themes associated with the inter-relationship between these variables.

MATERIALS AND METHODS

The study recruited eight participants through homeless organisations and treatment centres. Participants were screened for suitability (Brain Injury Screening Index; Drug Abuse Screening Tool; Alcohol Use Disorders Identification Test and then participated in recorded semi-structured interviews, transcribed and analysed using Interpretative Phenomenological Analysis.

RESULTS

The study identified five master themes: Adverse Childhood Experiences and Trauma; Mental Health; Cognitive Decline and Executive Function; Services; Relationships.

CONCLUSION

Healthcare professionals need to engage with children, their families, and adults, who have been exposed to adverse childhood experiences and should employ routine screening tools for brain injury to ensure their presence is factored into developing appropriate models of intervention.IMPLICATIONS FOR REHABILITATIONNeed person-centred approaches to intervention for those with acquired brain injury who are homeless and have substance abuse issues.Need to screen for the presence of acquired brain injury when engaging with individuals who are homeless or have substance abuse.Need screening of acquired brain injury and adverse childhood experiences to improve access to services post-brain injury.

Assessment of executive function in bilingual adults with history of mild traumatic brain injury

Background and objective:

Adults with a history of traumatic brain injury (TBI) often show deficits in executive function (EF), including the ability to inhibit, switch, and attend to task relevant information. Although performances differences between bilinguals and monolinguals have been observed in EF tasks, there is little research on the effect of TBI on EF in bilinguals. In this study, an ecologically valid standardized measure and experimental computerized tasks of EF were administered to Spanish-English bilingual adults with and without history of mild traumatic brain injury (mTBI).

Method:

Twenty-two bilinguals with a history of mTBI [mean age=20.1 years, SD=3.7; education=13.4 years, SD=0.7] and 20 control bilinguals [mean age=20.8 years, SD=3.6; education=13.7 years, SD=1.1], matched for age and education, completed language proficiency questionnaires, the Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES), English and Spanish language assessments, and a Flanker task (a test of inhibition).

Results:

Performance was analyzed using analyses of covariance. The results revealed that bilinguals with a history of mTBI performed worse on both the standardized assessment (FAVRES) and inhibition task. Interestingly, self-reported EF deficits were consistent with performance on these measures.

Conclusion:

The findings of this study provide useful information regarding assessment of EF deficits in bilinguals with a history mTBI. Computerized experimental tasks of EF may also prove useful in the assessment of EF in individuals with mTBI.

Normative Study of the Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES) Test in the French-Canadian Population

PURPOSE

The Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES; MacDonald, 2005) test was designed for use by speech-language pathologists to assess verbal reasoning, complex comprehension, discourse, and executive skills during performance on a set of challenging and ecologically valid functional tasks. A recent French version of this test was translated from English; however, it had not undergone standardization. The development of normative data that are linguistically and culturally sensitive to the target population is of importance. The present study aimed to establish normative data for the French version of the FAVRES, a commonly used test with native French-speaking patients with traumatic brain injury in Québec, Canada.

METHOD

The normative sample consisted of 181 healthy French-speaking adults from various regions across the province of Québec. Age and years of education were factored into the normative model.

RESULTS

Results indicate that age was significantly associated with performance on time, accuracy, reasoning subskills, and rationale criteria, whereas the level of education was significantly associated with accuracy and rationale.

CONCLUSION

Overall, mean scores on each criterion were relatively lower than in the original English version, which reinforces the importance of using the present normative data when interpreting performance of French speakers who have sustained a traumatic brain injury.

Relatively effortless listening promotes understanding and recall of medical instructions in older adults

Communication success under adverse conditions requires efficient and effective recruitment of both bottom-up (sensori-perceptual) and top-down (cognitive-linguistic) resources to decode the intended auditory-verbal message. Employing these limited capacity resources has been shown to vary across the lifespan, with evidence indicating that younger adults out-perform older adults for both comprehension and memory of the message. This study examined how sources of interference arising from the speaker (message spoken with conversational vs. clear speech technique), the listener (hearing-listening and cognitive-linguistic factors), and the environment (in competing speech babble noise vs. quiet) interact and influence learning and memory performance using more ecologically valid methods than has been done previously. The results suggest that when older adults listened to complex medical prescription instructions with “clear speech,” (presented at audible levels through insertion earphones) their learning efficiency, immediate, and delayed memory performance improved relative to their performance when they listened with a normal conversational speech rate (presented at audible levels in sound field). This better learning and memory performance for clear speech listening was maintained even in the presence of speech babble noise. The finding that there was the largest learning-practice effect on 2nd trial performance in the conversational speech when the clear speech listening condition was first is suggestive of greater experience-dependent perceptual learning or adaptation to the speaker's speech and voice pattern in clear speech. This suggests that experience-dependent perceptual learning plays a role in facilitating the language processing and comprehension of a message and subsequent memory encoding.