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Examining the role of BACKGROUND
Executive Functions to predict  Acquired brain injury affects information
processing capacities difficulties in
Functional Performance after volition, planning, purposive action, and action
Acquired Brain Injury monitoring aspects of task performance (Yogev
et al, 2008)
 Routine cognitive testing in the acute hospital
Presented By : Malabika Ghosh setting is not sensitive to subtle executive
Clinical Lead Occupational Therapist- Lancashire dysfunction, and its impact on functional
Teaching Hospitals
performance (Wilby,2005)
PhD Student– Lancaster University
E-Mail: malkaush99@yahoo.com
Executive Functions-
What are they?
Executive Functions
 These are higher cognitive processes that
modify information from many cortical
systems to modulate and produce
behaviour (Fuster, 1999)
Goal directed Engaging in
actions day to day tasks
Control of
 It has cognitive and behavioural
attention
components ( Fuster, 1999)
resources
The Supervisory Role Of Executive Functions RATIONALE
(Gazzaniga et al, 2002 & Fuster, 1999)
Planning Attention Error Correction Information
 Occupational therapy assessment in the acute
setting aims to establish functional baseline, and
Inhibition Processing
predict functional performance and needs to be
of habitual responsive to pressures for discharge alongside
responses ensuring risks are minimised.
 Cognitive screening on admission is advised to
Behavioural help predict expected functional recovery
Cognitive
Component
Executive Functions Component (Sands et al, 2003)
 Inspite of routine assessments and advice,
families and carers find it really hard to deal with
subtle aspects of behaviours and functioning.
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OBJECTIVES METHOD
 A Practice Analysis
 To evaluate cognitive and executive dysfunction,
to predict functional performance, and need for  15 consecutive patients (11 males, 4 females) –
support services after acquired brain injury, in diagnosed with acquired brain injury – admitted
the acute setting. to the acute neurosurgical ward - referred to
Occupational Therapy Services.
 Use of behavioural observations during test
administration and functional assessments, to  Neurosurgical intervention completed
augment assessment findings.
METHOD contd. RESULTS
 Patients scored between 23 to 77 out of 100.
Test norms indicate a score of 89 or above is required to reflect effective
The Addenbrooke’s Cognitive Assessment participation in everyday tasks
Battery used as the Standardised Test  6 patients unable to complete the test in one session,
for assessment of cognition and executive due to eg. fatigue, & inability to sustain engagement for
functions alongside behavioural the duration of the assessment
observations (Wilby,2005)
 Main Problem Areas identified:
 Attention
Memory
This has test of cognition ( MMSE) 
 Verbal fluency
incorporated in it (Mioshi et al, 2006).
RESULTS contd. RESULTS contd.
 Fluency : most impaired component  Attention and Concentration: second most
affected component.
 13 out of 15 patients i.e 86% of patients
demonstrated difficulties  12 out of 15 patients demonstrated difficulties i.e
80 %.
 Functional Implications :
 Patients become over-focussed on particular aspects  Functional Implications:
of a task  Inability to focus sufficiently to support new learning
 Cannot initiate engagement in activities in a timely  Allocating priority to tasks leading to difficulties in
and efficient manner making informed choices
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IMPLICATIONS ON PATIENT
RESULTS contd. MANAGEMENT
 MEMORY: next most affected component  Allpatients needed support services for
discharge
 11 out of 15 patients affected i.e 73 %
 Patients discharged home with ongoing
 Functional Implications: close monitoring by family/carer – 66%
 Ability to learn new skills  Patients needing support services in the
 Recall of recent pertinent information severely community ( eg. ABI Team) – 46%
compromised
 Patients needing Residential care – 20%
 Retrieval of long term memories was less affected  Patients needing further inpatient
 Patients were able to tap into automatic schemas for
function rehabilitation before going home – 13%
CONCLUSION SUMMARY
 Occupational Therapy plays a unique role in assessing
functional performance  Efficient and effective methods of inquiry to
extrapolate executive dysfunction helps to
 The acute setting requires quick, efficient and effective identify issues which have an impact on
methods of data inquiry
functional performance following acquired brain
 Need for ongoing management of disability following
injury
acquired brain injury and this has a profound impact on
the wider family and support networks
 Further research in this field on a larger patient
 It was possible to make valuable suggestions about
group will help provide valuable insights which
patient’s needs due to holistic assessment approach will improve quality of patient care.
used.
 Executive functions in addition to cognitive testing should
be routinely considered for all patients, following
acquired brain injury
REFERENCES
 Fuster JM. 1999. ‘Synopsis of function and dysfunction of the frontal lobe’.
Acta Psychhiatr Scand Suppl; 395:51-57.
 Gazzaniga M.S. Ivry R. Mangun, G. (2002) ‘Cognitive Neuroscience- the
Biology of the Mind’ 2nd Ed. Norton and Company Inc. London.
• Mioshi E, dawson K, Mitchell J et al ( 2006) ‘ The Addenbrooke’s Cognitive
Assessment Revised ( ACE-R): a brief cognitive test battery for dementia
screening’ International Journal Of Geriatric Psychiatry; 21:1078-1085.
 Sands LP, Yaffe K, Covinsky K ( 2003) ‘ Cognitive Screening predicts
magnitude of functional recovery from admission to 3 months after
discharge in hospitalised elders’. Journal of Gerontol A Biol Sci Med Sci;
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 Van Iersal MB, Verbeek AL, Bloem BR et al, (2006) ‘Frail elderly patients
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