The Executive Function Task Application Model (EFTAM): development and application

The Executive Function Task

Application Model (EFTAM):

development and application

Charlie Chung

_{, Alex Pollock}

_{, Tanya Campbell}

_{, Brian}

Durward

1_{Occupational Therapy, NHS Fife, Dunfermline}

2_{Nursing Midwifery and Allied Health Professions Research Unit, Glasgow} 3_{Occupational Rehabilitation Services, Stirling}

4_{NHS Education Scotland, Edinburgh}

Executive Function after Stroke: Implications for

Rehabilitation of Activities of Daily Living

The model was developed from the

literature review of a PhD

This presentation will cover:



Background



Executive function definition



Neuropsychology and occupational therapy

theories which informed model development



The Executive Function Task Application

Model



Case examples

Background



Following stroke, up to 75% of patients will

experience impairment of executive function

(Riepe et al. 2003)



Executive dysfunction may limit rehabilitation

potential.



Existing assessment methods cannot determine

how executive function is being applied to

real-life tasks.

“refers to a set of skills or processes

required for effective problem-solving,

planning and organisation,

self-monitoring, initiation, error correction

and behavioural regulation”

(Evans 2003) p. 53

The neuropsychology behind the

Executive Function Task

Executive Function Parallel Systems

Executive function is required for

tasks which:



Are novel



Are complex



Are difficult



Are dangerous



Require error correction

Task Concept

There are five stages to the aspect of client engagement which are

essential for productive action. These are:

1) Task selection, where the individual makes the decision to

engage in the activity.

2) Task execution, where the individual undertakes the process of

the activity.

3) Task completion, where the individual is aware that the end of

the activity has been reached.

4) Task evaluation, where the individual can evaluate the quality of

the activity outcome.

5) Task satisfaction, where the individual can achieve a positive

emotional response from the activity engagement.

CASE EXAMPLES

Upper body dressing task with verbalisation of

reasoning

Mary is an 86 year old female who experienced a

right hemisphere stroke which resulted in a left

sided weakness. Her performance was

characterised by:

•

Difficulty verbalising reasoning – short two and

three word answers

•

Unable to move from one part of the task to the

next

•

Required assistance to put on a cardigan

•

Expressed satisfaction with the dressing process

Janet is a 76 year old female with a right hemisphere

stroke resulting in severe left sided weakness. Her

performance was characterised by:

•

Able to verbalise a detailed account of her dressing

procedure.

•

Unable to solve the problem when her cardigan

became caught under her weak arm.

•

Able to verbalise that she was aware of the problem.

•

Unable to identify the source of the problem and

required assistance

•

Expressed dissatisfaction with the dressing process

INTERVENTION EXAMPLES

Task selection

Salience and external inhibition of rules (Amos 2002)

Self Awareness training - condition education, self

monitoring and judgment training, concrete feedback,

goal setting exercises (Cheng 2006; Goverover 2007)

Verbalisation, chunking and pacing for information

processing (Dirette 1999)

Planning

Pre-planning for anticipated obstacles (Goverover 2007)

Autobiographical episodic memory cueing procedure

(Hewitt 2007)

Goal Management Training steps 3 and 4 – list the steps

and learn the steps (Levine 2000)

Problem solving training - alternative strategy decision

making (von Cramon 1991)

Execution

Group treatment for problem solving – recognising

cognitive distortions, misattributes and illogical

thinking – role play (Rath 2003)

Multifaceted treatment of executive dysfunction -

initiation, execution and regulation training

(Spikman 2010)

Evaluation

Video Feedback (Schmidt 2013)

1.

Avoid focussing only on repetitive practice

2.

Verbalising thought processes can provide a

means in which to create EFTAM profiles.

3.

Allow time during intervention for adequate

awareness training, planning, evaluation and

reflection

4.

As a team, consider using an executive function

intervention for appropriate patients.

References

Amos, A. 2002, "Remediating deficits of switching attention in patients with acquired brain injury", Brain Injury, vol. 16, no. 5, pp. 407-413.

Cheng, S. K. W. & Man, D. W. K. 2006, "Management of impaired self-awareness in persons with traumatic brain injury", Brain Injury, vol. 20, no. 6, pp. 621-628.

Dirette, D. K., Hinojosa, J., & Carnevale, G. J. 1999, "Comparison of remedial and

compensatory interventions for adults with acquired brain injuries", Journal of Head Trauma

Rehabilitation, vol. 14, no. 6, pp. 595-601.

du Toit, H. 1991, Patient Volition and Action in Occupational Therapy IN Occupational Therapy in

Psychiatry and Mental Health, Fourth edn, Whurr, London and Philadelphia.

Evans, J. J. 2003, "Rehabilitation of Executive Deficits," in Neuropsychological Rehabilitation:

Theory and Practice, B. A. Wilson, ed., Psychology Press, pp. 53-70.

Gazzaniga, M. S., Ivry, R. B., & Mangun, G. R. 2002, "Executive Functions and Frontal Lobes," in Cognitive Neuroscience, Second edn, Norton, pp. 499-536.

References

Goverover, Y., Johnston, M. V., Toglia, J., & Deluca, J. 2007, "Treatment to improve self-awareness in persons with acquired brain injury", Brain Injury: [BI], vol. 21, no. 9, pp. 913-923.

Hewitt, J., Evans, J. J., & Dritschel, B. Theory driven rehabilitation of executive functioning: Improving planning skills in people with traumatic brain injury through the use of an

autobiographical episodic memory cueing procedure. [References]. Neuropsychologia 44[8], 1468-1474. 2006.

Levine, B., Robertson, I. H., Clare, L., Carter, G., Hong, J., Wilson, B. A., Duncan, J., & Stuss, D. T. 2000, "Rehabilitation of executive functioning: an experimental-clinical validation of goal

management training", Journal of the International Neuropsychological Society, vol. 6, no. 3, pp. 299-312.

Rath, J. F., Simon, D., Langenbahn, D. M., Sherr, R. L., & Diller, L. 2003, "Group treatment of problem-solving deficits in outpatients with traumatic brain injury: A randomised outcome study", Neuropsychological Rehabilitation, vol. 13, no. 4, pp. 461-488.

Riepe, M. W., Riss, S., Bittner, D., & Huber, R. 2003, "Screening for cognitive impairment in

patients with acute stroke. [References]", Dementia and Geriatric Cognitive Disorders, vol. 17, no. 1-2, pp. 49-53.

References

Schmidt, J., Fleming, J., Ownsworth, T., & Lannin, N. A. 2013, "Video feedback on functional task performance improves self-awareness after traumatic brain injury: a randomized controlled trial", Neurorehabilitation and Neural Repair, vol. 27, no. 4, pp. 316-324.

Sohlberg, M. M., Mateer, C. A., & Stuss, D. T. 1993, "Contemporary approaches to the

management of executive control dysfunction", Journal of Head Trauma Rehabilitation, vol. 8, no. 1, pp. 45-58.

Spikman, J. M., Boelen, D. H. E., Lamberts, K. F., Brouwer, W. H., & Fasotti, L. 2010, "Effects of a multifaceted treatment program for executive dysfunction after acquired brain injury on

indications of executive functioning in daily life", Journal of the International Neuropsychological

Society, vol. 16, no. 1, pp. 118-129.

von Cramon, D. Y., Matthes-von Cramon, G., & Mai, N. 1991, "Problem Solving Deficits in Brain Injured Patients: a Therapeutic Approach", Neuropsychol Rehabil, vol. 1, pp. 45-64.