Ecological Assessment of Everyday Executive Functioning at Home and at School using the BRIEF Questionnaire following Childhood Traumatic Brain Injury (TBI)

IntroductionCognitive and behavioural aspects of executive functioning (EF) are frequently impaired following childhood TBI. The Behavior Rating Inventory of Executive Function (BRIEF) questionnaire provides an ecological assessment of EFs in everyday life in home and school environments. The aims of this study were to describe the dysexecutive disorders in children with TBI using the BRIEF; to compare parent- and teacher-ratings and to analyse the demographic and medical variables influencing outcome.MethodsParticipants: Children/adolescents aged 5–17 years 11 months, referred to a paediatric rehabilitation department following TBI. Outcome measures: the parent–and the teacher-report of the BRIEF were collected during neuropsychological assessment (2009–2014), as well as the teacher-report (from 2014). Age at injury and assessment, parental education and TBI severity were collected.Results194 patients (142 boys) participated in the study [mild (n=13), moderate (n=12) or severe (n=169: mean duration of coma 7.2 days; SD=6.5)]. 193 parent-reports and 28 complete teacher reports of the BRIEF were available. Mean age at injury/assessment were 6.9 (SD=4.4), and 11.8 (SD=3.5) years respectively. According to parent-ratings, children had significantly elevated scores in all BRIEF indices [Global Executive Composite (GEC), Behaviour Regulation Index (BRI), Metacognition Index (MI)], and subscales (mean T-scores 61–64; all P<.0001), with 24% to 48.0% scoring in the clinical range. Teachers’ ratings indicated similar deficits in all sub-scales (mean T-scores 63–70; all P<.001), with 39.3–57.2% scoring in the clinical range. For patients with teacher and parent-reports (n=27), no significant difference was found between parent and teacher ratings, which were significantly correlated (r: .44–.72). Regression analyses indicated that GEC was significantly predicted by older age at assessment. The regression model for BRI was not significant. For MI, younger age at injury and older age at assessment were significant predictors.Discussion and conclusionThis study highlights elevated levels of executive dysfunction in everyday life following childhood TBI, evident in home and school environments. Younger age at injury seems to influence the cognitive rather than the behavioural aspects of EFs, whereas older age at assessment is related to higher levels of complaints, probably due to the increasing levels of expectations

Data for: Charlie Chaplin and gesture training in severe aphasia: a randomized double-blind single-case experimental design.

Supplemental data 1: details of gesture scores analysesSupplemental Data 2: Naming result

Data for: Charlie Chaplin and gesture training in severe aphasia: a randomized double-blind single-case experimental design.

Supplemental data 1: details of gesture scores analysesSupplemental Data 2: Naming resultsTHIS DATASET IS ARCHIVED AT DANS/EASY, BUT NOT ACCESSIBLE HERE. TO VIEW A LIST OF FILES AND ACCESS THE FILES IN THIS DATASET CLICK ON THE DOI-LINK ABOV

Feasibility of a shorter Goal Attainment Scaling method for a pediatric spasticity clinic — The 3-milestones GAS

International audienceBackgroundGoal Attainment Scaling (GAS) is a method for writing personalized evaluation scales to quantify progress toward defined goals. It is useful in rehabilitation but is hampered by the experience required to adequately “predict” the possible outcomes relating to a particular goal before treatment and the time needed to describe all 5 levels of the scale. Here we aimed to investigate the feasibility of using GAS in a clinical setting of a pediatric spasticity clinic with a shorter method, the “3-milestones” GAS (goal setting with 3 levels and goal rating with the classical 5 levels). Secondary aims were to (1) analyze the types of goals children's therapists set for botulinum toxin treatment and (2) compare the score distribution (and therefore the ability to predict outcome) by goal type.MethodsTherapists were trained in GAS writing and prepared GAS scales in the regional spasticity-management clinic they attended with their patients and families. The study included all GAS scales written during a 2-year period. GAS score distribution across the 5 GAS levels was examined to assess whether the therapist could reliably predict outcome and whether the 3-milestones GAS yielded similar distributions as the original GAS method.ResultsIn total, 541 GAS scales were written and showed the expected score distribution. Most scales (55%) referred to movement quality goals and fewer (29%) to family goals and activity domains.ConclusionThe 3-milestones GAS method was feasible within the time constraints of the spasticity clinic and could be used by local therapists in cooperation with the hospital team

Rehabilitation of executive functions

Executive functions (EF) are a complex set of supervisory functions that are involved in the control of mental processes. Burgess and Simons describe EF as those capacities that make people effective in the real world, allowing them to adapt to new situations and to develop and pursue their life goals in a constructive way. EF is an umbrella term, incorporating a range of aspects that are equally important in complex task behaviour, but can be differentially affected by brain damage. Miyake and colleagues applied a factor analytical approach to find out whether core elements of EF could be identified from different tasks. They used standard neuropsychological tests supposed to measure EF in healthy subjects and found three executive components, which they labelled mental flexibility, updating working memory (WM) and inhibition. WM supports inhibitory control, but inhibitory control in turn supports working memory by suppressing irrelevant information from WM limited-capacity workspace