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Clinical Neuropsych - Chapter 16 - Executive Functions and Motor Performance

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 16 – Executive Functions -the most complex behaviours, are the ability to respond in an adaptive manner to novel situations and are also the basis of many cognitive, emotional, and social skills -can be conceptualized as having four components 1. Volition 2. Planning and decision making 3. Purposive action 4. Effective performance -each executive function involves a distinctive set of activity related behaviours necessary for appropriate, socially responsible, and effectively self-serving adult conduct -defective executive behaviour typically involves a cluster of deficiencies of which one or two may be especially prominent -subcortical as well as cortical damage can impair executive function -a major obstacle in examining executive functions is maintaining the structure of the examination setting, while at the same time allowing patients the leeway to make their own decisions Volition - refers to the complex process of determining what one needs or wants and conceptualizing some kind of future realization of that need or want -it is the capacity for intentional behaviour -many individuals who lack volitional capacity simply do not think of anything to do -particularly when deficits are subtle, it becomes important to identify the presence of a volition defect -may be hard, due to the lack of formal tests that measure volition -volitionally competent persons make spontaneous and appropriate conversation -or are actively engaged in the examination proceedings (participating in test, placing caps back on pens, handing back test material Self-Awareness -awareness of one’s physical status -inaccurate body images can occur as distortions, perceptions of more severe impairment than is the case, or as feelings of being intact when actually impaired -awareness of the environment and situational context -the extent to which patients are aware of and responsive to what goes on around them is likely to be reflected in their use of environmental cues -social awareness -may show up in reports or observations of poor grooming and childish or crude behaviour that contrast sharply with a premorbid history of social competence Planning and Decision Making -identification and organization of the steps and elements needed to carry out an intention or achieve a goal constitute planning and involve a number of capacities -must be able to conceptualize changes from present circumstances, deal objectively with oneself in relation to the environment, view the environment objectively, conceive alternatives, weigh and make choices, and entertain both sequential and hierarchical ideas Maze Tracing -designed to yield data about the highest levels of mental functioning involving planning and foresight -very sensitive in eliciting planning deficits, but not commonly used in testing situations Porteus Maze Test -successful trial when the subjects traces the maze without entering blind alleys -not timed, and may take some subjects more than an hour to complete -some educational effects, as well as age effects that present as pervasive errors in subjects aged 45-65 years old -an executive function test sensitive to prefrontal damage, and maze test scores have successfully predicted the severity of brain disease Purposive Action -the translation of an intention or plan into productive, self-serving activity requires the actor to initiate, maintain, switch, and stop sequences of complex behaviour in an orderly and integrated manner -deficits can affect the ability to carry out reasonable plans regardless of motivation, knowledge, or capacity to perform the activity -deficits may affect large-scale purposive activities or the regulation and fine-tuning of discrete intentional activities or the regulation and fine-tuning of discrete intentional acts or complex movements -lack of persistence -extent to which patients have difficulty sticking with a task and completing projects -perseveration -extent to which patients get “stuck” on a particular behaviour, keep repeating the same activities over and over, or try the same approach to a problem even if it isn’t working -lack of stamina -extent to which patients becomes
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