Assessment of subcomponents of executive functioning in ecologically valid settings: the goal processing scale.
OBJECTIVE
To validate a new functional assessment tool, the Goal Processing Scale (GPS), and to apply it for testing for sources of dysfunction in patients with acquired brain injury. Determining which component processes of executive functioning underlie poor performance in complex, low-structure settings would be valuable for the assessment of deficits and for evaluating the effectiveness of treatments.


METHODS
Nineteen individuals with chronic acquired brain injury (mean age = 41.4 years; chronicity: 6 months to 39 years).


METHODS
Two functional assessment tasks: (1) GPS, which evaluates functional performance in the context of achieving a goal in a "real-world" setting, with rating scales measuring overall performance and 8 subdomains of executive functioning; (2) Multiple Errands Test, an unstructured assessment of ability to adhere to rules and complete multiple "real-world" tasks in a short time; and (3) a neuropsychological battery.


RESULTS
Intraclass correlation coefficients for 2 independent raters ranged from 0.75 to 0.98 for the GPS overall composite score and the subdomain scores. Performance on GPS overall and several subdomain scores correlated with performance on the Multiple Errands Test. Working memory and learning/memory neuropsychological measures predicted functional performance as measured using the GPS.


CONCLUSIONS
The GPS shows high interrater reliability, suggesting convergent validity with an established functional performance measure, and produces useful information regarding strengths and weaknesses in different subdomains of executive functioning. Working memory and learning/memory appear to be key determinants of goal-directed functioning for these individuals with brain injury.
Veteran's Administration Medical Center, San Francisco (Drs Novakovic-Agopian, Chen, Abrams, McKim, and Murphy and Mss Rossi and Binder); Veteran's Administration Northern California Health Care System, Martinez (Drs Novakovic-Agopian, Chen, D'Esposito, and Muir and Ms Binder); California Pacific Regional Rehabilitation Center, San Francisco (Drs Novakovic-Agopian and Rome; Mss Rossi, Kennedy, and Castelli; and Mr Garfinkle), University of California, San Francisco (Drs Novakovic-Agopian, Chen, Abrams, and Hills); University of California, Berkeley (Drs Chen and D'Esposito), California; and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Dr Turner).
Tatjana
T
Novakovic-Agopian
Anthony J-W
AJ
Chen
Scott
S
Rome
Annemarie
A
Rossi
Gary
G
Abrams
Mark
M
DʼEsposito
Gary
G
Turner
Ryan
R
McKim
Jim
J
Muir
Nancy
N
Hills
Cathy
C
Kennedy
John
J
Garfinkle
Michelle
M
Murphy
Deborah
D
Binder
Holli
H
Castelli
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis* / Q000534:rehabilitation*; D002648:Child; D015331:Cohort Studies; D056344:Executive Function; D005260:Female; D015600:Glasgow Coma Scale; D006040:Goals; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008570:Memory, Short-Term / Q000502:physiology*; D009483:Neuropsychological Tests; D015588:Observer Variation; D011446:Prospective Studies; D011594:Psychometrics; D018434:Sickness Impact Profile; D013647:Task Performance and Analysis; D016896:Treatment Outcome; D055815:Young Adult