Systematic behavioural observation of executive performance after brain injury.
OBJECTIVE
To develop an ecologically valid measure of executive functioning (i.e. Planning and Organization, Executive Memory, Initiation, Cognitive Shifting, Impulsivity, Sustained and Directed Attention, Error Detection, Error Correction and Time Management) during a functional chocolate brownie cooking task.


METHODS
In Study 1, the inter-rater reliability of a novel behavioural observation assessment method was assessed with 10 people with traumatic brain injury (TBI). In Study 2, 27 people with TBI and 16 healthy controls completed the functional task along with other measures of executive functioning to assess validity.


RESULTS
Intraclass correlation coefficients for six of the nine aspects of executive functioning ranged from .54 to 1.00. Percentage agreements for the remaining aspects ranged from 70% to 90%. Significant and non-significant, moderate, correlations were found between the functional cooking task and standard neuropsychological measures. The healthy control group performed better than the TBI group in six areas (d = 0.56 to 1.23).


CONCLUSIONS
In this initial trial of a novel assessment method, adequate inter-rater reliability was found. The measure was associated with standard neuropsychological measures, and our healthy control group performed better than the TBI group. The measure appears to be an ecologically valid measure of executive functioning.
a School of Psychology, Massey University , Wellington , New Zealand.
Mark W
MW
Lewis
b Centre for eHealth, Auckland University of Technology , Auckland , New Zealand.|c Centre for Person Centred Research, Auckland University of Technology , Auckland , New Zealand.
Duncan R
DR
Babbage
a School of Psychology, Massey University , Wellington , New Zealand.
Janet M
JM
Leathem
D000203:Activities of Daily Living; D000328:Adult; D000067289:Behavior Observation Techniques; D001930:Brain Injuries / Q000150:complications*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015203:Reproducibility of Results; D015599:Trauma Severity Indices; D055815:Young Adult
Executive functioning; assessment; cognition; cognitive functioning; cognitive performance; cognitive rehabilitation; ecological validity; neuropsychological assessment