Executive function during dressing : expression through talking and actions by people with and without stroke

• Main Author: Chung, Charlie S. Y.
• Published: Glasgow Caledonian University 2014
• Subjects: 616.81
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.687434

Introduction: Executive function (EF) is impaired In up to 75% of patients following stroke and can hinder recovery. Despite this high incidence of executive dysfunction (EO), interventions to improve task performance focus on repetitive practice which does not address EF development. To explore further options for addressing ED following stroke, the work in this thesis includes three key studies: 1. Review of executive function research and development of the e){executive function task application model (EFTAM): An exploration of components within established definitions of EF suggested that EF can be explained by five core components: concept formation, planning, initiation, inhibition and flexibility. However, within existing EF models the task process was limited to one stage, while, in contrast, occupational performance models conceptualize tasks as multifactorial. This suggested the need for a new model which integrated models of EF and occupational performance. Hence the EFTAM was constructed with the key aim of providing a model to demonstrate how EF is applied at the various stages of task performance. 2. Cochrane systematic review of cognitive rehabilitation: This review found insufficient evidence to support the effectiveness of cognitive rehabilitation for improving EF after stroke and acquired brain injury. The review also identified limitations relating to assessment of EF leading to the hypothesis that instructing patients to verbalise their thoughts may be a method of determining how patients apply EF during tasks. Thus, a qualitative study to explore how participants expressed EF through their actions and talking was indicated. 3. Ethnomethodological study to explore how individuals express EF through talking and actions: 20 participants with stroke, upper limb injury and a healthy individual were Video-recorded during a semi-structured interview including an upper body dressing task. Data analysis, using a narrative analysis framework, and based around the EF core components and the EFTAM, explored how EF was expressed during application to the task. The participants demonstrated several patterns of EF expression and dressing ability from their combined actions and talking. Conclusion: This thesis provides a comprehensive synthesis of current evidence relating to interventions for EF and identifies the clear limitation within current literature as the lack of suitable assessment tools. A new model integrating EF and task performance theories has been generated with the potential to provide a useful tool for profiling EF during task performance. Innovative methods have been used to explore storytelling during task performance, providing new insights in relation to how EF is applied to the different stages of a task. Future research should include further exploration of the application of these methods to a range of different tasks to unlock the potential of storytelling during task performance. This could enhance our understanding of EF and lead to the development of a new standardised EF assessment and effective interventions to treat ED.