presented by Karen L. McCulloch
Part of a multiple-part series of courses on cognitive impairments seen in neurologic conditions, the purpose of this course is to review issues relevant to physical therapists related to executive function and self-awareness. Although these cognitive functions are not the direct focus of physical rehabilitation, therapists should be knowledgeable about the effects of executive dysfunction and impaired self-awareness as they relate to safety and prognosis.
Karen L. McCulloch, PhD, PT, MS, NCS, is a Professor in Physical Therapy in the Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine at University of North Carolina – Chapel Hill, where she has taught entry-level and advanced-level students in neurorehabilitation since 1993. She has served in multiple roles within the Academy of Neurologic Physical Therapy, including the inaugural Director of Education, and has been honored with the Service to the Section Award and the APTA Lucy Blair Service Award. Karen has cared about individuals with traumatic brain injury since beginning as a PT in clinical practice, extending from moderate to severe brain injury to a recent focus on concussion. Her research has focused on developing outcome measures and interventions to improve active movement, balance, and functional mobility, with the aim to improve quality of life. She developed the Arm Motor Ability Test (for upper limb recovery following stroke) and the Walking and Remembering Test (for dual-task performance in older adults and individuals with acquired brain injury). She served as an ORISE Fellow with the Army Office of the Surgeon General, addressing TBI issues that affect individuals in military service. Her current research efforts are focused on wounded warriors with mild traumatic brain injury as part of a team that developed the Assessment of Military Multitask Performance, a test battery of challenging dual- and multi-task activities. She is currently leading a group writing a clinical practice guideline for physical therapy management of concussion, and is involved in intervention studies that address treatment for sports and military concussion. Funding support for her research has come from the Foundation for Physical Therapy, Centers for Disease Control and Prevention, National Institutes of Health, National Football League, and Department of Defense.
This chapter answers the question, "What is executive function?" Components of the brain involved in executive function are covered, highlighting the prefrontal cortex as a critical structure. Neurologic disorders and injuries that commonly demonstrate executive function deficits will be discussed.
Many executive function tests are administered by neuropsychologists or speech pathologists; however, these office-based tabletop or computer tests may not reflect "real-life" function clearly. This chapter covers different assessments used during executive function intervention and how a therapist can observe behaviors in their patient.
This chapter answers the question, "What is self-awareness?" Its influence on motivation and participation in therapy is discussed, as well as how it plays into the patient's safety and ability to be independent. Common self-awareness deficits and agnosias that may be present after a neurologic injury/damage are covered. Also described are screening and standardized measures for identifying executive function or self-awareness deficits.