Executive Function – revisited

As the blog progresses we will republish posts that garnered a lot of page views, especially those that have to do with research or opinion that are consistent with the theme of concussions as we currently understand them.  This post originally appeared November 2010.

Research is beginning to suggest that chronic exposure and delayed recovery from TBI (see concussions) is directly effecting executive functioning of the brain. In August 2010, the Journal of Clinical and Experimental Neuropsychology published an abstract on an experiment from Finland.

Hartikainen, Waljas, et al performed executive reaction time testing, standard neuropsych tests and diffusion tensor imaging on their subjects and found that there were significant differences in scores between those that still had symptoms and those that have fully recovered. The issue and problem that presented itself is that the scores indicated trouble in executive functioning of the “still-injured” brain as opposed to the recovered.

MindDisorders.com defines Executive Function as;

The term executive function describes a set of cognitive abilities that control and regulate other abilities and behaviors. Executive functions are necessary for goal-directed behavior. They include the ability to initiate and stop actions, to monitor and change behavior as needed, and to plan future behavior when faced with novel tasks and situations. Executive functions allow us to anticipate outcomes and adapt to changing situations. The ability to form concepts and think abstractly are often considered components of executive function.

These are high level abilities that influence the most basic things like attention, memory and motor functions. Along with the basics the executive functions of the brain allow each of us to adapt and perform in real life situations. Permanent or temporary deficits to the executive functioning of the brain are associated with; obsessive-compulsive disorder, depression, ADD/ADHD, Tourette’s Syndrome, schizophrenia, and autism.

There has been suspicion about how concussion symptoms specifically affect the brain, this could be our first hard evidence of the executive function angle. As with previous studies, actually quantifying executive function is difficult, more research is needed and welcomed.

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Clincal Utility of ImPACT: Mayers & Redick

A new article on the review of ImPACT and it utility of use in determining return-to-play status of a post concussed individual has been published in the Journal of Clinical and Experimental Psychology.  (Lester B. Mayers & Thomas S. Redick (2011): Clinical utility of ImPACT assessment for postconcussion return-to-play counseling: Psychometric issues, Journal of Clinical and Experimental Neuropsychology, DOI:10.1080/13803395.2011.630655)

The abstract reads; Computerized neuropsychological testing is commonly utilized in the management of sport-related concussion. In particular, the Immediate Postconcussion Assessment and Cognitive Testing 2.0 program (ImPACT) is widely used to assess the cognitive functioning of athletes before and after a concussion.We review the evidence for the clinical utility of this program in terms of validity, reliability, and use in return-to-play decisions. We conclude that the empirical evidence does not support the use of ImPACT testing for determining the time of postconcussion return to play.

The authors mention the other used computer tests, but chose to focus on ImPACT because of its wide use; from professional sports all the way down to youth sports.  The over all impression is that the current studies from independent sources Continue reading