Executive functions: Stuss model

Transcription

1 Executive functions: Stuss model

2 The model refers to frontal lobe functioning rather than executive functions; apologies to Don for interchanging the terms.

3 Four functional domains Action regulation Executive cognitive Behavioural/emotional self-regulation Metacognition

4 Neuroanatomy The frontal lobes: 4 main areas Activation regulation superior medial Executive cognition dorsolateral or prefrontal cortical cortex (left: planning and right: monitoring) Behavioural/emotional self-regulation- ventral medial/ orbital prefrontal cortex Metacognition frontal polar region

5 Theory of Prefrontal Function (Stuss, 2007) Activation regulation - Anterior cingulate and superior medial cortex - Brodmann areas 24, 32 and 33 Executive cognition - Dorsolateral prefrontal cortex - Brodmann areas 9 and 46 Behavioural/emotional self-regulation - Inferior medial/ventral frontal cortex - Brodmann areas 11, 25 and 47 Metacognition - Frontal polar cortex - Brodmann area 10

6 Activation regulation Disorders of activation and drive: providing activation and drive to organise and sustain action without necessarily providing the content of action (Stuss, 2007) Poor capacity to generate and maintain actions or mental processes Action regulation..clinically seen as apathy or abulia. Disorders of activation have an important impact on selfregulation.

7 Executive cognitive functions Control and direction (e.g. planning, monitoring, activating, switching, inhibiting) of lower level, more automatic functions (Stuss, 2007) Working memory (capacity for short-term storage, monitoring and manipulation of information) and inhibition are fundamental processes that enable executive cognitive functions Involved in abilities such as Verbal fluency Strategic encoding and retrieval of memory Working memory Sustained attention Monitoring of information Variability in reaction times Inhibition of irrelevant information

8 Behavioural/emotional self-regulation Difficulty in understanding the emotional consequences of their behaviour Required in situations where cognitive analysis, habit, or environmental cues are not sufficient to determine the most adaptive response (Stuss, 2007) Involved in abilities such as High-level decision making Reward processing: show reduced reaction to the negative consequences of their actions Prioritising goals Emotional processing, behavioural self-regulation Self-regulatory disorder: the inability to regulate behaviour according to internal goals and constraints particularly in less structured situations

9 Metacognitive processes Representation of one s own mental states, beliefs, attitudes and experiences (Stuss, 2007) Integrative aspects of personality, social cognition, self-awareness Integrates the higher level executive cognitive functions and emotional or drive-related inputs Involved in abilities such as Self-awareness Mentalising (ability to understand the mental state of oneself and others) Self-reflection Empathy Social understanding and judgment Appreciation of humor Shifting perspective Autonoetic or self-knowing memory Ability to make inferences about the world

10 Applying the Stuss Model at OZ Goal Apply the model to make sense of EF problems for our clients Executive Function Week: Part of the 6 week intensive phase of the programme 4 days on EF learning about it, reflecting on personal experiences, taster strategies, putting knowledge into practice

11 Aims Executive Function Week To learn what executive functions are To understand how brain injury affects executive functions To understand my own problems with executive functions To learn strategies to manage executive function difficulties 11

12 Executive Functions What are they? 12

13 Executive Functions Executive functions are the abilities that allow us to live independent and successful lives 13

14 Anatomy The FRONTAL LOBES are important for executive functioning These are often damaged by brain injury Many people with a brain injury have problems with executive functioning or dysexecutive syndrome 14

15 Who needs good executive functions? An orchestra conductor? The conductor has to plan the concert, select the music, organise the musicians, start the music, make decisions during the performance, monitor the overall sound, solve any problems during the performance and keep the main goal in mind! 15

16 Who else needs good executive functions? You do! Can you think of examples where you need good executive functions in your own life? 16

17 Executive functions are NOT personality flaws Executive function problems often get confused with personality problems Let s go through them in more detail 17

18 Activation doing Executive functions Executive cognitive thinking Emotional and behavioural self-regulation feeling and acting Metacognition awareness and socialising 18

19 Activation doing Problems with activation and drive Feeling bored Sleeping Slow to react and to think things through Hard to keep your momentum up Hard to get started with things Hard to stay engaged Seem disinterested Lethargy 19

20 Activation doing What does this feel like? 20

21 Activation doing No energy Bored Slow Hard to get started with things Hard to keep going even after I get started Hard to stay engaged Do I just not care any more? 21

22 Activation doing What does this look like to other people? 22

23 Activation doing She seems to be lazy now, lacking any motivation. She needs to be made to do things 23

24 Executive cognitive thinking Trouble making and carrying out plans Getting off track Trouble monitoring thoughts and actions Trouble switching from one task or idea to another Concrete thinking Trouble with problem solving 24

25 Executive cognitive thinking What does this feel like? 25

26 Executive cognitive thinking Hard to come up with new ideas It s easy to go off track and not get back on target Hard to get things finished Hard to stick with a plan or an idea Difficult to solve problems Hard to think outside the box Am I just stupid now? 26

27 Executive cognitive thinking What does this look like to other people? 27

28 Executive cognitive thinking Since the injury, my wife sees things from day to day and finds it very hard to plan ahead. We tried to plan a holiday together with the children, but she couldn t make decisions about where to go or when to go. In the end, I did all the planning and organising. 28

29 Executive cognitive thinking She s so repetitive she ll get stuck on one topic of conversation when everyone else has moved on she won t take advice but insists on trying to do things her own way, even when it clearly isn t working 29

30 Executive cognitive thinking Since his head injury, my husband has difficulty understanding anything subtle or abstract. He takes things very literally and is unable to see another point of view. He s so rigid. 30

31 Emotional and behavioural self-regulation feeling and acting Emotions come up more quickly and without warning Emotions are stronger than they should be for the situation Emotions are harder to control than they should be Anger outbursts Crying for no good reason Laughing when you don t want to Trouble controlling thoughts and actions Saying or doing things without thinking them through Being impulsive and not reflective Seeming childish and selfish 31

32 Emotional and behavioural selfregulation feeling and acting What does this feel like? 32

33 Emotional and behavioural selfregulation feeling and acting Out of control Emotional out of the blue! Can t predict what I will do or say Embarrassing I hate being rude or mean to other people Saying or doing things without thinking them through Have I become an out of control jerk? 33

34 The Lassie Syndrome

35 Emotional and behavioural selfregulation feeling and acting What does this look like to other people? 35

36 Emotional and behavioural selfregulation feeling and acting He says and does things that are quite rude, and very out of character for him.he says or does things without thinking 36

37 The Woman Who Killed Her Husband with a Frying Pan

38 Metacognition awareness and socialising Having an accurate understanding of how your brain injury has affected you Being aware of your impact on other people Being able to take someone else s point of view Being sympathetic to someone else Being able to read your own emotions Being able to read someone else s emotions 38

39 Metacognition awareness and socialising What does this feel like? 39

40 Metacognition awareness and socialising Other people keep saying I have changed, but I feel the same old me It s harder to get along with other people now I ve lost friends and even some family members Could there be something wrong that I don t know about or is it them? 40

41 Metacognition awareness and socialising What does this look like to other people? 41

42 Metacognition awareness and socialising She is a completely different person now and she doesn t even know it. 42

43 Recap: OZ translation of Stuss model domains of frontal functions: making sense of the muddle for our clients Activation doing Executive cognitive thinking Emotional and behavioural self-regulation feeling and acting Metacognition awareness and socialising 43