Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Health and Rehabilitation Sciences

Supervisor

Murray, Laura L.

Abstract

Executive functioning (EF) abilities are compromised subsequent to right hemisphere brain damage (RHD). EF supports communication including understanding and using pragmatics and discourse. Consequently, if EF abilities are impaired, communication challenges may occur. Accordingly, the objectives of the current study were to examine the RHD literature to identify: (a) EF deficits reported; (b) standardized EF assessments; (c) type of participant data reported and, (c) quality of the prior studies. Several electronic databases were searched between 1980 and March 2018. Results (71 articles) indicated that the most commonly assessed EF abilities were: (a) working memory, (b) verbal fluency, and (c) awareness of hemiplegia. The Bisiack Interview was the most commonly used standardized assessment, and most articles were rated low on the quality rating tool. These findings indicate that whereas EF deficits are common following RHD, recommendations for selecting measures to diagnose EF impairments in individuals with RHD await further research.

Summary for Lay Audience

A growing body of literature has indicated that various executive functioning (EF) abilities are compromised subsequent to brain damage. Individuals with intact EF can achieve desirable tasks through such fine cognitive control. EF supports communication and other complex daily activities via planning, monitoring, and controlling other cognitive processes to accomplish goal-oriented behaviors. However, because EF includes a wide array of cognitive processes, theoretical models and research have not yet specified which or how many of these cognitive processes should be included as EF. This can be problematic when researchers or clinicians wish to choose the most valid and reliable measures to assess EF abilities. For these reasons, this systematic review examined the types of EF problems and assessments that are commonly looked at after acquired brain damage, focusing on right hemisphere brain damage.

CINAHL, Scopus, PsychInfo, and PubMed electronic databases were searched between 1980 and March 2018. For the articles that met the eligibility criteria, various data regarding EF abilities (e.g., number of tests and EF domains) and a range of participant variables (e.g., sample size, type of acquired brain damage) were extracted. An evidence appraisal tool from Murray and colleagues (2018) was adapted to rate the quality of the included articles. A total of 71 articles met the eligibility criteria. The most commonly used EF assessments evaluated: (a) working memory, (b) verbal fluency or (c) anosognosia of hemiplegia. The majority of the studies were rated as low on the quality rating tool. Methodological concerns within the eligible studies included: (a) incomplete description of the assessor(s) and testing environment, (b) inconsistent documentation of or failure to equate RHD and control groups on variables (e.g., age; education) known to influence EF performance, (c) inadequate description of RHD participants’ profiles (e.g., number and location of brain lesions), and (d) failure to report or experimentally control the presence/absence of variables that could impede performance on EF measures (e.g., hearing and/or visual issues, neglect, handedness, depression). Collectively, the findings from this systematic review indicate that confidence in selecting reliable and valid EF measures to diagnose EF impairments in RHD individuals awaits further research.

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