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Assessment of Subcomponents of Executive Functioning in Ecologically Valid Settings: The Goal Processing Scale

Novakovic-Agopian, Tatjana PhD; Chen, Anthony J.-W. MD; Rome, Scott MD; Rossi, Annemarie OTR/L; Abrams, Gary MD; D'Esposito, Mark MD; Turner, Gary PhD; McKim, Ryan PsyD; Muir, Jim PhD; Hills, Nancy PhD; Kennedy, Cathy MS; Garfinkle, John MS, SLP; Murphy, Michelle PsyD; Binder, Deborah MS; Castelli, Holli OTR/L

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

Journal of Head Trauma Rehabilitation: March/April 2014 - Volume 29 - Issue 2 - p 136–146
doi: 10.1097/HTR.0b013e3182691b15
Original Articles

Objectives: To validate a new functional assessment tool, the Goal Processing Scale (GPS), and to apply it for testing for sources of dysfunction in patients with acquired brain injury. Determining which component processes of executive functioning underlie poor performance in complex, low-structure settings would be valuable for the assessment of deficits and for evaluating the effectiveness of treatments.

Participants: Nineteen individuals with chronic acquired brain injury (mean age = 41.4 years; chronicity: 6 months to 39 years).

Main Measures: Two functional assessment tasks: (1) GPS, which evaluates functional performance in the context of achieving a goal in a “real-world” setting, with rating scales measuring overall performance and 8 subdomains of executive functioning; (2) Multiple Errands Test, an unstructured assessment of ability to adhere to rules and complete multiple “real-world” tasks in a short time; and (3) a neuropsychological battery.

Results: Intraclass correlation coefficients for 2 independent raters ranged from 0.75 to 0.98 for the GPS overall composite score and the subdomain scores. Performance on GPS overall and several subdomain scores correlated with performance on the Multiple Errands Test. Working memory and learning/memory neuropsychological measures predicted functional performance as measured using the GPS.

Discussion: The GPS shows high interrater reliability, suggesting convergent validity with an established functional performance measure, and produces useful information regarding strengths and weaknesses in different subdomains of executive functioning. Working memory and learning/memory appear to be key determinants of goal-directed functioning for these individuals with brain injury.

Veteran's Administration Medical Center, San Francisco (Drs Novakovic-Agopian, Chen, Abrams, McKim, and Murphy and Mss Rossi and Binder); Veteran's Administration Northern California Health Care System, Martinez (Drs Novakovic-Agopian, Chen, D'Esposito, and Muir and Ms Binder); California Pacific Regional Rehabilitation Center, San Francisco (Drs Novakovic-Agopian and Rome; Mss Rossi, Kennedy, and Castelli; and Mr Garfinkle), University of California, San Francisco (Drs Novakovic-Agopian, Chen, Abrams, and Hills); University of California, Berkeley (Drs Chen and D'Esposito), California; and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Dr Turner).

Corresponding Author: Tatjana Novakovic-Agopian, PhD, SFVA Medical Center, 4150 Clement St, Mail Code 127, San Francisco, CA 94121 (tna@cns-site.com).

This material is based upon work supported by the Office of Research and Development Rehabilitation R&D Service Department of Veterans Affairs, and the California Pacific Medical Center (CPMC) Foundation. The authors thank participating patients and a number of individuals who made this study possible, in particular Gerald Carlin, OTR/L, for help with earlier versions of functional assessment tool and with participant recruitment; Richard Fitzsimons, MS, for conducting study neuropsychological evaluations; Guiomar Scheid, for help with participant scheduling; and Byron Morgenroth, MS, for help with organizing the portions of the study conducted at the CPMC.

The authors declare no conflicts of interest.

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