Assessment of executive functioning in children after TBI with a naturalistic open-ended task: A pilot study

Dr Mathilde P. Chevignard MD, PhDabc*, Violette Servanta, Aude Marillera, Geneviève Abadaa, Pascale Pradat-Diehlbcd & Anne Laurent-Vannieraa INR A. Hôpital National de Saint Maurice, Saint Maurice, Franceb INSERM, U731, 75013 Paris, Francec Université Pierre et Marie Curie-Paris 6, 75013 Paris, Franced Service de Médecine Physique et Réadaptation, Group Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France† Correspondence: DrMathilde P. Chevignard, INR A. Hôpital National de Saint Maurice, 14, rue du Val d’Osne, Saint Maurice, 94410 France m.chevignard@hopital-saint-maurice.frPurpose: Traumatic brain injury (TBI) often leads to executive functions (EF) deficits, resulting in severe longstanding disabilities in daily life activities. The sensitivity and ecological validity of neuropsychological tests have been questioned. The aim of this study was to pilot a novel open-ended naturalistic task and to compare it to other standardized assessments of EF in children post-TBI.Methods: Ten children aged 8–14, with moderate-to-severe TBI, and 18 matched controls participated in the study. The clinical group was assessed using cognitive tests and parent-based questionnaires of EF. An interactive ecological cooking task was designed.Results: Analyses indicated mild-to-moderate executive deficits in the cognitive tests in approximately half of the TBI group. For the experimental cooking task, all quantitative and qualitative variables were significantly impaired for the TBI group compared to the control group and failure in the cooking task was associated with lower scores in cognitive tests of EF. The task was able to discriminate the TBI children from the control group.Conclusion: This pilot study highlights the role of naturalistic assessments, to complement standardized tests in assessing patients’ dysexecutive impairments in complex activities of daily living post-childhood TBI.