Page 46 - Handbook of Electronic Assistive Technology

Chapter 2 • Cognitive Impairment and EAT 33

Plasticity

In the context of neurocognitive disorders, the potential for recovery, relearning or com-
pensation will be influenced by a number of factors that have been shown to affect outcome
(Berlucchi, 2011; Robertson and Murre, 1999). Generally speaking, older age is associated
with poorer outcomes, although early lesions may affect the development of certain brain
regions and impede various types of learning (Anderson et al., 2009). Cognitive reserve
is a term that has been used to describe the brain’s resistance to insult, apparent as a
discrepancy between clinical manifestation and severity of brain pathology (Stern, 2002).
Premorbid intelligence and level of education have been used as estimators of cognitive
reserve, but other life experiences, such as occupation and bilingualism, are associated
with similar protective effects. Cognitive reserve is related to higher connectivity, which
leads to better recovery after injury (Robertson and Murre, 1999). Learning and adapting
to a new assistive device requires a range of skills, and is thus likely to be influenced by the
same factors that affect recovery.

Executive Functioning

Executive functioning is the term used to describe various cognitive abilities that under-
pin goal-directed behaviour, including initiating and planning actions, solving novel
problems, correcting errors and selectively attending to relevant environmental stimuli
(O’Neill et al., 2013). The study of executive functions has been linked to the operations
of the frontal lobes. Lesions in different frontal regions of the brain are associated with
different executive difficulties, suggesting that there are a number of specific cognitive
processes underlying executive functioning (Stuss and Knight, 2013; Burgess et al., 2000).
For example, neurologically impaired patients showing dysexecutive symptoms range in
their presentation, from displaying social disinhibition and impulsivity to apathy and dif-
ficulty initiating actions, and experiencing problems with long-term planning and goal
maintenance.
The fact that the term ‘executive functioning’ is used to describe people with a wide
range of presentations makes it challenging to assess. Neuropsychological test batteries,
such as the Delis Kaplan Executive Function System (Delis et al., 2001) and the Behavioural
Assessment of the Dysexecutive Syndrome (Wilson et al., 1997), attempt to cover the main
executive processes. These include optimal planning while following set rules, decision
making and judgement, novel problem solving, inhibition of irrelevant tasks or stimuli,
switching between tasks, initiating tasks, controlling emotions, self-monitoring and sus-
taining attention.
People with executive impairment often find it difficult to sequence actions in an opti-
mal way when carrying out a task, for example, when baking a cake or shopping for items.
These two activities have even been used as real-life tests of executive functioning during
which people had to plan tasks in a way that would allow them to achieve a goal (bake a
chocolate cake or buy items within a budget), and perform the substeps of the task in the
correct, planned order (Chevignard et al., 2008; Shallice and Burgess, 1991). During these