Discuss the use of tests of executive functioning such as the Wisconsin Card Sorting Test (To test for perseveration and ability to change focus and direction-set changing ability)

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Mr. R. isa 17-year-old high school student previously in excellent health who has recently suffered a Traumatic Brain Injury in an auto accident. Unfortunately, at the time of the accident he was not wearing a seatbelt and therefore sharply struck the windshield with his forehead and was unconscious for approximately three hours. He was transported to the hospital ER where CAT scans indicated brain tissue damage in the orbitofrontal and dorsolateral areas. Following one week of observation in the hospital during which he seemed to rapidly improve, he was released to his family with follow-up visits scheduled with a neurologist. At home he does not seem to exhibit any gross physical difficulties although his ability to quickly respond to questions seems reduced in speed. His family has requested a neuropsychological consult to determine when he will be able to return to school. They are also complaining of his lack of concern with social proprieties, as he doesn’t seem to appropriately respond to parental guidance and he also engages in hilarious laughter and crude joking with his siblings and friends. His parents would like to know what is going on, and how long will he keep acting this way.

1) Discuss the use of tests of executive functioning such as the Wisconsin Card Sorting Test (To test for perseveration and ability to change focus and direction-set changing ability), the Category Test from the Halstead-Reitan Battery (Test of Abstract Reasoning), the Trails A and B (Test of ability to hold several tasks in mind at the same time as well as a test of cognitive speed), and the Picture Arrangement Test from the WAIS-IIII Battery (Test of Social skills ability indicating whether the Orbitofrontal area is damaged or not) to determine the extent of Mr. R’s changes in frontal lobe functionality. Within your answer, discuss how these tests indicate how abstract thinking is affected by brain injury, and how cognitive speed can be measured following frontal lobe injury. Finally, discuss the impact of orbitalfrontal injury-caused social problems such as lack of control of emotional expression.

2) Discuss the prognosis and possible course of rehabilitation for Mr. R.

 

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