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Investigating Executive Functioning in Everyday Life Using an Ecologically Oriented Virtual Reality Task Investigating Executive Functioning in Everyday Life using an Ecologically Oriented Virtual Reality Task by Diana Jovanovski A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy Department of Psychology University of Toronto © Copyright by Diana Jovanovski, 2010 Investigating Executive Functioning in Everyday Life using an Ecologically Oriented Virtual Reality Task Diana Jovanovski Doctor of Philosophy Department of Psychology University of Toronto 2010 Abstract Commonly employed executive function measures may be of limited use due to their modest ecological validity. A novel task was developed - the Multitasking in the City Test (MCT) - in an attempt to improve ecological validity. The MCT involves task demands that resemble the demands of everyday activities. In study one, healthy participants were recruited in order to explore ‘normal’ performance on the MCT and its relationship with other cognitive measures. The MCT showed poor associations with executive tests and significant correlations with non- executive tests. This suggested the MCT may evaluate executive functioning in a different way from other executive measures such that it does not simply measure component executive processes but the integration of these components into meaningful behaviour. Patients with stroke and traumatic brain injury were recruited for study two to further explore the ecological validity and MCT performance characteristics. Only the MCT and a semantic fluency task demonstrated good ecological validity via significant relationships with a behavioural rating scale. Patients and normals made qualitatively similar types of errors although patients made these errors more frequently. Patients demonstrated better planning ability but completed fewer tasks than normals on the MCT. This discrepancy was attributed to impaired initiation. In study ii three, the MCT and verbal fluency tasks were administered to brain-injured individuals both pre- and post-executive function rehabilitation to evaluate their utility as treatment outcome measures and to assess ecological validity via a different behavioural rating scale from the one used in study two. Strategies trained during treatment generalized to MCT but not verbal fluency performance. Both MCT and semantic fluency performance were found to have good ecological validity. Overall, the findings from this research project suggest the MCT and semantic fluency tasks have good ecological validity. They further suggest that several common executive function measures lack adequate ecological validity and may not be predictive of real world behaviour. Moreover, these results support the concept of an executive function ‘system’ that can be fractionated into a variety of executive processes and that impairments in one process (e.g., initiation) can exist alongside intact functioning in other processes (e.g., planning). iii Acknowledgments I am incredibly grateful for the invaluable support and encouragement of my supervisor, Konstantine Zakzanis. Without his mentorship and intellectual guidance, this work would not have been possible. Equally as important, I consider him a close personal friend and hope to continue collaborating with him on research projects and clinical endeavours in the years to come. I also wish to thank my other committee members, David Nussbaum and Suzanne Erb, for their guidance and support over the past several years. They are both bright and caring academics who truly fostered a rich, intellectually stimulating experience for me throughout this challenging yet rewarding journey. I am immensely appreciative of the help of several individuals on the development of this thesis. Specifically, I offer my heartfelt gratitude to Lesley Ruttan, Amery Treble, Dmytro Rewilak, Douglas Bors, Darren Kadis, and Douglas Garrett. For their friendship, understanding, and encouragement, I am also deeply appreciative of my dear friends Shirin Montazer and Tharsni Kankesan. I have relied on them as a constant source of advice and wisdom, both personally and professionally, and value their opinions dearly. I wish to thank Zachariah Campbell as well as his caring family for their encouragement in my pursuit of a doctoral degree. Zac’s unwavering support and confidence in me has provided an unparalleled source of strength and motivation throughout this journey. Most importantly, he has been a best friend and partner and I am extraordinarily fortunate to have him in my life. Finally, I am eternally indebted to my family, and especially my parents Tanas and Lubenka, for their love and unconditional support. My mother’s strength and selfless devotion to her children are a true inspiration. My father, with all of his remarkable accomplishments, has iv and always will be a most admirable role model for me in all realms of life. His dedication and tireless commitment to his family, ideals, and passions are characteristics I intend to emulate throughout my life. v Table of Contents Abstract……………………………………………………………………………………………ii Acknowledgments.…………………………………………………………………………….....iv Table of Contents……………………………………………………………………………...….vi List of Tables……………………………………………………………………………………viii List of Figures………………………………………………………………………………...…...x List of Appendices………………………………………………………………………………..xi Chapter 1: Introduction……………………………………………………………………………1 Chapter 2: Development and Performance Characteristics of an Ecologically Oriented Executive Function Measure in Healthy Adults…………………………………..…28 Abstract…………………………………………………………………………………..28 Introduction………………………………………………………………………………29 Method…………………………………………………………………………………...34 Results……………………………………………………………………………………44 Discussion………………………………………………………………………………..52 Chapter 3: Ecologically Valid Assessment of Executive Dysfunction in Patients with Acquired Brain Injury……………………..………………………………..…..59 Abstract…………………………………………………………………………………..59 Introduction……………………………………………………………………………....60 Method…………………………………………………………………………………..62 Results…………………………………………………………………………………...73 Discussion……………………………………………………………………………….81 vi Chapter 4: Evaluating the use of the MCT and Verbal Fluency Tasks as Outcome Measures for Goal Management Training………….………………………………..…………92 Abstract…………………………………………………………………………………..92 Introduction……………………………………………………………………................93 Method…………………………………………………………………………………...98 Results…………………………………………………………………………………..103 Discussion………………………………………………………………………………110 Chapter 5: General Discussion………………………………………………………..………...124 vii List of Tables Chapter 2 Table 2.1: Demographic characteristics of sample……………………………..............170 Table 2.2: Neuropsychological test performance of sample …………………………...171 Table 2.3: Qualitative errors made by normal participants on the MCT……………….172 Table 2.4: Correlations between MCT measures……………………………………….173 Table 2.5: Correlations between the MCT and cognitive tests…………………………174 Chapter 3 Table 3.1: Description of brain lesion site(s) of each patient…………………………..175 Table 3.2: Demographic characteristics of sample……………………………………..176 Table 3.3: Neuropsychological test performance and FrSBe scores of sample……………………………………………………………………….177 Table 3.4: Qualitative comparison of errors made by the patient and normal sample on the MCT…………………………………………………………178 Table 3.5: Correlations between MCT measures……………………………………….179 Table 3.6: Correlations between the MCT and other executive function tests…………180 Table 3.7: Correlations between the MCT and non-executive tests……………………181 Table 3.8: Correlations between executive tests and FrSBe – family ratings………….182 Chapter 4 Table 4.1: Neuropsychological test performance and questionnaire results of sample pre- and post-intervention…………………………………………...183 Table 4.2: Qualitative comparison of errors made by the sample on the MCT pre- and post-intervention…………………………………………………..184 Table 4.3: Effect sizes of neuropsychological test and questionnaire scores from pre- to post-intervention……………………………………………….185 Table 4.4: Demographic characteristics of normal sample……………………………..186 viii Table 4.5: MCT performance on two administrations of the task in a normal sample……………………………………………………………….187 Table 4.6: Effect sizes of MCT scores in patient and normal samples…………………188 ix List of Figures Chapter 2 Figure 2.1: Bird’s eye view map of the virtual environment for the Multitasking in the City Test…………………………………………………………….189 Figure 2.2: Screen shots of the Multitasking in the City Test………………………….190 Chapter 4 Figure 4.1: Ratings on the Dysexecutive Questionnaire at pre- and post-intervention……………………………………………………………191 Figure 4.2: Scatter plots of the relationship between the Dysexecutive Questionnaire-Other Executive Function scale (DEX-I EF) and executive function measures…………………………………………..194 x List of Appendices Appendix A: Abbreviations List………………………………………………………………..199 Appendix B: Multitasking in the City Test (MCT) Instructions………………………………..201 Appendix C: Computer Skills Questionnaire…………………………………………………..203 Appendix D: Dysexecutive Questionnaire (DEX) Executive Function (EF) Scale……………204 xi Chapter 1 Introduction As the most complex faculties of the human brain, the executive functions are fundamental to independent, purposive, and necessary behaviours and are often ascribed to the prefrontal cortex. One of the most extensive descriptions of the executive functions was articulated by the Russian neuropsychologist Alexander Luria (1966), who observed that patients with damage to the frontal lobes often presented with intact speech and motor and sensory
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