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Rehabilitation of Executive Functions: Implications and Strategies Rehabilitation of executive functions: Implications and strategies Rehabilitación de las funciones ejecutivas: implicaciones y estrategias Reabilitação das funções executivas: Implicações e estratégias BRUNO KLUWE-SCHIAVON* BRENO SANVICENTE-VIEIRA* THIAGO WENDT VIOLA* LEO SCHUCH AZEVEDO E SOUZA** MARCELO MONTAGNER RIGOLI*** ROCHELE PAZ FONSECA**** RODRIGO GRASSI-OLIVEIRA***** Pontifical Catholic University of Rio Grande do Sul, Brazil Abstract ne, academic, social and labor fields. There is a growing body of studies trying to determine the causes, implica- Executive Functions (EF) concern a range of abilities tions, associations and the best way to take care of these including problem-solving, planning, initiation, self- effects. This work intends to review DS, focusing on the monitoring, conscious attention, cope with new situa- most important fields related to this area, such as psycho- tions and the ability to modify plans if necessary. It’s a pathology associations, cognitive reserve, assessment high cognitive function that is crucial for a person to get and cognitive rehabilitation programs. engaged and maintain daily activities whilst keeping a Keywords (MeSH Terms): Executive functions, reha- good quality of life. Problems in the EF were formerly bilitation, cognitive reserve and neurobehavioral ma- known as Dysexecutive Syndrome (DS). There are many nifestations models concerning DS, although the literature on the subject still remains unclear. Several works appoint the Resumen effects brought by elderly life, as well as abuse of drugs and some psychopathologies. These factors are known Las funciones ejecutivas constituyen un conjunto de to increase the distress of the frontal circuits and that habilidades que incluye la resolución de problemas, la could be associated to executive deficits. The effects of planificación, la iniciación, el autocontrol, la conciencia DS would compromise individuals in day-to-day routi- ante situaciones nuevas y la capacidad de modificar los * Developmental Cognitive Neuroscience Research Group; Postgraduate Program in Psychology - Human Cognition - Pontifical Catholic University of Rio Grande do Sul (PUCRS). Av. Ipiranga, nº 6681, prédio 11, sala 936, CEP 90619-900, Porto Alegre/RS, Brazil Telephone: 55 51 33203550 (#7740). Fax: 55 51 33203633. E-mail: [email protected]. ** Postgraduate Program in Psychology - Human Cognition - Pontifical Catholic University of Rio Grande do Sul. *** Cognition Emotion and Behavior Research Group; Postgraduate Program in Psychology - Human Cognition - Pontifical Catholic University of Rio Grande do Sul. **** MS, MD, PhD; Clinical and Experimental Neuropsychology Research Group; Postgraduate Program in Psychology - Human Cognition - Pontifical Catholic University of Rio Grande do Sul. ***** MS, MD, PhD; Developmental Cognitive Neuroscience Research Group; Postgraduate Program in Psychology - Human Cognition - Pon- tifical Catholic University of Rio Grande do Sul. Para citar este artículo: Kluwe-Schiavon, B., Sanvicente-Vieira, B, Viola, T. W., Souza, L. S. A., Rigoli, M. M., Fonseca R. P., & Grassi-Oliveira, R. (2013). Rehabilitation of executive functions: Implications and strategies. Avances en Psicología Latinoamericana, 31 (1), pp. 110-120. 110 Avances en Psicología Latinoamericana/Bogotá (Colombia)/Vol. 31(1)/pp. 110-120/2013/ISSNe2145-4515 Rehabilitation of executive functions: Implications and strategies planes si es necesario. Se trata de funciones de alto nivel lidar com estes efeitos. O presente artigo busca revisar cognitivo, que son cruciales para que una persona man- estudos acerca da SD, focando em aspectos centrais co- tenga sus actividades diarias y para la promoción de una mo psicopatologias, reserva cognitiva e programas de buena calidad de vida. El déficit en estas funciones se reabilitação cognitiva. conoce como síndrome disejecutivo (SD). Hay muchos Palavras-chave: funções executivas, reabilitação, re- modelos teóricos sobre SD; sin embargo, la literatura no serva cognitiva manifestações neurocomportamentais es muy clara en relación con los componentes involucra- dos ni con la forma de investigar y resolver este proble- ma. Varios estudios muestran que la edad, el consumo de Executive Functions (EF) sustancias y la psicopatología pueden afectar a algunas and psychopathology de estas funciones a través de daños en los circuitos frontales asociados a ellos. El efecto de este daño puede In the past, when studying prefrontal damaged pa- poner en peligro las actividades rutinarias del día a día, tients, researchers noticed there were specific im- imponer dificultades en la socialización y afectar su vida pairments in some functions like initiation, sequen- laboral. Hay un cuerpo creciente de estudios que tratan cing, flexibility, monitoring, judgment, planning, de determinar las causas, consecuencias y modelos que decision-making and difficulty in learning new son capaces de dar cuenta de estos efectos y promover tasks (Elliott, 2003; Hughes, 2002; Stuss, 2009). estrategias de tratamiento más eficaces. Este artículo At that time this functional impairment was ter- pretende hacer una revisión de la SD, centrándose en los med “Frontal Lobe Syndrome”, although some of aspectos relacionados más importantes, tales como las those patients with problems had their frontal lobes comorbilidades, la reserva cerebral, la reserva cognitiva neurologically intact (Sbordone, 2000). Then the y los programas de rehabilitación. incapacity to control these basic cognitive functions Palabras clave: funciones ejecutivas, rehabilitación, at stake became known as the Dysexecutive Syn- reserva cognitiva y manifestaciones neuroconductuales drome (Wilson & Gilsky, 2009). In this sense, DS is not necessarily associated to frontal lobe injury, but Resumo rather a series of deficits in processing, planning, initiating behaviors, maintaining those behaviors, As funções executivas constituem um conjunto de habi- self-regulation and self-monitoring, set-shifting lidades que envolvem o planejamento e a resolução de and cognitive flexibility, and meta-cognition. problemas, desde a iniciação, consciência e auto controle According to Stuss (2009) there are at least four de comportamentos frente a novas situações, além da ca- categories related to frontal functions, but not ne- pacidade de modificar tais planos quando necessário. As cessarily related to frontal lobe injuries, as shown funções executivas envolvem um alto grau de controle in table 1. cognitivo e são cruciais para atender as atividades diárias Studies have pointed out executive deficits in e manter uma qualidade de vida. Os déficits associados many psychiatric disorders. For example, polysubs- a estas funções é denominado Síndrome Disexecutiva tance users and subjects with different psychiatric (SD). Existem muitos modelos teóricos que procuram disorders, including attention deficit hyperactivity elucidar a SD, no entanto, a literatura não é muito clara disorder (ADHD), Post-Traumatic Stress Disorder quanto os componentes envolvidos, formas de inves- (PTSD), schizophrenia and mood disorders, such tigar e estratégias para resolver estes déficits. Vários as bipolar depression (Deckersbach et al., 2010; estudos apontam que os efeitos da idade, do consumo Eack et al., 2010; Elliott, 2003; Fernandez-Serrano, de substâncias e de psicopatologias podem contribuir Perez-Garcia, Perales, & Verdejo-Garcia, 2010; para a deterioração de circuitos frontais associados aos McEwen, 2003; Savitz, Solms, & Ramesar, 2005; déficits executivos, comprometendo ainda mais o fun- Stuss, 2009). Likewise, EF is related to subcortical cionamento diário, acadêmico, social e laboral. Existe disorders. Once impaired, EF have been reported to um vasto campo de estudos visando determinar as cau- be associated with Parkinson`s disease, progressive sas, implicações, fatores associados e a melhor forma de supranuclear palsy, Huntington`s disease, Korsa- Avances en Psicología Latinoamericana/Bogotá (Colombia)/Vol. 31(1)/pp. 110-120/2013/ISSNe2145-4515 111 Bruno Kluwe, Breno Sanvicente, Thiago Wendt, Leo Azevedo, Marcelo Montagner, Rochele Paz, Rodrigo Grassi Table 1 Actually, the disease with the largest range of Different categories of frontal lobe functioning rehabilitation interventions is schizophrenia, with Categories Functions significant brain volume loses observed in these patients (Pfefferbaum, Sullivan, Hedehus, Moseley, Process of initiation and sustaining Energization & Lim, 1999; Zipparo et al., 2008). Furthermore, of any response mode patients with schizophrenia demonstrated a signifi- Executive cognitive Planning, checking the task and cant decline in social skills, increasing the need for functions adjustment of behavior proposals with more comprehensive interventions. Required in situations where These interventions must combine neurocognitive cognitive analysis, habit, or Behavioral/ and psychosocial components, whose results have environmental cues are not emotional self shown positive effects on the functioning of these sufficient to determine the most regulatory functions individuals (Kluwe-Schiavon, Sanvicente-Vieira, adaptive response, a high-level Kristensen, & Grassi-Oliveira, 2012). In our last decision making session we described some rehabilitation programs Integration of cognition and for schizophrenia, although before allow us to re- emotion, aspects of personality, Meta-cognitive view the protective factors involved and the mea- social cognition, consciousness, process sures that evidence such deficits. theory
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