Chevignard M, Taillefer C, Picq C, Pradat-Diehl P
Service de rééducation des pathologies neurologiques acquises de l'enfant, INR A, hôpital national de Saint-Maurice, 14, rue du Val-d'Osne, 94410 Saint-Maurice, France.
Ann Readapt Med Phys. 2008 Mar;51(2):74-83. doi: 10.1016/j.annrmp.2007.10.008. Epub 2007 Dec 26.
Dysexecutive syndrome is one of the most frequent sequel of severe traumatic brain injury. It causes severe disabilities and it is incompletely assessed by the classical "paper and pencil" neuropsychological tests. We developed an ecological assessment conducted in a naturalistic situation, consisting of a cooking task, and we described a classification of errors. This assessment is very sensitive, even to a mild dysexecutive syndrome.
To describe the disabilities in activities of daily living of a traumatic brain-injured patient and to demonstrate the sensitivity of an ill-structured ecological assessment.
We report a single case study illustrating how the ecological assessment by the cooking task helped better understand and characterize the patient's disabilities.
The patient presented severe disabilities in daily life activities, which were well described by his family. His cognitive disorders were mild in the cognitive tests, even those supposed to be more ecological, such as the Six Elements Task or script generation. He exhibited very severe disorders in the cooking task, with a very high number of errors. Moreover, duration of the cooking task was very long; he did not achieve the goal and exhibited dangerous behaviour.
The cooking task involves abilities to deal with multitasking, which particularly involve executive functions. The most severe disorders were observed during the patient's interaction with the environment while conducting a complex goal-directed action plan, indicating control disorders. This type of naturalistic assessment provides very useful information to help patients organise their familial, social or professional reintegration.
执行功能障碍综合征是重度创伤性脑损伤最常见的后遗症之一。它会导致严重残疾，而传统的“纸笔”神经心理学测试对其评估并不全面。我们开展了一项在自然情境下进行的生态评估，其中包括一项烹饪任务，并描述了错误分类。这种评估非常敏感，即使对于轻度执行功能障碍综合征也是如此。
描述一名创伤性脑损伤患者日常生活活动中的残疾情况，并证明结构不良的生态评估的敏感性。
我们报告了一个单病例研究，说明烹饪任务的生态评估如何有助于更好地理解和描述患者的残疾情况。
患者在日常生活活动中存在严重残疾，其家人对此有很好的描述。他在认知测试中的认知障碍较轻，即使是那些被认为更具生态性的测试，如六项元素任务或脚本生成测试。他在烹饪任务中表现出非常严重的障碍，错误数量非常多。此外，烹饪任务的持续时间非常长；他没有完成目标，还表现出危险行为。
烹饪任务涉及处理多任务的能力，这尤其涉及执行功能。在患者执行复杂的目标导向行动计划与环境互动的过程中观察到了最严重的障碍，表明存在控制障碍。这种自然主义评估为帮助患者进行家庭、社会或职业重新融入提供了非常有用的信息。
