PRODUCTIVE FUNCTIONING: TRAINING DECISION MAKING
 
Satish, U. and Streufert, S., SUNY Upstate Medical University, USA
 
Mild and moderate head injury constitutes approximately 70-80% of all patients with head trauma. While many head injury patients have a "good" medical recovery, between 15% and 27% continue to exhibit subtle deficits that are often concomitant with social dysfunction and lost vocational productivity. Standard techniques often tend to be far removed from day-to- day task demands and fail to transfer into meaningful real world performance. The development and/or use of more sensitive and real-world- relevant techniques to both assess and remediate patients with residual deficits are needed. Patients were assessed using both a standard neuropsychological battery and a complex ecologically validated simulation technique was designed to provide a well controlled real world-like environment. Performance effectiveness is calculated on multiple measures that range from response to simpler task demands (reaction time, activity level, etc.) to more complex functioning (initiative, breadth of approach, planning, strategy, and more). Scores on several domains of productive functioning, such as, activity, initiative and breadth were especially low. These parameters of functioning are relevant to and validated to real world functioning. The simulation technique is able to assess residual deficits in patients who continue to experience subtle difficulties. Further, their performance as compared to normative data clearly indicates those areas which require remediation. Since the specific areas can be noted, remediation is more focused and cost effective.