This fictional case scenario is designed to help students and practitioners apply core cognitive assessment concepts to a real-world situation involving traumatic brain injury (TBI). Use the structured questions to critically analyze how executive dysfunction impacts function and how OT intervention should be tailored.
Case Profile
- Name: Mr. David “Dave” Miller
- Age: 32
- Occupation: Graphic designer
- Diagnosis: Moderate TBI from a car accident (3 months ago)
- Living situation: Residing with parents during recovery
- Pre-injury functioning: Highly independent, organized, and creative
Presenting Concerns
Dave’s parents report:
- Difficulty initiating and completing tasks (e.g., cooking, laundry)
- Poor planning and organization
- Struggles with problem-solving when routines are disrupted
- Leaves tasks unfinished or completed incorrectly
- Limited awareness of his impairments and overestimates his abilities
Dave is eager to return to work and live independently.
Guided Learning Questions
1. What cognitive deficits may be present?
Based on Dave’s profile, which executive functions might be impaired?
- Consider: Initiation, planning, organization, task persistence, problem-solving, self-monitoring
2. How do these deficits affect occupational performance?
Reflect on how these executive challenges could impact his ability to:
- Prepare meals or manage household routines
- Handle deadlines and multitasking at work
- Maintain personal safety and self-care
3. Why might formal tests be insufficient for capturing these issues?
Why are performance-based assessments better suited than abstract paper-and-pencil tests for evaluating executive dysfunction in Dave’s case?
- What might be missed in traditional testing?
4. What OT tools can assess executive function functionally?
Identify assessments appropriate for Dave’s situation:
- Executive Function Performance Test (EFPT)
- Multiple Errands Test (MET)
- BRIEF-A (self-report and informant versions)
How does each tool provide insight?
5. How would a dynamic assessment approach help?
During a meal preparation task, how could dynamic assessment provide deeper understanding?
- How would you use cueing and environmental adjustments?
- What would you look for in Dave’s responses?
6. How can self-awareness be assessed and addressed?
Dave seems unaware of his limitations.
- What is the role of self-awareness and metacognition in rehab?
- How might you explore intellectual, emergent, and anticipatory awareness through structured tasks and feedback?
Conclusion
Dave’s case highlights the real-life challenges of executive dysfunction following TBI. By combining observation, performance-based assessments, and awareness-building strategies, occupational therapists can create meaningful, client-centered intervention plans.
Note: This scenario is fictional and generated using AI (Notebook LM) for educational use, grounded in evidence-based OT practice frameworks.