Magister Scientiae (Occupational Therapy) - MSc(OT) / The recovery process for traumatic brain injuries (TBIs) can be lengthy and taxing on the patient, family and healthcare resources. Part of this recovery process includes interventions for the improvement of executive functioning (EF) required for high level functioning such as return to work (RTW). However, evidence for best practice interventions to improve EF for RTW post TBI is lacking. Randomised control trials (RCTs) evaluating interventions for EF for RTW post TBI are available but have not been synthesised. The review aimed to determine the best practice interventions for improving EF for successful RTW post TBI. Method: A systematic review using a predetermined search strategy to find relevant titles published from inception to June 2020 in six electronic databases (EBSCOhost and PUBMED [both including MEDLINE]; CINAHL, Cochrane Database for Systematic Reviews, OT Seeker, and Taylor and Francis Online) was conducted following ethics approval by the Institutional Ethics Review Board. / 2023

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Indiana University-Purdue University Indianapolis (IUPUI) / Only one third of older breast cancer survivors (BCS) meet national physical activity (PA) guidelines. Theories of self-regulation and research with older adults suggest that executive function (EF) plays an important role in PA, yet the impact of lower EF on older survivors’ PA is unknown. My project addressed this gap using secondary data from the Thinking and Living with Cancer (TLC) cohort study, which examined cognitive function among older BCS pre-treatment, followed every 12 months, and contemporaneously assessed matched controls. My first aim was to test two hypotheses regarding EF change and PA and determine if these relationships differ between BCS and controls. My hypotheses were: 1) EF decline from baseline to 12 months will predict lower PA at 24 months, and 2) lower PA at 12 months will predict EF decline from 12 to 24 months. My second aim was to explore whether the effects of EF change on PA in BCS differed based on risk factors for accelerated cognitive decline (i.e., older age, more advanced cancer stage, comorbidity, and APOE ε4 genotype). The TLC study measured EF with neuropsychological tests and PA with the International Physical Activity Questionnaire-Short Form. For aims 1 and 2, I used multiple regression with multiple imputation. Primary results showed no significant effect of EF change from baseline to 12 months on PA at 24 months (β=-0.01, p=0.88) and no significant group (BCS vs. controls) by EF interaction (β=-0.05, p=0.33). Separate models in BCS and controls showed similar findings. In the entire sample, PA at 12 months significantly predicted EF change from 12 to 24 months (β=0.17, p=0.01), but there was no significant group by PA interaction (β=-0.06, p=0.54). Separate analyses by group found a significant effect of PA for controls (β=0.07, p=0.02), but not for BCS (β=0.05, p=0.27). Regarding the second aim, there were no significant interactions between EF change and the proposed risk factors on PA. Findings were largely inconsistent with theory and prior research. Continued research in this area will inform future exercise interventions to improve physical and cognitive health for the growing population of older cancer survivors.

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Researchers have found positive associations between physical activity and executive function in adolescence and adulthood. However, research in early childhood has revealed only negative relationships. In the present study, I explored whether maternal encouragement of physical activity might moderate this relationship in very young children. Using video recordings from an archival dataset, eight maternal encouragement measures were derived from mother-child free play sessions. Although it was expected that maternal encouragement of child activity would broadly play a moderating role in the relationship between children’s physical activity and their executive function, only maternal questions seemed to moderate this relationship. One explanation for these overarching null findings is that maternal encouragement of physical activity may not have a moderating effect until later, such as when children are well on their way into language. Future efforts to explore the impacts of physical activity on executive function may benefit from experimental approaches.

The population of young adults with autism spectrum disorder (ASD) is growing as more individuals with ASD age into adulthood. Almost half of the children diagnosed with ASD who were surveyed in 2010 demonstrated average or above average intelligence (CDC, 2014). Despite promising intellectual abilities, only 17.4% of young adults with ASD enroll in a four-year college, and only 38.8% of students with ASD graduate postsecondary education within eight years of leaving high school (Newman et al., 2011). Therefore, there is a growing niche for postsecondary support programs specifically designed for students with ASD. This doctoral project includes two parts: the development of an evidence-based online course for postsecondary students with ASD and the proposed evaluation of the online course. There are five theoretical reasons for poor postsecondary outcomes for young adults with ASD: (1) the increasing prevalence of ASD, (2) the absence of a “golden standard” in postsecondary transition for young adults with ASD, (3) the existing differences between educational and disability rights legislation at the secondary and postsecondary education levels, (4) the diagnostic characteristics of ASD, and (5) the characteristics of collegiate culture. The proposed online course curriculum will utilize evidence-based content and design from 29 pre-existing postsecondary support programs for students with ASD, and successful executive function and social skills curricula for students with ASD (“Unstuck and On Target”, Cannon, Kenworthy, Alexander, Werner, & Anthony, 2011; “PEERS for Young Adults”, Gantman, Kapp, Orenski, & Laugeson, 2011; “PEERS Curriculum for School-Based Professionals”, Laugeson, 2014). The proposed feasibility study will measure the feasibility and acceptability of participation in an online course for college students with ASD. The proposed feasibility study will also measure preliminary outcomes regarding participants’ executive functioning, social skills, self-determination, and life satisfaction.

Parkinson’s disease (PD) is characterized by motor dysfunction and multiple non-motor symptoms. Though motor/non-motor interactions are common, the lines of research focusing on motor and non-motor symptoms mainly remain separate. The present studies assessed interactions between several motor aspects of PD (impaired gait, side of motor-symptom onset, tremor, motor-symptom severity) and non-motor symptoms (cognition, anxiety, self-perceived stigma) in non-demented individuals with idiopathic PD. Study 1 examined cognitive and motor performance during dual tasking, specifically executive function while walking. The impact of dual tasking on walking (speed, stride frequency) was greater for PD (N=19) than NC participants (N=13). The PD group had fewer set-shifts than NC on dual tasking, and demonstrated greater cognitive variability on dual tasking. Study 2 considered mechanisms of visuospatial dysfunction in PD (N=79) by assessing how side of motor-symptom onset (left versus right) and cognition (attention, executive function) affect spatial judgment on a dynamic line bisection task. In contrast to a rightward-biased parietal-neglect pattern, the PD group showed a leftward bias that occurred when attention was directed to the left side of space, regardless of side of onset. The extent and variability of bias correlated with frontally-mediated neuropsychological performance for PD but not NC (N=67). Both results suggested frontal-attentional rather than parietal-neglect mechanisms of spatial bias. Study 3 assessed how motor symptoms contribute to self-reported anxiety on the Beck Anxiety Inventory (BAI). Factor analysis identified a five-item PD motor factor, which correlated with motor-symptom severity and mediated the difference on BAI total scores between PD (N=100) and NC (N=74). Removal of the motor-factor items (e.g., “hands trembling”) significantly reduced BAI scores for PD relative to NC and reduced the size of the correlation between the BAI and motor-symptom severity. Study 4 examined the contributions of motor and non-motor symptoms to self-perceived stigma in PD (N=362). Contrary to expectations, perceived stigma was not predicted by motor symptoms but rather by depression and, for men only, by younger age. These studies provide insight into interactions that occur between motor and non-motor symptoms in PD in multiple aspects of daily function, highlighting potential avenues for future research and intervention.