Problem-solving abilities of participants with and without diffuse neurologic involvement

Background: Impaired problem solving is a frequent consequence of brain trauma and other conditions that result in diffuse neurologic involvement. Information about how individuals with diffuse neurologic involvement solve problems is important to the development of strategies designed to help them achieve the highest degree of independent living despite neuropsychological compromise, and may aid clinical decision making in general. Aims: To examine and compare problem-solving abilities of participants with and without diffuse neurologic involvement. Methods & Procedures: We used the Rapid Assessment of Problem Solving test (RAPS; Marshall, Karow, Morelli, Iden, & Dixon, 2003a), a modification of Mosher and Hornsby's (1966) 20 Question task, to examine the problem-solving abilities of two groups of neurologically intact (NI) participants and three groups of participants with diffuse neurologic involvement (DNI). The RAPS is a clinical test of problem-solving abilities in which the client asks yes/no questions to identify a "target picture" in a 32-item array. The DNI groups included individuals with recent and chronic acquired traumatic brain injuries, and a third group of participants with severe mental illness. It was hypothesised that participants with DNI would perform less well on the RAPS than the NI participants, and that these differences would be reflected in lower scores on the RAPS and differences in the frequency with which certain types of questions were used to solve problems. Outcomes & Results: Findings revealed significant differences between NI groups and two of the three DNI groups on objective scores, types of questions asked, and the strategies used to solve problems on the RAPS. The NI participants used a more systematic, organised approach to solving problems, whereas participants with DNI were less organised, inconsistent, and sometimes inflexible in their use of problem-solving strategies. Conclusions: Findings suggest the problem-solving abilities of participants with and without DNI are distinguishable in terms of selected components of Scholnick and Friedman's (1993) developmental theory of planning. These include a decision to plan, strategy choice and execution, and monitoring effects of prior actions.