B – 41 Executive Functioning Errors are Associated with Provider’s Perception of Patient Impulsivity During Subacute Neurological Rehabilitation

Abstract Objective In-hospital falls are a major concern for patients with neurological disorders, particularly those experiencing executive dysfunction. It remains unclear whether fall risk ratings, meant to safeguard patients, are influenced more by healthcare providers' perceptions of patient impulsivity or by measurable executive dysfunction. This study examined the relationship between fall risk, executive function, and impulsivity in an acute neurorehabilitation setting. Method Twenty-four inpatients with stroke or traumatic brain injury completed a brief neurocognitive assessment. Nurses rated patients’ impulsivity by completing the Behavior Rating Inventory of Executive Function – Adult Version, Inhibition subscale. Executive function error composites were derived by averaging error frequencies across key tasks, resulting in an Executive Function Error Index (EFEI), Self-corrected and Uncorrected Error Composites. Pearson correlations were conducted to evaluate associations between fall risk, executive functioning errors, and perceived impulsivity. Results Impulsivity and fall risk were significantly associated, with impulsivity accounting for 30% of the variance. EFEI and perceived impulsivity were significantly associated, with EFEI accounting for 26% of the variance. No significant relationship was detected between perceived impulsivity and self-corrected errors; however, uncorrected errors were significantly associated with higher perceived impulsivity, with uncorrected errors accounting for 19% of the variance. Conclusion Patients perceived as more impulsive were rated as being at higher risk for falls. Patients rated as more impulsive by providers demonstrated increased executive function errors overall. Findings suggest that poor error detection may underlie provider’s perceptions of patient impulsivity. This study demonstrates the role of neuropsychological assessment of performance monitoring for safety improvement in subacute neurological populations.