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Eliav R, Nadler Tzadok Y, Segal-Rotenberg S, Kizony R. Efficacy of Intervention of Participation and Executive Functions (I-PEX) for Adults Following Traumatic Brain Injury: A Preliminary Pilot Randomized Controlled Trial. Neurorehabil Neural Repair 2024:15459683241231529. [PMID: 38375580 DOI: 10.1177/15459683241231529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND Participation restrictions following traumatic brain injury are associated with executive function (EF) deficits (EFDs). The subacute recovery phase's specific characteristics (enhanced brain plasticity and impaired self-awareness) and contextual factors (inpatient setting) warrant adjusting cognitive rehabilitation protocols. The Intervention of Participation and Executive Functions (I-PEX) was designed to improve EFDs during subacute inpatient rehabilitation. OBJECTIVE To investigate the I-PEX's preliminary efficacy to improve EFDs during the performance of complex daily activities and enhance self-awareness, cognitive self-efficacy, participation, and quality of life postdischarge. METHODS A pilot pre-, post-, and follow-up double-blind randomized controlled trial with 25 participants randomly allocated to the I-PEX (n = 13) or treatment-as-usual (n = 12) group. Cognitive assessments were administered pre- and postintervention, and quality of life and participation questionnaires 1-month postdischarge. Data analysis included repeated measures analysis of variance mixed design and independent t-tests, extracting effect sizes. RESULTS Significant group-by-time interaction effect with a medium effect size was found for the primary outcome measure; EFs manifested in complex daily activities, indicating a larger improvement for the experimental group. The group effect was not significant. The experimental group's mean delta score (pre-post improvement) was significantly higher (1.75 ± 2.89; t(23) = 2.52, P = .019), with a large effect size (d = 1.012, 95% confidence interval [0.166-1.840]). We found no significant group and interaction effects for EFs, self-awareness, and cognitive self-efficacy or no significant differences in participation or quality of life postdischarge. CONCLUSIONS Results provide initial evidence for the I-PEX efficacy in treating EFDs in the subacute phase and could help determine effect size for future studies. CLINICAL TRIAL REGISTRY NUMBER ClinicalTrial.gov NCT04292925.
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Affiliation(s)
- Rotem Eliav
- Department of Occupational Therapy, Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Department of Occupational Therapy, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
| | - Yael Nadler Tzadok
- Department of Occupational Therapy, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
| | - Shir Segal-Rotenberg
- Department of Occupational Therapy, Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Department of Occupational Therapy, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
| | - Rachel Kizony
- Department of Occupational Therapy, Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Depatrment of Occupational Therapy, Sheba Medical Center, Tel-Hashomer, Israel
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Boulos ME, Colella B, Meusel LA, Sharma B, Peter MK, Worthington T, Green REA. Feasibility of group telerehabilitation for individuals with chronic acquired brain injury: integrating clinical care and research. Disabil Rehabil 2024; 46:750-762. [PMID: 36855274 DOI: 10.1080/09638288.2023.2177357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 02/02/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Acquired brain injury (ABI) is a leading cause of lifelong disability, but access to treatment in the chronic stages has significant barriers. Group-based, remotely delivered neurorehabilitation reduces costs, travel barriers, and infection risk; however, its feasibility for patients with ABI is not well-established. OBJECTIVES To investigate the feasibility of remotely group-based cognitive and mood therapies for persons with chronic ABI. METHODS Three hundred and eighty-eight adults with chronic ABI participated in group tele-neurorehabilitation modules comprising Cognitive Behavioral Therapy, Goal Management Training®, Relaxation and Mindfulness Skills Training, and/or a novel Concussion Education & Symptom Management program. Assessments comprised quantitative metrics, surveys, as well as qualitative semi-structured interviews in a subset of participants. RESULTS High retention, adherence, and satisfaction were observed. Facilitators of treatment included accessibility, cost-effectiveness, and convenience. Adoption of technology was high, but other people's technological interruptions were a barrier. Self-reported benefits specific to group-based format included improved mood, stress management, coping, interpersonal relationships, cognitive functioning, and present-mindedness. CONCLUSIONS The present study examined chronic ABI patients' perceptions of telerehabilitation. Patients found remotely delivered, group-based mood, and cognitive interventions feasible with easy technology adoption. Group format was considered a benefit. Recommendations are provided to inform design of remotely delivered ABI programs.
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Affiliation(s)
- Mary E Boulos
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Brenda Colella
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Liesel-Ann Meusel
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Bhanu Sharma
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Medical Sciences, McMaster University, Hamilton, Canada
| | - Marika K Peter
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Thomas Worthington
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Robin E A Green
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Ertas-Spantgar F, Korabova S, Gabel A, Schiering I, Müller SV. Guiding patients with traumatic brain injury through the instrumental activities of daily living with the RehaGoal App: a feasibility study. Disabil Rehabil Assist Technol 2024; 19:254-265. [PMID: 35713480 DOI: 10.1080/17483107.2022.2080290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Individuals with traumatic brain injuries (TBI) often experience executive function impairments that impact activities of daily living. Assistive technologies can help overcome these disabilities and Goal Management Training (GMT) provides an effective therapeutic approach for treating such impairments. To capture the benefits of GMT with assistive technology we developed the RehaGoal App. In this study, we investigate whether combining a modified GMT (mGMT) with the RehaGoal App is feasible in terms of study design, and preliminary evaluation of the attainment of self-defined goals. We also examine if the app produces useful metrics data, tests its usability, and gauges its potential for improving goal attainment. METHODS We used a case study design to evaluate four individuals with impairments in executive functions after TBI. They underwent an 8-week mGMT and RehaGoal App intervention to achieve a self-defined goal. To investigate the intervention's feasibility, we collected Goal Attainment Scale (GAS) scores at two-time points, neuropsychological data at study start, System Usability Scale (SUS) scores at study end, and metrics data throughout the study period. RESULTS Participant retention and compliance rates were high. All participants improved on GAS. Metrics data was collected successfully and revealed different participant usage behaviours. Overall, the SUS scores of the participants indicated excellent app usability. CONCLUSIONS The intervention was feasible but the study design should be modified. Preliminary evaluation of GAS, SUS, and metrics data provided useful insights on user behaviour, app usability, and its role in achieving self-defined goals. The app received overall positive participant ratings.IMPLICATION FOR REHABILITATIONMetric data can be useful as it can give therapists additional opportunities to gain more information about the realization of intervention tasks between the therapy sessions allowing them to use this information to adjust therapy elements.RehaGoal App in combination with a modified GMT may be able to support participants with impairment in executive functions in completing the task of daily living.The study shows that the RehaGoal App is feasible in rehabilitation for a small sample size and that it may be scaled up in the future larger randomized controlled trial.
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Affiliation(s)
- Funda Ertas-Spantgar
- Faculty of Social Work, Ostfalia University of Applied Sciences, Wolfenbüttel, Germany
| | - Sona Korabova
- Faculty of Neurocognitive Psychology, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Alexander Gabel
- Faculty of Computer Science, Ostfalia University of Applied Sciences, Wolfenbüttel, Germany
| | - Ina Schiering
- Faculty of Computer Science, Ostfalia University of Applied Sciences, Wolfenbüttel, Germany
| | - Sandra Verena Müller
- Faculty of Social Work, Ostfalia University of Applied Sciences, Wolfenbüttel, Germany
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Okita Y, Kawaguchi Y, Inoue Y, Ohno K, Sawada T, Levack W, Tomori K. Characteristics of goal-setting tools in adult rehabilitation: A scoping review. Clin Rehabil 2024; 38:234-250. [PMID: 37644842 PMCID: PMC10725121 DOI: 10.1177/02692155231197383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES This scoping review aims to map the literature on goal-setting tools in adult rehabilitation, exploring their characteristics, target users and supporting evidence to inform practice and future research in this area. METHODS We completed a comprehensive search of four databases to identify relevant articles on tools for goal setting in rehabilitation. We followed Arkey and O'Malley's scoping review process to guide article selection, data extraction and data analysis. RESULTS We identified a total of 165 studies that reported on 55 different goal-setting tools, including tools for goal selection and goal documentation (n = 31), goal setting and intervention planning (n = 15), and for measuring the quality of the goal-setting process (n = 9). Over half of the tools were primarily designed for use in rehabilitation of physical disabilities (n = 32). Some tools fell under multiple sub-categories based on their characteristics as follows: 22 framework tools, 12 interview tools, 9 outcome measurement tools for goal achievement, 6 outcome measurement tools for goal quality and 25 documentation tools. The majority of goal-setting instruments targeted goals at the level of activity and participation (n = 51) and aimed to facilitate a client-centred or shared decision-making approach to rehabilitation planning (n = 46). CONCLUSIONS This study provides a comprehensive overview of existing goal-setting tools, highlighting their characteristics, target users and identified needs. These findings can enhance practitioners' awareness of the range of goal-setting tools available and can enable more effective utilization of these tools in clinical practice. Further research should investigate how clinicians can combine multiple tools to deliver goal setting.
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Affiliation(s)
- Yuho Okita
- School of Health Science, Swinburne University of Technology, Melbourne, Australia
| | - Yuko Kawaguchi
- Department of Rehabilitation, Kaikoukai Rehabilitation Hospital, Aichi, Japan
| | - Yuki Inoue
- Central Rehabilitation Department, Yokohama Rousai Hospital, Kanagawa, Japan
| | - Kanta Ohno
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Tatsunori Sawada
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - William Levack
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Kounosuke Tomori
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
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McShan EE, Juengst S, Douglas ME, Noorbakhsh D, Calhoun S, Bennett M, Suhalka A, Dubiel R, Driver S. Efficacy of a group-based education intervention for people with traumatic brain injury: supplementary results from a 12-month randomized controlled trial. Brain Inj 2023; 37:1205-1214. [PMID: 37355803 DOI: 10.1080/02699052.2023.2225874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/25/2023] [Accepted: 06/12/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE Our team developed an attention control condition, called the Brain Health Group (BHG), for a randomized controlled trial (RCT; NCT03594734). The focus of the BHG was on brain health education and self-management. The objectives of this supplementary analysis are to (1) Describe compliance with the 12-month BHG; (2) Examine efficacy for improving general self-efficacy (GSE, primary) and secondary outcomes; and (3) Describe findings from the program evaluation. DESIGN English-speaking adults (18-64 years old) who were ≥6 months post a moderate-to-severe TBI were randomized to the BHG (n = 29) or active intervention (n = 28). Data were collected at baseline and 12 months, including GSE, depression, satisfaction with life (SWL), self-rated abilities for health practices (SRAHP), and alcohol use. Program evaluation was conducted at 12 months. RESULTS Attendance was 89%, and goal tracking was 63%. Within group analysis showed a significant increase in SRAHP scores (p = 0.018). Non-significant increases in GSE and SWL were observed, and participants perceived the BHG as helpful. No significant changes in depression or alcohol use were reported. CONCLUSION People with TBI can engage in and benefit from the BHG and perceive the program as helpful for improving knowledge about brain health and awareness of self-management skills.
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Affiliation(s)
- Evan Elizabeth McShan
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation; Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Shannon Juengst
- Clinical Investigator Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas b
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center; North Texas Traumatic Brain Injury Model System, Dallas, Texas
- Department of Physical Medicine and Rehabilitation, UT Health Sciences Center at Houston, Houston, Texas
| | - Megan E Douglas
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation; Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Donna Noorbakhsh
- Speech Language Pathologist Certified Brain Injury Specialist Day Neuro Program, Baylor Scott and White Institute for Rehabilitation; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Stephanie Calhoun
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation; Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Monica Bennett
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation; Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
- Biostatistics Core Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Alexandria Suhalka
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation; Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Rosemary Dubiel
- TBI Services Baylor Scott and White Institute for Rehabilitation; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Simon Driver
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation; Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
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Waid-Ebbs JK, Wen PS, Grimes T, Datta S, Perlstein WM, Hammond CS, Daly JJ. Executive function improvement in response to meta-cognitive training in chronic mTBI / PTSD. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1189292. [PMID: 37484602 PMCID: PMC10360208 DOI: 10.3389/fresc.2023.1189292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 04/24/2023] [Indexed: 07/25/2023]
Abstract
Objective We tested Goal Management Training (GMT), which has been recommended as an executive training protocol that may improve the deficits in the complex tasks inherent in life role participation experienced by those with chronic mild traumatic brain injury and post-traumatic stress disease (mTBI/PTSD). We assessed, not only cognitive function, but also life role participation (quality of life). Methods We enrolled and treated 14 individuals and administered 10 GMT sessions in-person and provided the use of the Veterans Task Manager (VTM), a Smartphone App, which was designed to serve as a "practice-buddy" device to ensure translation of in-person learning to independent home and community practice of complex tasks. Pre-/post-treatment primary measure was the NIH Examiner, Unstructured Task. Secondary measures were as follows: Tower of London time to complete (cTOL), Community Reintegration of Service Members (CRIS) three subdomains [Extent of Participation; Limitations; Satisfaction of Life Role Participation (Satisfaction)]. We analyzed pre-post-treatment, t-test models to explore change, and generated descriptive statistics to inspect given individual patterns of change across measures. Results There was statistically significant improvement for the NIH EXAMINER Unstructured Task (p < .02; effect size = .67) and cTOL (p < .01; effect size = .52. There was a statistically significant improvement for two CRIS subdomains: Extent of Participation (p < .01; effect size = .75; Limitations (p < .05; effect size = .59). Individuals varied in their treatment response, across measures. Conclusions and Clinical Significance In Veterans with mTBI/PTSD in response to GMT and the VTM learning support buddy, there was significant improvement in executive cognition processes, sufficiently robust to produce significant improvement in community life role participation. The individual variations support need for precision neurorehabilitation. The positive results occurred in response to treatment advantages afforded by the content of the combined GMT and the employment of the VTM learning support buddy, with advantages including the following: manualized content of the GMT; incremental complex task difficulty; GMT structure and flexibility to incorporate individualized functional goals; and the VTM capability of ensuring translation of in-person instruction to home and community practice, solidifying newly learned executive cognitive processes. Study results support future study, including a potential randomized controlled trial, the manualized GMT and availability of the VTM to ensure future clinical deployment of treatment, as warranted.
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Affiliation(s)
- J. Kay Waid-Ebbs
- Department of Veterans Affairs (VA), Rehabilitation Research and Development, Brain Rehabilitation Research Center, Gainesville, FL, United States
| | - Pey-Shan Wen
- Department of Occupational Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, United States
| | - Tyler Grimes
- Department of Mathematics and Statistics, University of North Florida, Jacksonville, FL, United States
| | - Somnath Datta
- Department of Biostatistics, University of Florida, Gainesville, FL, United States
| | - William M. Perlstein
- Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Carol Smith Hammond
- Audiology and Speech Pathology Service, Durham VAMC, Durham, NC, United States
- General Internal Medicine, Duke University, Durham, NC, United States
| | - Janis J. Daly
- Department of Veterans Affairs (VA), Rehabilitation Research and Development, Brain Rehabilitation Research Center, Gainesville, FL, United States
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
- Department of Neurology, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
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Wheeler S, Acord-Vira A. Occupational Therapy Practice Guidelines for Adults With Traumatic Brain Injury. Am J Occup Ther 2023; 77:7704397010. [PMID: 37624997 DOI: 10.5014/ajot.2023.077401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
IMPORTANCE Occupational therapy practitioners are uniquely qualified to address the occupational needs of people with traumatic brain injury (TBI) and their caregivers to maximize participation, health, and well-being. OBJECTIVE These Practice Guidelines are informed by systematic reviews of the effectiveness of interventions that address impairments and skills to improve the occupational performance of people with TBI, as well as interventions for caregivers of people with TBI. The purpose of these guidelines is to summarize the current evidence available to assist clinicians' clinical decision-making in providing interventions for people with TBI and their caregivers. METHOD We reviewed six systematic reviews and synthesized the results into clinical recommendations to be used in occupational therapy clinical practice. RESULTS Sixty-two articles served as the basis for the clinical recommendations. CONCLUSIONS AND RECOMMENDATIONS Strong to moderate evidence supports multimodal sensory stimulation, unimodal auditory stimulation, physical activity, virtual reality, cognitive interventions, vision therapy, goal-focused interventions, individual and group training and education, and caregiver supports. Occupational therapy practitioners should incorporate these interventions into individual and group sessions to maximize recovery and promote occupational participation. Additional interventions are also available, based on emerging evidence and expert opinion, including prevention approaches, complexity of injury, and the use of occupation-based performance assessments. What This Article Adds: These Practice Guidelines provide a summary of evidence in clinical recommendations tables supporting occupational therapy interventions that address impairments resulting from and skills to improve occupational performance after TBI. The guidelines also include case study examples and evidence graphics for practitioners to use to support clinical reasoning when selecting interventions that address the goals of the person with TBI and their caregiver's needs.
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Affiliation(s)
- Steven Wheeler
- Steven Wheeler, PhD, OTR/L, FAOTA, CBIS, is Professor and Chair of Occupational Therapy, Division of Occupational Therapy, West Virginia University, Morgantown;
| | - Amanda Acord-Vira
- Amanda Acord-Vira, EdD, OTR/L, FAOTA, CBIS, is Associate Professor of Occupational Therapy, Division of Occupational Therapy, West Virginia University, Morgantown
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Vas A, Luedtke A, Ortiz E, Mackie N, Gonzalez S. Cognitive Rehabilitation: Mild Traumatic Brain Injury and Relevance of OTPF. Occup Ther Int 2023; 2023:8135592. [PMID: 37283959 PMCID: PMC10241584 DOI: 10.1155/2023/8135592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 04/30/2023] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
There is increased awareness of the long-term cognitive sequelae of mild traumatic brain injury (mTBI). Therefore, researchers and clinicians have developed and tested cognitive training protocols to address these challenges. The current review summarized literature that examined existing cognitive rehabilitation/training programs. Specifically, the review listed the impact of these programs on functional domains informed by the Occupational Therapy Practice Framework (OTPF). Literature between the years 2008 and 2022 was gathered from nine databases. Results indicate that several cognitive rehabilitation programs have proven to positively influence domains of occupation, client factors, performance, and context. Occupational therapy practitioners have an opportunity to engage in mTBI management. Furthermore, adopting domains of OTPF may guide assessments, treatment planning, and long-term follow-up.
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Affiliation(s)
- Asha Vas
- School of Occupational Therapy, Texas Woman's University, Dallas, TX 75235, USA
| | - Anna Luedtke
- Baylor Scott & White Medical Center, Dallas, Texas, USA
| | - Eryn Ortiz
- Thrive Skilled Pediatric Care, Dallas, Texas, USA
| | - Natalie Mackie
- School of Occupational Therapy, Texas Woman's University, Dallas, TX 75235, USA
| | - Samantha Gonzalez
- School of Occupational Therapy, Texas Woman's University, Dallas, TX 75235, USA
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Anderson AC, Robinson AH, Giddens E, Hartshorn B, Allan E, Rowe C, Lawrence T, Chong TTJ, Lubman DI, Verdejo-Garcia A. Proof-of-concept trial of Goal Management Training + to improve executive functions and treatment outcomes in methamphetamine use disorder. Drug Alcohol Depend 2023; 246:109846. [PMID: 37004463 DOI: 10.1016/j.drugalcdep.2023.109846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/30/2023] [Accepted: 03/13/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Deficits in executive function are common in methamphetamine use disorder (MUD), likely contributing to difficulties in sustained treatment success. Cognitive remediation interventions are designed to treat such deficits but have not been adapted to the needs of people with MUD. This study presents a proof-of-concept trial to evaluate a new cognitive remediation program for MUD, Goal Management Training+ (GMT+). METHODS This was a cluster-randomised crossover trial comparing GMT+ with a psychoeducation-based control (Brain Health Workshop; BHW). GMT+ is a therapist-administered group-based cognitive remediation for executive dysfunction comprising four 90-minute weekly sessions and daily journal activities. BHW is a lifestyle psychoeducation program matched to GMT+ for therapist involvement, format, and duration. Participants (n = 36; GMT n = 17; BHW n = 19) were recruited from therapeutic communities in Victoria, Australia. Primary outcomes included intervention acceptability, feasibility, and improvements in self-reported executive function. Secondary outcomes included cognitive tests of executive function, severity of methamphetamine dependence, craving, and quality of life. We performed mixed linear modelling and calculated Hedges' g effect sizes. RESULTS GMT+ participant ratings and program retention indicated high acceptability. There was no difference between GMT+ and BHW on self-reported executive function (g = 0.06). Cognitive tasks suggested benefits of GMT+ on information gathering (g = 0.88) and delay-discounting (g = 0.80). Severity of methamphetamine dependence decreased more in GMT+ (g = 1.47). CONCLUSIONS GMT+ was well-accepted but did not improve self-reported executive functioning. Secondary outcomes suggested GMT+ was beneficial for objective cognitive performance and severity of dependence.
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Affiliation(s)
- Alexandra C Anderson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Monash Addiction Research Centre, Monash University, Victoria, Australia
| | - Alex H Robinson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Monash Addiction Research Centre, Monash University, Victoria, Australia
| | - Emily Giddens
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Breanna Hartshorn
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Eric Allan
- Odyssey House Victoria, Melbourne, Victoria, Australia
| | - Carol Rowe
- Odyssey House Victoria, Melbourne, Victoria, Australia
| | | | - Trevor T-J Chong
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Victoria, Australia; Monash Addiction Research Centre, Monash University, Victoria, Australia
| | - Antonio Verdejo-Garcia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Monash Addiction Research Centre, Monash University, Victoria, Australia.
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INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part III: Executive Functions. J Head Trauma Rehabil 2023; 38:52-64. [PMID: 36594859 DOI: 10.1097/htr.0000000000000834] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Moderate-to-severe traumatic brain injury (MS-TBI) causes debilitating and enduring impairments of executive functioning and self-awareness, which clinicians often find challenging to address. Here, we provide an update to the INCOG 2014 guidelines for the clinical management of these impairments. METHODS An expert panel of clinicians/researchers (known as INCOG) reviewed evidence published from 2014 and developed updated recommendations for the management of executive functioning and self-awareness post-MS-TBI, as well as a decision-making algorithm, and an audit tool for review of clinical practice. RESULTS A total of 8 recommendations are provided regarding executive functioning and self-awareness. Since INCOG 2014, 4 new recommendations were made and 4 were modified and updated from previous recommendations. Six recommendations are based on level A evidence, and 2 are based on level C. Recommendations retained from the previous guidelines and updated, where new evidence was available, focus on enhancement of self-awareness (eg, feedback to increase self-monitoring; training with video-feedback), meta-cognitive strategy instruction (eg, goal management training), enhancement of reasoning skills, and group-based treatments. New recommendations addressing music therapy, virtual therapy, telerehabilitation-delivered metacognitive strategies, and caution regarding other group-based telerehabilitation (due to a lack of evidence) have been made. CONCLUSIONS Effective management of impairments in executive functioning can increase the success and well-being of individuals with MS-TBI in their day-to-day lives. These guidelines provide management recommendations based on the latest evidence, with support for their implementation, and encourage researchers to explore and validate additional factors such as predictors of treatment response.
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Brown J, Kaelin D, Mattingly E, Mello C, Miller ES, Mitchell G, Picon LM, Waldron-Perine B, Wolf TJ, Frymark T, Bowen R. American Speech-Language-Hearing Association Clinical Practice Guideline: Cognitive Rehabilitation for the Management of Cognitive Dysfunction Associated With Acquired Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2455-2526. [PMID: 36373898 DOI: 10.1044/2022_ajslp-21-00361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cognitive-communication impairments following acquired brain injury (ABI) can have devastating effects on a person's ability to participate in community, social, vocational, and academic preinjury roles and responsibilities. Guidelines for evidence-based practices are needed to assist speech-language pathologists (SLPs) and other rehabilitation specialists in the delivery of cognitive rehabilitation for the adult population. PURPOSE The American Speech-Language-Hearing Association, in conjunction with a multidisciplinary panel of subject matter experts, developed this guideline to identify best practice recommendations for the delivery of cognitive rehabilitation to adults with cognitive dysfunction associated with ABI. METHOD A multidisciplinary panel identified 19 critical questions to be addressed in the guideline. Literature published between 1980 and 2020 was identified based on a set of a priori inclusion/exclusion criteria, and main findings were pooled and organized into summary of findings tables. Following the principles of the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision Framework, the panel drafted recommendations, when appropriate, based on the findings, overall quality of the evidence, balance of benefits and harms, patient preferences, resource implications, and the feasibility and acceptability of cognitive rehabilitation. RECOMMENDATIONS This guideline includes one overarching evidence-based recommendation that addresses the management of cognitive dysfunction following ABI and 11 subsequent recommendations focusing on cognitive rehabilitation treatment approaches, methods, and manner of delivery. In addition, this guideline includes an overarching consensus-based recommendation and seven additional consensus recommendations highlighting the role of the SLP in the screening, assessment, and treatment of adults with cognitive dysfunction associated with ABI. Future research considerations are also discussed.
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Affiliation(s)
| | | | | | | | - E Sam Miller
- Maryland State Department of Education, Baltimore
| | | | | | | | | | - Tobi Frymark
- American Speech-Language-Hearing Association, Rockville, MD
| | - Rebecca Bowen
- American Speech-Language-Hearing Association, Rockville, MD
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12
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Radomski MV, Giles GM, Carroll G, Anheluk M, Yunek J. Cognitive Interventions to Improve a Specific Cognitive Impairment for Adults With TBI (June 2013-October 2020). Am J Occup Ther 2022; 76:23933. [PMID: 36166674 DOI: 10.5014/ajot.2022/76s2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on cognitive interventions to improve a specific cognitive impairment for adults with TBI.
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Affiliation(s)
- Mary Vining Radomski
- Mary Vining Radomski, PhD, OTR/L, FAOTA, is Director, Courage Kenny Research, Courage Kenny Research Center/Allina Health
| | - Gordon Muir Giles
- Gordon Muir Giles, PhD, OTR/L, is Professor, Samuel Merritt University
| | - Ginger Carroll
- Ginger Carroll, MS, OT/L, CPPM, Courage Kenny Research Center/Allina Health
| | - Mattie Anheluk
- Mattie Anheluk, MOT, OTR/L, Courage Kenny Rehabilitation Institute- Minneapolis/Allina Health
| | - Joe Yunek
- Joe Yunek, MS, OTR/L, Courage Kenny Rehabilitation Institute- Minneapolis/Allina Health
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13
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Jensen DA, Lundervold AJ, Stubberud J, Halmøy A, Haavik J, Sørensen L. Goal management training improves executive control in adults with ADHD: an open trial employing attention network theory to examine effects on attention. BMC Psychol 2022; 10:207. [PMID: 36028907 PMCID: PMC9414421 DOI: 10.1186/s40359-022-00902-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Adults with Attention-Deficit/Hyperactivity Disorder (ADHD) typically experience poorer attentional control. According to the attention network theory, attentional control relies on three interacting networks of alerting, orienting, and executive control. In ADHD, it is mainly the alerting and executive control networks that are suggested and found to be compromised. Methods In the current study, we investigated if a group-based metacognitive remediation program (Goal Management Training [GMT]) in adults with ADHD would enhance attentional control using an experimental measure of the attention network theory. We expected that GMT would specifically enhance the executive control and alerting networks. Results Data from post- and follow up-assessments of 21 adults (age: 39.05 [11.93]) with ADHD who had completed GMT were included. Linear mixed-effects modeling revealed significant improvements in the functioning of the executive control network for the majority of the participants, although a small subset of participants showed a negative development following the intervention. Results also showed an improvement in the orienting network at follow up, but no change in the alerting network. Conclusion The results may indicate that improvements in the functioning of the executive control network are central to the positive effects of GMT reported in disorders characterized by impaired attentional control. Trial registration: The study was retrospectively registered in the ISRCTN (Identifier: ISRCTN91988877) on the 18/01/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00902-9.
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Affiliation(s)
- Daniel A Jensen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway. .,Division of Mental Health, Betanien Hospital, Bergen, Norway.
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Jan Stubberud
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anne Halmøy
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jan Haavik
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Lin Sørensen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
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14
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Smetheram T, Amiama ME, Hébert D, Law G, Dawson DR. Occupational Therapy Interventions for Poststroke Fatigue: A Scoping Review. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2022; 42:182-188. [DOI: 10.1177/15394492221087968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Fatigue after stroke can negatively affect the survivors’ well-being. Despite the high prevalence and consequences of poststroke fatigue (PSF), there is no specific guidance for occupational therapy practitioners (OTPs) to address this symptom. Objectives: The objectives of the study were to identify and describe the research on potential occupational therapy (OT) interventions for PSF. Method: Three databases were searched using scoping review methodology. Two authors completed a title and abstract and full-text review. Study characteristics, participant characteristics, qualities of interventions, and outcome measures were extracted and synthesized. Results: Eight studies met selection criteria. Studies were conducted with stroke and traumatic brain injury patients in outpatient, inpatient, and community settings. Interventions included psychoeducation and behavior change, multicomponent programs, and mindfulness-based stress reduction therapies. The Fatigue Severity Scale and the Mental Fatigue Scale were commonly used. Conclusion: Evidence for OT interventions targeting PSF is limited. Recommendations for future research are provided.
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Affiliation(s)
| | | | | | - Geoff Law
- University Health Network, Toronto, Ontario, Canada
| | - Deirdre R. Dawson
- University of Toronto, Ontario, Canada
- Baycrest Health Sciences, Toronto, Ontario, Canada
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15
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Wadams A, Suting L, Lindsey A, Mozeiko J. Metacognitive Treatment in Acquired Brain Injury and Its Applicability to Aphasia: A Systematic Review. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:813416. [PMID: 36188940 PMCID: PMC9397955 DOI: 10.3389/fresc.2022.813416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Abstract
Purpose The purpose of this systematic review is to identify the utility of metacognitive therapeutic intervention for persons with acquired brain injury (ABI), with a focus on persons with aphasia. Methods A search of six databases resulted in two hundred and sixty-six unique manuscripts relating to the explicit use of metacognitive treatment for people with ABI. Two independent reviewers rated abstracts for inclusion or exclusion of the study given predetermined criteria. Twenty-nine articles, five of which included people with aphasia, were selected for inclusion in this systematic review. SCED+ and PEDro+ rating scales were used to rate the methodological quality of each study. Results Methodological quality of the 29 studies that met inclusion criteria ranged from weak to high quality studies. Three -hundred and sixty-nine individuals with ABI took part in the 29 studies. Varying treatment methods were employed. Outcome measures were inconsistent. Metacognitive treatment has been applied to people with aphasia with positive results, but efficacy of the treatment cannot yet be determined. Conclusions Metacognitive therapeutic intervention tends to be effective for persons with acquired brain injury (ABI) despite variability between intervention designs and treatment outcomes across studies. Due to so few studies with participants with aphasia, we were unable to draw conclusions regarding the efficacy of metacognitive treatment for people with aphasia. Further research on the efficacy of metacognitive treatment for this population is warranted.
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Affiliation(s)
- Amanda Wadams
- Department of Speech, Language and Hearing Science, University of Connecticut, Mansfield, MA, United States
- *Correspondence: Amanda Wadams
| | - Louisa Suting
- Department of Speech, Language and Hearing Science, University of Connecticut, Mansfield, MA, United States
| | - André Lindsey
- School of Education, Speech Pathology, Nevada State College, Henderson, NV, United States
| | - Jennifer Mozeiko
- Department of Speech, Language and Hearing Science, University of Connecticut, Mansfield, MA, United States
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16
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Olsen A, Dennis EL, Stubberud J, Hovenden ES, Solbakk AK, Endestad T, Kristian Hol P, Schanke AK, Løvstad M, Tornås S. Regional brain volume prior to treatment is linked to outcome after cognitive rehabilitation in traumatic brain injury. NEUROIMAGE: CLINICAL 2022; 35:103126. [PMID: 36002956 PMCID: PMC9421497 DOI: 10.1016/j.nicl.2022.103126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/01/2022] [Accepted: 07/23/2022] [Indexed: 11/17/2022] Open
Abstract
Advanced neuroimaging has potential to inform new practices in cognitive rehabilitation. Regional brain volume was linked to effect of cognitive rehabilitation in traumatic brain injury. The most robust effects were observed in midline fronto-parietal brain regions.
Cognitive rehabilitation is useful for many after traumatic brain injury (TBI), but we lack critical knowledge about which patients benefit the most from different approaches. Advanced neuroimaging techniques have provided important insight into brain pathology and systems plasticity after TBI, and have potential to inform new practices in cognitive rehabilitation. In this study, we aimed to identify candidate structural brain measures with relevance for rehabilitation of cognitive control (executive) function after TBI. Twenty-eight patients (9 female, mean age 40.5 (SD = 13.04) years) with TBI (>21 months since injury) that participated in a randomized controlled cognitive rehabilitation trial (NCT02692352) were included in the analyses. Regional brain volume was extracted from T1-weighted MRI scans before treatment using tensor-based morphometry. Both positive and negative associations between treatment outcome (everyday cognitive control function) and regional brain volume were observed. The most robust associations between regional brain volume and improvement in function were observed in midline fronto-parietal regions, including the anterior and posterior cingulate cortices. The study provides proof of concept and valuable insight for planning future studies focusing on neuroimaging in cognitive rehabilitation after TBI.
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Affiliation(s)
- Alexander Olsen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Emily L Dennis
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA; George E. Wahlen Veteran Affairs Medical Center, Salt Lake City UT, USA
| | - Jan Stubberud
- Department of Psychology, University of Oslo, Oslo, Norway; Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Elizabeth S Hovenden
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA; George E. Wahlen Veteran Affairs Medical Center, Salt Lake City UT, USA
| | - Anne-Kristin Solbakk
- RITMO, Department of Psychology, University of Oslo, Norway; Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Norway; Department of Neuropsychology, Helgeland Hospital, 8657 Mosjøen, Norway
| | - Tor Endestad
- RITMO, Department of Psychology, University of Oslo, Norway; Department of Neuropsychology, Helgeland Hospital, 8657 Mosjøen, Norway
| | - Per Kristian Hol
- The Intervention Centre, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne-Kristine Schanke
- Department of Psychology, University of Oslo, Oslo, Norway; Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Marianne Løvstad
- Department of Psychology, University of Oslo, Oslo, Norway; Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Sveinung Tornås
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
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17
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Dynamics of Neuropsychological Symptoms during the Training of Executive Functions in Neurological Patients. Healthcare (Basel) 2021; 9:healthcare9121716. [PMID: 34946442 PMCID: PMC8701304 DOI: 10.3390/healthcare9121716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/26/2021] [Accepted: 12/10/2021] [Indexed: 11/28/2022] Open
Abstract
Executive function disorder rehabilitation in neurological patients is associated with many difficulties. We investigated the effectiveness of group training, proposed by B. Wilson et al., which has the model of frontal lobes functioning by D. T. Stuss as the theoretical background. The study participants were 16 patients with executive function disorder caused by TBI, strokes, and infections. The training was shortened from 9 weeks to 3 and adopted to the conditions of the rehabilitation centre where the study was held. The evaluation of training effectiveness was carried out by the methods of neuropsychological diagnostics proposed by A. R. Luria as well as standardized quantitative tests (CWIT test, Raven test, FAB) and questionnaires (EBIQ) aimed at assessing the state of executive functions and general well-being. In result positive trends, but not reaching the level of significance, were revealed in the performance of all evaluating methods, with the exception of “arithmetic problems” and “inhibitory control” as part of the FAB test. Statistically significant result was obtained concerning such tests as “counting”, “analysis of story pictures”, and index of total uncorrected errors in the CWIT test. Thus, the results of eventual assessment showed positive dynamic of executive functions state.
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18
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Egset KS, Weider S, Stubberud J, Hjemdal O, Ruud E, Hjort MA, Eilertsen MEB, Sund AM, Røkke ME, Reinfjell T. Cognitive Rehabilitation for Neurocognitive Late Effects in Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Feasibility and Case-Series Study. Front Psychol 2021; 12:724960. [PMID: 34777103 PMCID: PMC8581253 DOI: 10.3389/fpsyg.2021.724960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/06/2021] [Indexed: 11/13/2022] Open
Abstract
Neurocognitive late effects following the diagnosis and treatment of childhood acute lymphoblastic leukemia (ALL) commonly include impaired executive functions (EFs), with negative consequences for one's health-related quality of life and mental health. However, interventions for EF impairments are scarce. Thus, the aims of this study were to (1) explore the feasibility and acceptability of the cognitive rehabilitation program Goal Management Training (GMT) and (2) examine whether GMT is associated with positive outcomes across cases of ALL survivors with EF complaints. Four participants (median age 31.5 years) underwent nine GMT modules in a total of five group sessions. Rehabilitation was focused on compensatory strategies to improve real-life EFs. Participants were evaluated at 2-week and 6-month follow-ups. Evaluation of feasibility and acceptability included adherence, a semi structured interview, self-reports, and safety. Additionally, therapists' experience with implementation was evaluated. Outcome measures included self-reports and neurocognitive tests of attention, EF, and processing speed. All participants completed GMT and rated the intervention as useful, suitable, and satisfactory. The reliable change index showed improved daily life EFs (two participants) and neurocognitive performance (three participants) at 6-month follow-up. Additionally, all participants improved on a "real-life" task involving EF. A future randomized controlled trial is recommended.
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Affiliation(s)
- Kaja Solland Egset
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siri Weider
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jan Stubberud
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Research, Lovisenberg Diakonale Hospital, Oslo, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ellen Ruud
- Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Magnus Aassved Hjort
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Mary-Elizabeth Bradley Eilertsen
- Department of Public Health and Nursing, Center for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Mari Sund
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Magnhild Eitrem Røkke
- Kavli Institute for Systems Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trude Reinfjell
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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19
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Brandt AE, Finnanger TG, Hypher RE, Rø TB, Skovlund E, Andersson S, Risnes K, Stubberud J. Rehabilitation of executive function in chronic paediatric brain injury: a randomized controlled trial. BMC Med 2021; 19:253. [PMID: 34724955 PMCID: PMC8561897 DOI: 10.1186/s12916-021-02129-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Impaired executive functions (EFs, i.e., purposeful, goal-directed behaviour) cause significant disability after paediatric acquired brain injury (pABI) warranting efficient interventions. Goal Management Training (GMT) is a metacognitive protocol proven effective for executive dysfunction in adults. This pre-registered, blinded, parallel-randomized controlled trial evaluated efficacy of a paediatric adaptation (pGMT) compared to a psychoeducative control (paediatric Brain Health Workshop, pBHW) to improve EF. METHODS Children aged 10 to 17 years with pABI (e.g., traumatic brain injury, brain tumour), ≥ 1 year post-onset or ended treatment, with parent-reported EF complaints were eligible. Participants were randomized (computer-algorithm) to either group-based pGMT (n = 38) or pBHW (n = 38). The active control was tailored to keep non-specific factors constant. Thus, both treatments comprised of 7 sessions at hospitals over 3 consecutive weeks, followed by 4 weeks of telephone counselling of participants, parents, and teachers. Parent-reported daily life EF, assessed by the questionnaire Behavior Rating Inventory of Executive Function (BRIEF; Behavioral Regulation Index (BRI) and Metacognition Index (MI)), were co-primary outcomes 6 months post-intervention. Secondary outcomes included neuropsychological tests and a complex naturalistic task (Children's Cooking Task). RESULTS Seventy-three participants (96%) completed allocated interventions and 71 (93%) attended the 6-month follow-up. The results demonstrated no significant difference in effectiveness for the two interventions on parent-reported EF: For BRIEFBRI, mean (SD) raw score for pGMT was 42.7 (8.8) and 38.3 (9.3) for pBHW. Estimated difference was - 2.3 (95% CI - 5.1 to 0.6). For BRIEFMI, the corresponding results were 80.9 (20.4) for GMT and 75.5 (19.3) for pBHW. Estimated difference was - 1.4 (95% CI -8.5 to 5.8). In performance-based tests, pGMT was associated with improved inhibition and executive attention, while pBHW was associated with fewer errors in the naturalistic task. CONCLUSIONS In pABI, metacognitive training (pGMT) did not demonstrate additional effectiveness on parent-reported daily life EF at 6-month follow-up, when compared to a psychoeducative control. Both interventions were well-tolerated and demonstrated distinct improvements at different EF assessment levels. To conclude on pGMT efficacy, larger studies are needed, including further investigation of appropriate assessment levels and possible differences in effect related to treatment duration, developmental factors, and injury characteristics. TRIAL REGISTRATION ClinicalTrials.gov , NCT0321534211, 11 July 2017.
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Affiliation(s)
- Anne E. Brandt
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Postbox 3250 Torgarden, NO-7006 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torun G. Finnanger
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Postbox 3250 Torgarden, NO-7006 Trondheim, Norway
| | - Ruth E. Hypher
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Torstein B. Rø
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Postbox 3250 Torgarden, NO-7006 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | | | - Kari Risnes
- Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Postbox 3250 Torgarden, NO-7006 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jan Stubberud
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
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20
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Jensen DA, Halmøy A, Stubberud J, Haavik J, Lundervold AJ, Sørensen L. An Exploratory Investigation of Goal Management Training in Adults With ADHD: Improvements in Inhibition and Everyday Functioning. Front Psychol 2021; 12:659480. [PMID: 34566748 PMCID: PMC8458564 DOI: 10.3389/fpsyg.2021.659480] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Adults with attention deficit/hyperactivity disorder (ADHD) are predominantly treated with medication. However, there is also a need for effective, psychologically based interventions. As ADHD is strongly associated with reduced inhibitory control, cognitive remediation approaches should be efficient. Goal management training (GMT) aims at enhancing inhibitory control and has shown positive effects on inhibitory control in non-ADHD patient groups. The aim of the current study was to explore whether GMT would specifically enhance inhibitory control in adults with ADHD, and if such an enhancement would lead to secondary improvements in self-reported everyday functioning. Methods: Twenty-one participants with ADHD (mean age: 39.05 years [SD 11.93]) completed the intervention and assessments pre-, post- and 6 months after the intervention. Measures included neuropsychological tests and self-report questionnaires pertaining to cognitive- and executive functioning, emotion regulation, quality of life, and ADHD symptoms. Results: Compared to baseline, the participants showed enhanced inhibitory control on performance-based measures at post-assessment and 6-month follow-up. The participants also reported increased productivity and reduced cognitive difficulties in everyday life at both assessments post-treatment, as well as improvements in aspects of emotion regulation and a reduction in the severity of core ADHD-symptoms at 6-month follow-up. Conclusion: Our exploratory study showed that GMT seems to specifically improve one of the core executive dysfunctions in ADHD, namely inhibitory control, with a positive effect lasting at least 6 months post-treatment. The adults with ADHD also reported improved self-regulation in their everyday life after completing GMT, providing strong arguments for further investigations of GMT as a treatment option for this group of adults. Clinical Trial Registration: The study is registered under ISRCTN.com (ISRCTN91988877; https://doi.org/10.1186/ISRCTN91988877).
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Affiliation(s)
- Daniel André Jensen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Division of Mental Health, Betanien Hospital, Bergen, Norway
| | - Anne Halmøy
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jan Stubberud
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Jan Haavik
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Biomedicine, University of Bergen, Bergen, Norway
| | | | - Lin Sørensen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
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21
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Tarantino V, Burgio F, Toffano R, Rigon E, Meneghello F, Weis L, Vallesi A. Efficacy of a Training on Executive Functions in Potentiating Rehabilitation Effects in Stroke Patients. Brain Sci 2021; 11:1002. [PMID: 34439621 PMCID: PMC8392264 DOI: 10.3390/brainsci11081002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 01/08/2023] Open
Abstract
Cognitive impairment after a stroke has a direct impact on patients' disability. In particular, impairment of Executive Functions (EFs) interferes with re-adaptation to daily life. The aim of this study was to explore whether adding a computer-based training on EFs to an ordinary rehabilitation program, regardless of the specific brain damage and clinical impairment (motor, language, or cognitive), could improve rehabilitation outcomes in patients with stroke. An EF training was designed to have minimal motor and expressive language demands and to be applied to a wide range of clinical conditions. A total of 37 stroke patients were randomly assigned to two groups: a training group, which performed the EF training in addition to the ordinary rehabilitation program (treatment as usual), and a control group, which performed the ordinary rehabilitation exclusively. Both groups were assessed before and after the rehabilitation program on neuropsychological tests covering multiple cognitive domains, and on functional scales (Barthel index, Functional Independence Measure). The results showed that only patients who received the training improved their scores on the Attentional Matrices and Phonemic Fluency tests after the rehabilitation program. Moreover, they showed a greater functional improvement in the Barthel scale as well. These results suggest that combining an EF training with an ordinary rehabilitation program potentiates beneficial effects of the latter, especially in promoting independence in activities of daily living.
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Affiliation(s)
- Vincenza Tarantino
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy
| | - Francesca Burgio
- IRCCS San Camillo Hospital, 30126 Venice, Italy; (F.B.); (R.T.); (E.R.); (F.M.)
| | - Roberta Toffano
- IRCCS San Camillo Hospital, 30126 Venice, Italy; (F.B.); (R.T.); (E.R.); (F.M.)
| | - Elena Rigon
- IRCCS San Camillo Hospital, 30126 Venice, Italy; (F.B.); (R.T.); (E.R.); (F.M.)
| | | | - Luca Weis
- Department of Neuroscience, University of Padova, 35128 Padova, Italy;
| | - Antonino Vallesi
- IRCCS San Camillo Hospital, 30126 Venice, Italy; (F.B.); (R.T.); (E.R.); (F.M.)
- Department of Neuroscience & Padova Neuroscience Center, University of Padova, 35128 Padova, Italy
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Event related potentials indexing the influence of emotion on cognitive processing in veterans with comorbid post-traumatic stress disorder and traumatic brain injury. Clin Neurophysiol 2021; 132:1389-1397. [PMID: 34023623 DOI: 10.1016/j.clinph.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 02/23/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Emotion regulation and cognitive executive control are significantly impaired in both post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). These illnesses are increasingly common in veterans and their co-occurrence may exacerbate symptoms and recovery. The current study sought to investigate neural correlates of these impairments via event-related potentials (ERPs) and examined the association of PTSD symptom severity and impulsivity with these correlates. METHODS Electroencephalographic data from seventy-nine veterans with PTSD and TBI and 17 control participants were recorded during a visual emotional oddball task and analyzed for the N2 and P3b ERPs. RESULTS Results revealed that veterans showed a reduced P3b ERP in response to both target images and standard images. However, for standard images that followed a negative emotional distractor, the veterans showed a heightened N2 amplitude while the controls did not. In addition, impulsivity predicted modulation of the P3b across stimulus conditions, with a greater P3b amplitude associated with an increase in impulsivity. CONCLUSIONS These findings suggest that veterans showed hyper-responsivity to background information and reduced ERPs to task-relevant information. SIGNIFICANCE These findings may reflect heightened internal states that create neural noise and a reduced ability to modulate relevant responses.
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Nunes LG, Seabra AG. Development of a Program based on Goal Management Training for Adolescents with Executive Dysfunctions Complaints. THE SPANISH JOURNAL OF PSYCHOLOGY 2021; 24:e20. [PMID: 33745481 DOI: 10.1017/sjp.2021.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study aimed to develop a program based on Goal Management Training (GMT) and to investigate its effectiveness on executive functions, through formal instruments and an ecological task. Participants were 25 adolescents with complaints of executive dysfunctions. They underwent neuropsychological assessment of working memory, inhibitory control, cognitive flexibility, planning, and intellectual ability. Participants also took part in a cooking activity and were evaluated for errors per action, of omission, activity performance time, recipe consultation. After, they were randomly allocated to an active control group (CG), which underwent psychoeducation sessions, and an experimental group (EG), stimulated through GMT in eight sessions. Then participants underwent another assessment and follow-up after 4 weeks. In post-intervention analyses, results showed an improvement in executive functions in EG, in the working memory measurement and time of the ecological activity (g = 1.78 and .93, respectively), IQ (g = -1.01), reasoning (g = -.89), flexibility (g = -1.21), and inhibition (g = -3.11). In follow-up evaluation, large-size effects were observed on flexibility (g = -2.95), inhibition (g = -5.78) and execution time of the ecological activity (g = .98). Significant interactions between assessment Time x Group revealed EG gains in IQ, scores in reasoning and flexibility. EG also had longer execution time in flexibility and inhibition tests. That is, EG had greater scores and probably was less impulsive in these tests. Furthermore, EG decreased the number of verifications and the time in the ecological task, that is, had a more efficient performance. Results suggest the intervention can be as instrument to promote executive function.
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Hagen BI, Stubberud J. Goal Management Training and Computerized Cognitive Training in Depression-a 2-Year Follow-Up of a Randomized Controlled Trial. Front Psychiatry 2021; 12:737518. [PMID: 34630185 PMCID: PMC8497809 DOI: 10.3389/fpsyt.2021.737518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Information on the long-term effects of cognitive remediation (CR) in major depressive disorder (MDD) is lacking. The present study reports 2-year follow-up data from a previously published randomized controlled trial (RCT) from our research group, comparing Goal Management Training (GMT), a strategy-based CR intervention, to drill-and-practice computerized cognitive training (CCT). In previous work, we found comparable improvements in executive function (EF), in addition to reductions in depressive symptoms, following both GMT and CCT at 6-month follow-up. Methods: Forty-two participants of the RCT, all diagnosed with MDD, were invited to complete rating-scales pertaining daily-life EF, rumination, and depressive symptoms. Explorative analyses compared the 2-year follow-up with previously published baseline and 6-month follow-up data, using non-parametric statistics. Similarly, GMT and CCT were compared at the 2-year follow-up, and completers were compared with non-completers. Results: Twenty participants completed the study. Overall, completers (n = 20) and non-completers (n = 22) were similar. There were no significant differences between GMT (n = 11) and CCT (n = 9) for any outcome 2 years post-treatment. Reduction compared to baseline in depressive symptoms and rumination, but not in daily-life EFs, emerged for GMT only. Conclusions: Findings suggest long-term improvements in mental health following GMT, while improvements in everyday EFs might require additional treatment or maintenance to sustain. Caution is warranted in the interpretation due to the small sample size and high attrition rates.
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Affiliation(s)
| | - Jan Stubberud
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
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25
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Cantisano N, Menei P, Roualdes V, Seizeur R, Allain P, Le Gall D, Roy A, Dinomais M, Besnard J. Patient-reported functional executive challenges and caregiver confirmation in adult brain tumor survivors. J Cancer Surviv 2020; 15:696-705. [PMID: 33106993 DOI: 10.1007/s11764-020-00961-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/18/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The main objective of this study was to provide further information concerning the validity of patient-reported executive function (EF) in survivors of primary brain tumor (PBT) compared with a report provided by each patient's caregiver. METHODS Forty survivors of PBT, 40 non-cancer controls and their proxies completed an assessment of functional executive disorders (e.g., planning, inhibition, shifting, action initiation). Comparisons of self and informant EF reports were examined, for both patients and non-cancer controls. The extent of the concordance between patients' reports and their caregivers' reports was also determined. RESULTS PBT survivors and their caregivers reported more problems related to EF in contrast with the non-cancer comparison group (significant differences). There was a high level of agreement between patients' and caregivers' ratings within the patient group. CONCLUSIONS This study provides evidence suggesting that at an average of 3.67 (SD = 2.31) years following treatment for a PBT, EF difficulties are reported by patients and their caregivers. This study establishes a consistency between what is reported by survivors and what is reported by those who frequently interact with them. Further research investigating the link between these ratings and quality of life as well as other functions is encouraged. IMPLICATIONS FOR CANCER SURVIVORS This study's results demonstrate the importance of listening to PBT survivors' perception of EF difficulties. While not confirmed by neuropsychological evaluations, the functional executive challenges reported by these survivors' close relatives reflect what PBT survivors themselves report. Specialists should pay close attention to these difficulties to guarantee optimal post-cancer care.
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Affiliation(s)
- Nicole Cantisano
- Centre d'Etudes en Psychopathologie et Psychologie de la Santé (EA 7411), University of Toulouse Jean Jaurès, Toulouse, France
| | - Philippe Menei
- Department of Neurosurgery, Angers University Hospital, Angers, France
| | - Vincent Roualdes
- Department of Neurosurgery, Nantes University Hospital, Nantes, France
| | - Romuald Seizeur
- Department of Neurosurgery, Brest Regional University Hospital, Brest, France
| | - Philippe Allain
- Department of Neurology, Angers University Hospital, Angers, France
- Laboratoire de Psychologie des Pays de la Loire (EA 4638), University of Angers, Angers, France
| | - Didier Le Gall
- Department of Neurology, Angers University Hospital, Angers, France
- Laboratoire de Psychologie des Pays de la Loire (EA 4638), University of Angers, Angers, France
| | - Arnaud Roy
- Laboratoire de Psychologie des Pays de la Loire (EA 4638), University of Angers, Angers, France
- Centre Référent des Troubles d'Apprentissage et Centre de Compétence Nantais de Neurofibromatose, Nantes University Hospital, Nantes, France
| | - Mickaël Dinomais
- Department of Pediatric Physical Medicine and Rehabilitation, Angers University Hospital, Angers, France
| | - Jérémy Besnard
- Laboratoire de Psychologie des Pays de la Loire (EA 4638), University of Angers, Angers, France.
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26
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Hagen BI, Landrø NI, Lau B, Koster EHW, Stubberud J. Predictors of Long-Term Improvement Following Cognitive Remediation in a Sample With Elevated Depressive Symptoms. Front Psychol 2020; 11:2232. [PMID: 33013583 PMCID: PMC7516280 DOI: 10.3389/fpsyg.2020.02232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/10/2020] [Indexed: 11/13/2022] Open
Abstract
Objective Cognitive remediation (CR) techniques (interventions to enhance cognitive functioning) have proven moderately effective in improving cognition and daily functioning in major depressive disorder (MDD). However, baseline predictors of treatment response are lacking. The present study aimed to identify factors influencing long-term CR outcomes in a sample with current or previous, mild or moderate MDD and with self-reported cognitive deficits. Methods Forty-two completers of group-based CR (strategy learning or drill-and-practice), were pooled into one sample. Based on change scores from baseline to 6-month follow-up, participants were categorized as “improvers” or “non-improvers” using reliable change index calculations. Measures included a questionnaire of everyday executive functioning and a neuropsychological test of attention. Finally, improvers and non-improvers were compared in terms of various sociodemographic, psychological, illness-related, and neuropsychological baseline variables. Results Seventeen participants improved reliably in everyday executive functioning, and fourteen demonstrated a reliable improvement in attention. No statistically significant differences emerged between improvers and non-improvers. Conclusion No major predictors of CR were identified. Importantly, the current findings are insufficient to guide clinical decision-making. Large-scale studies with a priori hypotheses are needed to make advances in the future.
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Affiliation(s)
| | | | - Bjørn Lau
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Ernst H W Koster
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Jan Stubberud
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
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27
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Hagen BI, Lau B, Joormann J, Småstuen MC, Landrø NI, Stubberud J. Goal management training as a cognitive remediation intervention in depression: A randomized controlled trial. J Affect Disord 2020; 275:268-277. [PMID: 32734919 DOI: 10.1016/j.jad.2020.07.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/18/2020] [Accepted: 07/05/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) is associated with deficits in executive functioning (EF) that may have a detrimental effect on everyday functioning. Despite this, there are no established cognitive remediation interventions available targeting EF in MDD. Hence, the primary aim of the present pre-registered randomized controlled trial was to evaluate the effectiveness of Goal Management Training (GMT), a metacognitive and strategy-based cognitive remediation intervention to improve EF in MDD. METHODS Sixty-three participants with current or previous mild or moderate MDD and self-reported executive deficits were included and randomized to nine sessions of either GMT (two hours, once weekly; n = 35) or computerized cognitive training (one hour, twice weekly; n = 28). Assessments were conducted at baseline (T1), immediately following training (T2), and at six-month follow-up (T3). The primary outcome measure was The Behavior Rating Inventory of Executive Function - Adult version, pertained to daily life EF. Secondary outcome measures included additional EF assessments (performance-based measures and questionnaires), and depressive symptom severity. RESULTS Forty-three participants completed treatment. Both groups improved following training, and linear mixed model analyses revealed no statistically significant differences between the groups for any outcome measure. Additional exploratory within-group analyses revealed a statistically significant reduction of everyday executive dysfunction and reduced depressive symptoms at the six-month follow-up in GMT only. LIMITATIONS The study was single-blind, and the sample size was modest. CONCLUSIONS Our findings indicate comparable improvements in everyday and performance-based measures of EF, in addition to reductions in depressive symptoms following both GMT and CCT.
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Affiliation(s)
| | - Bjørn Lau
- Department of Psychology, University of Oslo, Norway
| | - Jutta Joormann
- Department of Psychology, Yale University, United States
| | - Milada Cvancarova Småstuen
- Department of Research, Lovisenberg Diaconal Hospital, Norway; Faculty of Health Science, Oslo Metropolitan University, Norway
| | | | - Jan Stubberud
- Department of Research, Lovisenberg Diaconal Hospital, Norway; Department of Psychology, University of Oslo, Norway
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28
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Jaywant A, Steinberg C, Lee A, Toglia J. Feasibility and acceptability of the multicontext approach for individuals with acquired brain injury in acute inpatient rehabilitation: A single case series. Neuropsychol Rehabil 2020; 32:211-230. [PMID: 32873157 DOI: 10.1080/09602011.2020.1810710] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Multicontext (MC) approach, a metacognitive intervention designed to improve awareness, strategy use, and executive functioning, may be beneficial for individuals with acquired brain injury (ABI) undergoing acute inpatient rehabilitation. The goal of this study was to provide evidence of feasibility and acceptability of the MC approach and to explore clinical outcomes. A case series of eight individuals with acquired brain injury and at least mild executive functioning impairment were recruited from an acute inpatient rehabilitation unit. The MC approach - involving guided questioning and patient self-generation of strategies practiced across everyday functional cognitive tasks - was implemented within routine occupational therapy. Occupational therapists implemented the MC approach with high adherence to the treatment protocol. Therapists' perceived challenges were the time constraints of inpatient rehabilitation as well as client factors. Participants rated the MC approach as highly satisfying and engaging. They described subjective improvements in their ability to use executive functioning strategies. The MC approach was associated with improvement in awareness, strategy use, and executive functioning at the conclusion of treatment. The MC approach may be a beneficial intervention for individuals with acquired brain injury and executive dysfunction undergoing acute inpatient rehabilitation. Further evaluation with larger samples in controlled trials is warranted.Trial registration: ClinicalTrials.gov identifier: NCT04363645..
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Affiliation(s)
- Abhishek Jaywant
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Alyson Lee
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Joan Toglia
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA.,School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, USA
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29
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Use It or Lose It? A 5-Year Follow-up Study of Goal Management Training in Patients with Acquired Brain Injury. J Int Neuropsychol Soc 2019; 25:1082-1087. [PMID: 31232252 DOI: 10.1017/s1355617719000626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To determine the perceived 5-year outcome of Goal Management Training (GMT) for individuals with chronic acquired brain injury and executive dysfunction, when compared to a nonspecific psychoeducational intervention (Brain Health Workshop, BHW). METHODS Of the 67 subjects in the initial randomized controlled trial [Tornås et al. (2016). Journal of the International Neuropsychological Society, 1-17], 50 (GMT, n = 21; BHW, n = 29) subjects returned written consent and questionnaires (54% male, age 45.8 ± 10.9 years). The 5-year follow-up consisted of two questionnaires, including the Behavior Rating Inventory of Executive Function for daily life executive function (EF) and Quality of Life after Brain Injury to assess health-related quality of life (HRQoL). Changes related to daily life EF and HRQoL were assessed pre-treatment, post-treatment, 6-month follow-up, and 5-year follow-up. Data were analyzed using a 2 × 4 mixed-design ANOVA. RESULTS The findings indicate that GMT is efficacious in improving EF and HRQoL 6-month post-treatment. However, these changes failed to remain significant at 5-year follow-up. CONCLUSIONS Data from 50 participants receiving either GMT or BHW suggested that the significant GMT-related improvements on perceived EF and HRQoL observed at 6-month follow-up were no longer present at 5-year follow-up. These findings indicate a need to promote maintenance of interventions post-treatment.
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30
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Kornblith E, Posecion L, Abrams G, Chen AJW, Burciaga J, D'Esposito M, Novakovic-Agopian T. Long-Term Effect of Cognitive Rehabilitation Regardless of Prerehabilitation Cognitive Status for Veterans with TBI. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:436-448. [PMID: 31456428 DOI: 10.1080/23279095.2019.1652174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Persisting difficulties in executive functioning (EF) are common after traumatic brain injury (TBI). Cognitive rehabilitation can be effective, but the impact of pretreatment neurocognitive functioning on long term effects of rehabilitation is unknown. Because this information can impact treatment planning, we examined the relationship between prerehabilitation neurocognitive status and long-term effects of EF training. Archival data were drawn from a trial of Goal-Oriented Attentional Self-Regulation group-format EF training for Veterans with TBI [mild-severe; 11 years postinjury; 96% male, 32% nonwhite, 14.21 years education (SD 1.72), 41.13 years old (SD 11.39)]. Using prerehabilitation neurocognitive performance, participants were clustered into cognitive difficulty (CD) and cognitively normal (CN) groups. Six-plus months after EF rehabilitation training, participants completed a structured telephone interview and/or in-person cognitive/functional/emotional assessment using standardized measures of cognitive, daily, and emotional functioning frequently employed in TBI research. At 6+ months post-EF training compared to prerehabilitation, CD and CN improved in multiple cognitive (Overall Attention/EF: F(1,18) = 26.17, partial η2 = .59; Total Memory: F(1,18) = 6.82, partial η2 = .28) and functional domains (Goal Processing Scale [GPS] total score: F(1,15) = 6.71, partial η2 = .31). CD improved more than CN on Learning and Memory functional domain [F(1,15) = 6.10, partial η2 = .29]. Results of our small archival analysis raise the possibility that Veterans with chronic TBI may demonstrate long-term effects of EF training.
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Affiliation(s)
- Erica Kornblith
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Lainie Posecion
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Gary Abrams
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Anthony J-W Chen
- University of California, San Francisco, CA, USA.,Rehabilitation, Veterans Affairs Northern California Health Care System, Martinez, CA, USA.,University of California, Berkeley: Berkeley, CA
| | - Joaquin Burciaga
- University of California, Berkeley: Berkeley, CA.,Children's Health Council, Palo Alto, CA, USA
| | - Mark D'Esposito
- Children's Health Council, Palo Alto, CA, USA.,Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
| | - Tatjana Novakovic-Agopian
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
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31
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Novakovic-Agopian T, Kornblith E, Abrams G, McQuaid JR, Posecion L, Burciaga J, D'Esposito M, Chen AJW. Long-term effects of executive function training among veterans with chronic TBI. Brain Inj 2019; 33:1513-1521. [PMID: 31423838 DOI: 10.1080/02699052.2019.1645357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective: To investigate long-term effects of GOALS executive function training in Veterans with chronic TBI. In a recently completed study Veterans with chronic TBI showed improvement immediately post-GOALS but not control training on measures of executive function, functional task performance, and emotion regulation. We now examine the long-term maintenance of post-GOALS training changes in the same sample. Setting: San Francisco VA Health Care System (SFVAHCS), and VA Northern California Health-Care System (VANCHS) in Martinez. Participants and Design: 24 Veterans with chronic TBI were assessed at baseline, post-GOALS training, and long-term follow-up 6+ months following completion of training with a structured telephone interview, neuropsychological and complex functional performance measures, and self-report measures of daily and emotional functioning. Results: Participants reported an increased likelihood of involvement in competitive employment/volunteering at follow-up (61%) compared to baseline (26%; χ2 = 5.66, p < .01, ѱ = .35). Repeated measures MANOVAS indicated improvement on attention/executive function (F = 13.85, p < .01, partial η2 = .42), complex functional task performance (GPS Total: F = 9.12, p < .01, partial η2 = .38) and daily functioning (MPAI Total: F = 3.23, p < .05, partial η2 = .21), and reduction in overall mood disturbance (POMS Total: F = 3.42, p < .05, partial η2 = .22) at follow-up relative to baseline. Discussion: Training in attention regulation applied to participant-defined goals is associated with meaningful long-term improvement in cognitive skills, emotion regulation, and daily functioning in Veterans with chronic TBI.
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Affiliation(s)
- Tatjana Novakovic-Agopian
- Mental Health Service, San Francisco VA Health Care System , San Francisco , California , USA.,Department of Psychiatry, University of California , San Francisco , California , USA.,Neurology Service, Veteran's Administration Northern California Health Care System , Martinez , California , USA
| | - Erica Kornblith
- Mental Health Service, San Francisco VA Health Care System , San Francisco , California , USA
| | - Gary Abrams
- Neurology Service, San Francisco VA Health Care System , San Francisco , California , USA.,Department of Neurology, University of California , San Francisco , California , USA
| | - John R McQuaid
- Mental Health Service, San Francisco VA Health Care System , San Francisco , California , USA.,Department of Psychiatry, University of California , San Francisco , California , USA
| | - Lainie Posecion
- Mental Health Service, San Francisco VA Health Care System , San Francisco , California , USA
| | - Joaquin Burciaga
- Mental Health Service, San Francisco VA Health Care System , San Francisco , California , USA
| | - Mark D'Esposito
- Neurology Service, Veteran's Administration Northern California Health Care System , Martinez , California , USA.,Helen Wills Neuroscience Institute, University of California , Berkeley , USA
| | - Anthony J W Chen
- Neurology Service, Veteran's Administration Northern California Health Care System , Martinez , California , USA.,Neurology Service, San Francisco VA Health Care System , San Francisco , California , USA.,Helen Wills Neuroscience Institute, University of California , Berkeley , USA
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Hypher RE, Brandt AE, Risnes K, Rø TB, Skovlund E, Andersson S, Finnanger TG, Stubberud J. Paediatric goal management training in patients with acquired brain injury: study protocol for a randomised controlled trial. BMJ Open 2019; 9:e029273. [PMID: 31375619 PMCID: PMC6688684 DOI: 10.1136/bmjopen-2019-029273] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/27/2019] [Accepted: 07/08/2019] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Compromised integrity of the brain due to paediatric acquired brain injury (pABI) has been associated with cognitive impairment, particularly executive dysfunction, in addition to somatic and emotional symptoms and reduced everyday function. Goal Management Training (GMT) is a cognitive rehabilitation intervention for improving executive function (EF) that has received empirical support in studies of adults with ABI. The purpose of the present study is to determine the efficacy of a recently developed paediatric version of GMT (pGMT) for children and adolescents with ABI and reported executive dysfunction. METHODS AND ANALYSIS This study protocol describes a parallel randomised controlled trial including allocation concealment and assessor blinding. Eighty survivors after pABI, aged 10-17 years at the time of intervention, will be recruited. Participants will be randomly allocated to either pGMT (n=40) or a psychoeducative control intervention (n=40; paediatric Brain Health Workshop). Both interventions consist of seven group sessions for participants and parents, followed by external cueing and telephone counselling. The study also includes involvement of teachers. Assessments will be performed at baseline, immediately postintervention and at 6 months' follow-up. Primary outcome measure will be changes in daily life EF as reported by parents (The Behavior Rating Inventory of Executive Function). Secondary outcomes include other assessments of EF (neuropsychological tests and questionnaires). Furthermore, we aim to assess generalisation effects of pGMT on other cognitive functions, as well as emotional, behavioural, adaptive and family function, academic performance, fatigue and quality of life. ETHICS AND DISSEMINATION Results from this study will be disseminated to relevant research, clinical, health service and patient communities through publications in peer-reviewed and popular science journals, in addition to presentations at scientific conferences. The study will be conducted in accordance with the Helsinki declaration and the Ethical Research Involving Children (ChildWatch International and Unicef). In accordance to Good Clinical Practice our study includes safety and quality monitoring guarantees in compliance with research ethics and safety. The trial will be reported in accordance with the Consolidated Standards of Reporting Trials 2010 statement and Standard Protocol Items for Reporting in Trials recommendations, in addition to being registered at ClinicalTrials.gov. The study has been approved by the Regional Committees for Medical and Health Research Ethics Norway (2017/772). TRIAL REGISTRATION NUMBER NCT03215342.
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Affiliation(s)
- Ruth Elizabeth Hypher
- Department of Clinical Neurosciences for Children, Division of Paediatric and Adolescent Medicine, Oslo Universitetssykehus, Oslo, Norway
| | - Anne Elisabeth Brandt
- Children's Clinic, St Olavs's Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Kari Risnes
- Children's Clinic, St Olavs's Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Torstein Baade Rø
- Children's Clinic, St Olavs's Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Stein Andersson
- Department of Psychology, Universitetet i Oslo, Oslo, Norway
| | | | - Jan Stubberud
- Department of Clinical Neurosciences for Children, Division of Paediatric and Adolescent Medicine, Oslo Universitetssykehus, Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
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Brunette AM, Calamia M, Black J, Tranel D. Is Episodic Future Thinking Important for Instrumental Activities of Daily Living? A Study in Neurological Patients and Healthy Older Adults. Arch Clin Neuropsychol 2019; 34:403-417. [PMID: 29893785 PMCID: PMC6454851 DOI: 10.1093/arclin/acy049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 05/10/2018] [Accepted: 05/16/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Episodic future thinking is the ability to mentally project oneself into the future. This construct has been explored extensively in cognitive neuroscience and may be relevant for adaptive functioning. However, it has not been determined whether the measurement of episodic future thinking might be valuable in a clinical neuropsychological setting. The current study investigated (1) the relationship between episodic future thinking and instrumental activities of daily living (IADLs); and (2) whether episodic future thinking is related to IADLs over and above standard measures of cognition. METHOD Sixty-one older adults with heterogeneous neurological conditions and 41 healthy older adults completed a future thinking task (the adapted Autobiographical Interview), a performance-based measure of instrumental activities of daily living (the Independent Living Scales), and standard clinical measures of memory and executive functioning. RESULTS Episodic future thinking significantly predicted IADLs after accounting for age, education, gender, and depression (increase in R2 = .050, p = .010). Episodic future thinking significantly predicted IADLs over and above executive functioning (increase in R2 = .025, p = .030), but was not predictive of IADLs over and above memory (p = .157). CONCLUSIONS This study suggests that episodic future thinking is significantly associated with IADLs, beyond what can be accounted for by executive functioning. However, episodic future thinking did not predict IADLs over and above memory. Overall, there is limited evidence for the clinical utility of episodic future thinking. The findings suggest that an episodic future thinking task does not provide enough valuable information about IADLs to justify its inclusion in a clinical neuropsychological setting.
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Affiliation(s)
- Amanda M Brunette
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Jenah Black
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Daniel Tranel
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Aarnes R, Stubberud J, Lerdal A. A literature review of factors associated with fatigue after stroke and a proposal for a framework for clinical utility. Neuropsychol Rehabil 2019; 30:1449-1476. [DOI: 10.1080/09602011.2019.1589530] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Rannveig Aarnes
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Jan Stubberud
- Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Anners Lerdal
- Lovisenberg Diaconal Hospital, Oslo, Norway
- Faculty of Medicine, Department of Health and Society, Institute of Nursing Science, University of Oslo, Oslo, Norway
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Cognitive Rehabilitation With Mobile Technology and Social Support for Veterans With TBI and PTSD: A Randomized Clinical Trial. J Head Trauma Rehabil 2018; 34:1-10. [PMID: 30169439 DOI: 10.1097/htr.0000000000000435] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate effects of cognitive rehabilitation with mobile technology and social support on veterans with traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). PARTICIPANTS There were 112 dyads, comprised by a veteran and a family member or friend (224 participants in total). DESIGN Dyads were randomized to the following: (1) a novel intervention, Cognitive Applications for Life Management (CALM), involving goal management training plus mobile devices for cueing and training attentional control; or (2) Brain Health Training, involving psychoeducation plus mobile devices to train visual memory. MAIN MEASURES Executive dysfunction (disinhibition, impulsivity) and emotional dysregulation (anger, maladaptive interpersonal behaviors) collected prior to randomization and following intervention completion at 6 months. RESULTS The clinical trial yielded negative findings regarding executive dysfunction but positive findings on measures of emotion dysregulation. Veterans randomized to CALM reported a 25% decrease in anger over 6 months compared with 8% reduction in the control (B = -5.27, P = .008). Family/friends reported that veterans randomized to CALM engaged in 26% fewer maladaptive interpersonal behaviors (eg, aggression) over 6 months compared with 6% reduction in the control (B = -2.08, P = .016). An unanticipated result was clinically meaningful change in reduced PTSD symptoms among veterans randomized to CALM (P < .001). CONCLUSION This preliminary study demonstrated effectiveness of CALM for reducing emotional dysregulation in veterans with TBI and PTSD.
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Hart T, Driver S, Sander A, Pappadis M, Dams-O'Connor K, Bocage C, Hinkens E, Dahdah MN, Cai X. Traumatic brain injury education for adult patients and families: a scoping review. Brain Inj 2018; 32:1295-1306. [PMID: 30084694 DOI: 10.1080/02699052.2018.1493226] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Traumatic brain injury (TBI) is increasingly viewed as a chronic condition, bringing long-term needs for patient and caregiver knowledge pertaining to symptom and problem management over time. In light of these needs, we performed a scoping review of the literature on brain injury education provided to adult patients and/ or family members affected by TBI. Objectives were to describe the types of educational interventions that have been developed; to review the effects of these interventions; and to determine gaps that might be filled by future research efforts. Of 88 articles meeting search criteria and subjected to data extraction, 34 concerned education about mild TBI and 54, moderate to severe TBI. Most mild TBI articles focused on education in the Emergency Room, while most moderate/ severe TBI education was directed toward family members/ caregivers and was frequently combined with other treatment components, making the effects of education difficult to discern. Only 1 article incorporated elements of self-management training (SMT), a model proved effective in other chronic health conditions. We recommend further exploration of SMT principles in long-term TBI care, as well as more precise definition of treatment components in all patient and family interventions, so that the specific effects of education and other treatment elements may be more readily evaluated.
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Affiliation(s)
- Tessa Hart
- a Moss Rehabilitation Research Institute , Elkins Park , PA , USA
| | - Simon Driver
- b Department of Rehabilitation Research , Baylor Scott and White Institute for Rehabilitation , Dallas , TX , USA
| | - Angelle Sander
- c Department of Physical Medicine and Rehabilitation , Baylor College of Medicine , Houston , TX , USA.,d Brain Injury Research Center , TIRR Memorial Hermann , Houston , TX , USA
| | - Monique Pappadis
- d Brain Injury Research Center , TIRR Memorial Hermann , Houston , TX , USA.,e Division of Rehabilitation Sciences, School of Health Professions , University of Texas Medical Branch at Galveston , TX , USA
| | - Kristen Dams-O'Connor
- f Department of Rehabilitation Medicine, Department of Neurology Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Claire Bocage
- g American Institutes for Research , Washington , DC , USA
| | - Emma Hinkens
- g American Institutes for Research , Washington , DC , USA
| | - Marie N Dahdah
- b Department of Rehabilitation Research , Baylor Scott and White Institute for Rehabilitation , Dallas , TX , USA.,h Department of Medical Psychology , Baylor Scott and White Medical Center , Plano , TX , USA
| | - Xinsheng Cai
- g American Institutes for Research , Washington , DC , USA
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Informing evaluation of a smartphone application for people with acquired brain injury: a stakeholder engagement study. BMC Med Inform Decis Mak 2018; 18:33. [PMID: 29848312 PMCID: PMC5975503 DOI: 10.1186/s12911-018-0611-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 05/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brain in Hand is a smartphone application (app) that allows users to create structured diaries with problems and solutions, attach reminders, record task completion and has a symptom monitoring system. Brain in Hand was designed to support people with psychological problems, and encourage behaviour monitoring and change. The aim of this paper is to describe the process of exploring the barriers and enablers for the uptake and use of Brain in Hand in clinical practice, identify potential adaptations of the app for use with people with acquired brain injury (ABI), and determine whether the behaviour change wheel can be used as a model for engagement. METHODS We identified stakeholders: ABI survivors and carers, National Health Service and private healthcare professionals, and engaged with them via focus groups, conference presentations, small group discussions, and through questionnaires. The results were evaluated using the behaviour change wheel and descriptive statistics of questionnaire responses. RESULTS We engaged with 20 ABI survivors, 5 carers, 25 professionals, 41 questionnaires were completed by stakeholders. Comments made during group discussions were supported by questionnaire results. Enablers included smartphone competency (capability), personalisation of app (opportunity), and identifying perceived need (motivation). Barriers included a physical and cognitive inability to use smartphone (capability), potential cost and reliability of technology (opportunity), and no desire to use technology or change from existing strategies (motivation). The stakeholders identified potential uses and changes to the app, which were not easily mapped onto the behaviour change wheel, e.g. monitoring fatigue levels, method of logging task completion, and editing the diary on their smartphone. CONCLUSIONS The study identified that both ABI survivors and therapists could see a use for Brain in Hand, but wanted users to be able to personalise it themselves to address individual user needs, e.g. monitoring activity levels. The behaviour change wheel is a useful tool when designing and evaluating engagement activities as it addresses most aspects of implementation, however additional categories may be needed to explore the specific features of assistive technology interventions, e.g. technical functions.
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Stamenova V, Levine B. Effectiveness of goal management training® in improving executive functions: A meta-analysis. Neuropsychol Rehabil 2018. [PMID: 29540124 DOI: 10.1080/09602011.2018.1438294] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Our objective was to review the literature and quantitatively summarise the effectiveness of Goal Management Training® (GMT) (alone or in combination with other training approaches) in improving executive functions in adult populations. Ovid, Scopus, Web of Science, and ProQuest Dissertations & Theses Global were searched for articles citing "goal management training". Any group trials (n > 3) in adults that used multiple-session GMT programmes were included in the analyses. Outcome variables were extracted and classified into one of nine cognitive measures domains: executive functioning tasks, everyday executive functioning tasks, subjective executive tasks rated by the patient, subjective executive tasks rated by proxy, working memory, speed of processing, long-term memory, instrumental activities of daily living and general mental health status questionnaires. A total of 21 publications, containing 19 separate treatment group samples were included in the final analyses. Significantly positive small to moderate effect sizes were observed in all cognitive measure domains (except speed of processing) with effects maintained at follow-up assessments for all followed-up outcome measures, except for subjective ratings by patients and proxy. The analysis suggests that GMT is an effective intervention, leading to moderate improvements in executive functions that are usually maintained at follow-up.
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Affiliation(s)
- Vessela Stamenova
- Women's College Hospital Institute for Health System Solutions and Virtual Care , Toronto , ON , Canada
| | - Brian Levine
- Rotman Research Institute at Baycrest, University of Toronto , Toronto , ON , Canada
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Ledbetter AK, Sohlberg MM, Fickas SF, Horney MA, McIntosh K. Evaluation of a computer-based prompting intervention to improve essay writing in undergraduates with cognitive impairment after acquired brain injury. Neuropsychol Rehabil 2017; 29:1226-1255. [PMID: 29108478 DOI: 10.1080/09602011.2017.1383272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study evaluated a computer-based prompting intervention for improving expository essay writing after acquired brain injury (ABI). Four undergraduate participants aged 18-21 with mild-moderate ABI and impaired fluid cognition at least 6 months post-injury reported difficulty with the writing process after injury. The study employed a non-concurrent multiple probe across participants, in a single-case design. Outcome measures included essay quality scores and number of revisions to writing counted then coded by type using a revision taxonomy. An inter-scorer agreement procedure was completed for quality scores for 50% of essays, with data indicating that agreement exceeded a goal of 85%. Visual analysis of results showed increased essay quality for all participants in intervention phase compared with baseline, maintained 1 week after. Statistical analyses showed statistically significant results for two of the four participants. The authors discuss external cuing for self-monitoring and tapping of existing writing knowledge as possible explanations for improvement. The study provides preliminary evidence that computer-based prompting has potential to improve writing quality for undergraduates with ABI.
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Improving Emotion Regulation Following Web-Based Group Intervention for Individuals With Traumatic Brain Injury. J Head Trauma Rehabil 2017; 32:354-365. [DOI: 10.1097/htr.0000000000000345] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Fortune DG, Richards HL. Assessing Cognitive Estimation and Its Effects on Community Integration in People with Acquired Brain Injury Undergoing Rehabilitation. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2874819. [PMID: 28815180 PMCID: PMC5549505 DOI: 10.1155/2017/2874819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/25/2017] [Accepted: 06/04/2017] [Indexed: 01/13/2023]
Abstract
The purpose of the present study was to examine the convergent and divergent validity of the Biber Cognitive Estimation Test (BCET) in individuals with ABI undergoing postacute rehabilitation and to assess the measure's ability to account for unique variance in community integration following rehabilitation. Participants with ABI referred for postacute rehabilitation (N = 201) were assessed on the BCET and a number of other neuropsychological tests that have been demonstrated to rely on aspects of executive processing (Trail-Making Test, Modified Six Elements Test, and verbal fluency measures) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Internal consistency of the total BCET was good; however, interpretable solutions for existing subscales were not discerned. The BCET total score demonstrated positive associations with tests of executive functioning; however, it was also significantly associated with more general aspects of neuropsychological functioning suggesting that it does not solely assess executive processes in ABI patients undergoing rehabilitation. Hierarchical multiple regression suggested that the BCET accounted for significant additional variance in community integration after severity of disability, executive functioning, and more general aspects of neuropsychological status were statistically controlled. While the subscale structure of the BCET may be somewhat inconsistent, the total scale score accounts for some unique variance in pragmatic rehabilitation outcome and may be a useful tool in postacute rehabilitation assessment protocols.
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Affiliation(s)
- Dónal G. Fortune
- Department of Psychology, University of Limerick, Limerick, Ireland
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Stubberud J, Edvardsen E, Schanke AK, Lerdal A, Kjeverud A, Schillinger A, Løvstad M. Description of a multifaceted intervention programme for fatigue after acquired brain injury: a pilot study. Neuropsychol Rehabil 2017; 29:946-968. [DOI: 10.1080/09602011.2017.1344132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jan Stubberud
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Espen Edvardsen
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Anne-Kristine Schanke
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Anners Lerdal
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Nursing Science, University of Oslo, Oslo, Norway
| | | | - Andreas Schillinger
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
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Tornås S, Stubberud J, Solbakk AK, Evans J, Schanke AK, Løvstad M. Moderators, mediators and nonspecific predictors of outcome after cognitive rehabilitation of executive functions in a randomised controlled trial. Neuropsychol Rehabil 2017. [PMID: 28651477 DOI: 10.1080/09602011.2017.1338587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Moderators, mediators and nonspecific predictors of treatment after cognitive rehabilitation of executive functions in a randomised controlled trial Objective: To explore moderators, mediators and nonspecific predictors of executive functioning after cognitive rehabilitation in a randomised controlled trial, comparing Goal Management Training (GMT) with an active psycho-educative control-intervention, in patients with chronic acquired brain injury. METHODS Seventy patients with executive dysfunction were randomly allocated to GMT (n = 33) or control (n = 37). Outcome measures were established by factor-analysis and included cognitive executive complaints, emotional dysregulation and psychological distress. RESULTS Higher age and IQ emerged as nonspecific predictors. Verbal memory and planning ability at baseline moderated cognitive executive complaints, while planning ability at six-month follow-up mediated all three outcome measures. Inhibitory cognitive control emerged as a unique GMT specific mediator. A general pattern regardless of intervention was identified; higher levels of self-reported cognitive-and executive-symptoms of emotional dysregulation and psychological distress at six-month follow-up mediated less improvement across outcome factors. CONCLUSIONS The majority of treatment effects were nonspecific to intervention, probably underscoring the variables' general contribution to outcome of cognitive rehabilitation interventions. Interventions targeting specific cognitive domains, such as attention or working memory, need to take into account the patients' overall cognitive and emotional self-perceived functioning. Future studies should investigate the identified predictors further, and also consider other predictor candidates.
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Affiliation(s)
- Sveinung Tornås
- a Department of Research, Sunnaas Rehabilitation Hospital , Nesoddtangen , Norway
| | - Jan Stubberud
- a Department of Research, Sunnaas Rehabilitation Hospital , Nesoddtangen , Norway
| | - Anne-Kristin Solbakk
- b Department of Neurosurgery, Division of Clinical Neuroscience , Oslo University Hospital - Rikshospitalet , Oslo , Norway.,c Department of Psychology , University of Oslo , Oslo , Norway.,e Department of Neuropsychology , Helgeland Hospital , Mosjøen , Norway
| | - Jonathan Evans
- d Department of Mental Health and Wellbeing , Institute of Health & Wellbeing, University of Glasgow, Gartnavel Royal Hospital , Glasgow , Scotland , UK
| | - Anne-Kristine Schanke
- a Department of Research, Sunnaas Rehabilitation Hospital , Nesoddtangen , Norway.,c Department of Psychology , University of Oslo , Oslo , Norway
| | - Marianne Løvstad
- a Department of Research, Sunnaas Rehabilitation Hospital , Nesoddtangen , Norway.,c Department of Psychology , University of Oslo , Oslo , Norway
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Kumar KS, Samuelkamaleshkumar S, Viswanathan A, Macaden AS. Cognitive rehabilitation for adults with traumatic brain injury to improve occupational outcomes. Cochrane Database Syst Rev 2017; 6:CD007935. [PMID: 28631816 PMCID: PMC6481568 DOI: 10.1002/14651858.cd007935.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cognitive impairment in people with traumatic brain injury (TBI) could affect multiple facets of their daily functioning. Cognitive rehabilitation brings about clinically significant improvement in certain cognitive skills. However, it is uncertain if these improved cognitive skills lead to betterments in other key aspects of daily living. We evaluated whether cognitive rehabilitation for people with TBI improves return to work, independence in daily activities, community integration and quality of life. OBJECTIVES To evaluate the effects of cognitive rehabilitation on return to work, independence in daily activities, community integration (occupational outcomes) and quality of life in people with traumatic brain injury, and to determine which cognitive rehabilitation strategy better achieves these outcomes. SEARCH METHODS We searched CENTRAL (the Cochrane Library; 2017, Issue 3), MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), and clinical trials registries up to 30 March 2017. SELECTION CRITERIA We identified all available randomized controlled trials of cognitive rehabilitation compared with any other non-pharmacological intervention for people with TBI. We included studies that reported at least one outcome related to : return to work, independence in activities of daily living (ADL), community integration and quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials. We used standard methodological procedures expected by Cochrane. We evaluated heterogeneity among the included studies and performed meta-analysis only when we could include more than one study in a comparison. We used the online computer programme GRADEpro to assess the quality of evidence, and generate 'Summary of findings' tables. MAIN RESULTS We included nine studies with 790 participants. Three trials (160 participants) compared cognitive rehabilitation versus no treatment, four trials (144 participants) compared cognitive rehabilitation versus conventional treatment, one trial (120 participants) compared hospital-based cognitive rehabilitation versus home programme and one trial (366 participants) compared one cognitive strategy versus another. Among the included studies, we judged three to be of low risk of bias.There was no difference between cognitive rehabilitation and no intervention in return to work (risk ratio (RR) 1.80, 95% confidence interval (CI) 0.74 to 4.39, 1 study; very low-quality evidence). There was no difference between biweekly cognitive rehabilitation for eight weeks and no treatment in community integration (Sydney Psychosocial Reintegration Scale): mean difference (MD) -2.90, 95% CI -12.57 to 6.77, 1 study; low-quality evidence). There was no difference in quality of life between cognitive rehabilitation and no intervention immediately following the 12-week intervention(MD 0.30, 95% CI -0.18 to 0.78, 1 study; low-quality evidence). No study reported effects on independence in ADL.There was no difference between cognitive rehabilitation and conventional treatment in return to work status at six months' follow-up in one study (RR 1.43, 95% CI 0.87 to 2.33; low-quality evidence); independence in ADL at three to four weeks' follow-up in two studies (standardized mean difference (SMD) -0.01, 95% CI -0.62 to 0.61; very low-quality evidence); community integration at three weeks' to six months' follow-up in three studies (Community Integration Questionnaire: MD 0.05, 95% CI -1.51 to 1.62; low-quality evidence) and quality of life at six months' follow-up in one study (Perceived Quality of Life scale: MD 6.50, 95% CI -2.57 to 15.57; moderate-quality evidence).For active duty military personnel with moderate-to-severe closed head injury, there was no difference between eight weeks of cognitive rehabilitation administered as a home programme and hospital-based cognitive rehabilitation in achieving return to work at one year' follow-up in one study (RR 0.95, 95% CI 0.85 to 1.05; moderate-quality evidence). The study did not report effects on independence in ADL, community integration or quality of life.There was no difference between one cognitive rehabilitation strategy (cognitive didactic) and another (functional experiential) for adult veterans or active duty military service personnel with moderate-to-severe TBI (one study with 366 participants and one year' follow-up) on return to work (RR 1.10, 95% CI 0.83 to 1.46; moderate-quality evidence), or on independence in ADL (RR 0.90, 95% CI 0.75 to 1.08; low-quality evidence). The study did not report effects on community integration or quality of life.None of the studies reported adverse effects of cognitive rehabilitation. AUTHORS' CONCLUSIONS There is insufficient good-quality evidence to support the role of cognitive rehabilitation when compared to no intervention or conventional rehabilitation in improving return to work, independence in ADL, community integration or quality of life in adults with TBI. There is moderate-quality evidence that cognitive rehabilitation provided as a home programme is similar to hospital-based cognitive rehabilitation in improving return to work status among active duty military personnel with moderate-to-severe TBI. Moderate-quality evidence suggests that one cognitive rehabilitation strategy (cognitive didactic) is no better than another (functional experiential) in achieving return to work in veterans or military personnel with TBI.
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Affiliation(s)
- K Suresh Kumar
- London School of Hygiene and Tropical MedicineClinical Research DepartmentKeppel StreetLondonUKWC1E 7HT
| | | | - Anand Viswanathan
- Christian Medical CollegeCochrane South Asia, Prof. BV Moses Center for Evidence‐Informed Health Care and Health PolicyBagayamVelloreTamil NaduIndia632002
| | - Ashish S Macaden
- Raigmore Hospital (NHS Highland)Stroke and Rehabilitation MedicineInvernessUKIV2 3UJ
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Gracey F, Fish JE, Greenfield E, Bateman A, Malley D, Hardy G, Ingham J, Evans JJ, Manly T. A Randomized Controlled Trial of Assisted Intention Monitoring for the Rehabilitation of Executive Impairments Following Acquired Brain Injury. Neurorehabil Neural Repair 2016; 31:323-333. [PMID: 27913796 DOI: 10.1177/1545968316680484] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acquired brain injury (ABI) can impair executive function, impeding planning and attainment of intentions. Research shows promise for some goal-management rehabilitation interventions. However, evidence that alerts assist monitoring and completion of day-to-day intentions is limited. OBJECTIVE To examine the efficacy of brief goal-directed rehabilitation paired with periodic SMS text messages designed to enhance executive monitoring of intentions (assisted intention monitoring [AIM]). METHODS A randomized, double-blind, controlled trial was conducted. Following a baseline phase, 74 people with ABI and executive problems were randomized to receive AIM or control (information and games) for 3 weeks (phase 1) before crossing over to either AIM or no intervention (phase 2). The primary outcome was change in composite score of proportion of daily intentions achieved. A total of 59 people (71% male; 46% traumatic brain injury) completed all study phases. RESULTS Per protocol crossover analysis found a significant benefit of AIM for all intentions [ F(1, 56) = 4.28; P = .04; f = 0.28; 3.7% mean difference; 95% CI = 0.1%-7.4%] and all intentions excluding a proxy prospective memory task [ F(1, 55) = 4.79; P = .033; f = 0.28, medium effect size; 3% mean difference; 95% CI = 0.3%-5.6%] in the absence of significant changes on tests of executive functioning. Intention-to-treat analyses, comparing AIM against control at the end of phase 1 revealed no statistically significant differences in the attainment of intentions. CONCLUSION Combining brief executive rehabilitation with alerts may be effective for some in improving achievement of daily intentions, but further evaluation of clinical effectiveness and mechanisms is required.
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Affiliation(s)
- Fergus Gracey
- 1 University of East Anglia, Norwich Research Park, Norwich, UK
- 2 Acquired Brain Injury Rehabilitation Alliance, Cambridge, UK
- 3 Princess of Wales Hospital, Cambridgeshire, UK
| | - Jessica E Fish
- 3 Princess of Wales Hospital, Cambridgeshire, UK
- 4 MRC Cognition and Brain Sciences Unit, Cambridge, UK
| | | | - Andrew Bateman
- 2 Acquired Brain Injury Rehabilitation Alliance, Cambridge, UK
- 3 Princess of Wales Hospital, Cambridgeshire, UK
| | - Donna Malley
- 3 Princess of Wales Hospital, Cambridgeshire, UK
| | - Gemma Hardy
- 3 Princess of Wales Hospital, Cambridgeshire, UK
- 4 MRC Cognition and Brain Sciences Unit, Cambridge, UK
| | - Jessica Ingham
- 3 Princess of Wales Hospital, Cambridgeshire, UK
- 4 MRC Cognition and Brain Sciences Unit, Cambridge, UK
| | | | - Tom Manly
- 4 MRC Cognition and Brain Sciences Unit, Cambridge, UK
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Zermatten V, Rochat L, Manolov R, Van der Linden M. Can an external device create and trigger intention in a patient with a severe brain injury? Neuropsychol Rehabil 2016; 28:1211-1228. [PMID: 27873539 DOI: 10.1080/09602011.2016.1255230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Goal-directed behaviour (GDB), the capacity that allows us to control our environment according to our desires and needs, requires different stages from initial intention to goal achievement. Although GDB is frequently disrupted after acquired brain injury, few studies have addressed the remediation of reduced GDB in patients with severe brain injury. The present study aimed to raise this question in RZ, a patient with severe brain injury who presented a serious reduction in GDB related to difficulties in creating an intention from internal determinants and in selecting an action plan, as well as to memory and attentional impairments. Our objective was to investigate the efficacy of an intervention programme to create and trigger a specific intention in RZ. More specifically, this programme consisted in written prompts, first accompanied by an alarm provided by his mobile phone, but gradually reduced until only the alarm remained, which was implemented in order to improve RZ's attendance at workshop sessions. Results showed that RZ's attendance rate at the workshop sessions increased, indicating that the use of an external device allowed us to create and trigger intention in a patient with severe cognitive impairments.
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Affiliation(s)
- Victorine Zermatten
- a Cognitive Psychopathology and Neuropsychology Unit , University of Geneva , Geneva , Switzerland.,b Fondation Foyers Valais de Coeur , Sion , Switzerland.,c Service de neuropsychologie et de logopédie, Clinique Romande de Réadaptation, SUVA-Care , Sion , Switzerland
| | - Lucien Rochat
- a Cognitive Psychopathology and Neuropsychology Unit , University of Geneva , Geneva , Switzerland.,d Swiss Centre for Affective Sciences , University of Geneva , Geneva , Switzerland
| | - Rumen Manolov
- e Department of Social Psychology and Quantitative Psychology , University of Barcelona , Barcelona , Spain.,f Institute of Neurosciences, University of Barcelona , Barcelona , Spain
| | - Martial Van der Linden
- a Cognitive Psychopathology and Neuropsychology Unit , University of Geneva , Geneva , Switzerland.,d Swiss Centre for Affective Sciences , University of Geneva , Geneva , Switzerland.,g Cognitive Psychopathology Unit, Psychology Department , University of Liège , Liège , Belgium
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Goal Management Training and Mindfulness Meditation improve executive functions and transfer to ecological tasks of daily life in polysubstance users enrolled in therapeutic community treatment. Drug Alcohol Depend 2016; 165:9-14. [PMID: 27246405 DOI: 10.1016/j.drugalcdep.2016.04.040] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND We have previously shown that Goal Management Training+Mindfulness Meditation (GMT+MM) improves executive functions in polysubstance users enrolled in outpatient treatment. The aim of this study was to establish if GMT+MM has similar positive effects on executive functions in polysubstance users in residential treatment, and if executive functions' gains transfer to more ecologically valid goal-oriented tasks. METHODS Thirty-two polysbustance users were randomly allocated to eight weeks of GMT+MM (n=16) or control, i.e., no-intervention (n=16); both groups received treatment as usual. Outcome measures included performance in laboratory tasks of basic and complex executive functions (i.e., basic: working memory and inhibition; complex: planning and self-regulation) and in an ecological task of goal-directed behavior (the Multiple Errands Test - contextualized version, MET-CV) measured post-interventions. RESULTS Results showed that GMT+MM was superior to control in improving basic measures of working memory (Letter-number sequencing; F=4.516, p=0.049) and reflection impulsivity (Information Sampling Test; F=6.217, p=0.018), along with initial thinking times during planning (Zoo Map Test; F=8.143, p=0.008). In addition, GMT+MM was superior to control in improving performance in the MET-CV (task failures; F=8.485, p=0.007). CONCLUSION Our findings demonstrate that GMT+MM increases reflective processes and the achievement of goals in daily activities, furthermore ecological test can detects changes easily than laboratory tasks.
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Cuberos-Urbano G, Caracuel A, Valls-Serrano C, García-Mochón L, Gracey F, Verdejo-García A. A pilot investigation of the potential for incorporating lifelog technology into executive function rehabilitation for enhanced transfer of self-regulation skills to everyday life. Neuropsychol Rehabil 2016; 28:589-601. [DOI: 10.1080/09602011.2016.1187630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Gustavo Cuberos-Urbano
- Department of Clinical Psychology, School of Psychology, University of Granada, Granada, Spain
| | - Alfonso Caracuel
- Mind, Brain and Behavior Research Center, University of Granada, Granada, Spain
- Department of Developmental Psychology, School of Education, University of Granada, Granada, Spain
| | - Carlos Valls-Serrano
- Department of Clinical Psychology, School of Psychology, University of Granada, Granada, Spain
| | | | - Fergus Gracey
- Oliver Zangwill Centre for Neuropsychological Rehabilitation, Cambridgeshire Community Services NHS Trust, The Princess of Wales Hospital, Ely, Cambridgeshire, UK
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Antonio Verdejo-García
- Department of Clinical Psychology, School of Psychology, University of Granada, Granada, Spain
- Institute of Neurosciences F. Olóriz, School of Medicine, University of Granada, Granada, Spain
- School of Psychological Sciences & Monash Institute of Cognitive and Clinical Neuroscience, Monash University, Melbourne, Australia
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