Cognitive Rehabilitation Therapy for Traumatic Brain Injury Evaluating the Evidence (2011) / Chapter Skim
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8 Executive Function
8 Executive Function
Pages 137-162
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From page 137... ...
. Deficits in executive functions may include an inability to perform these cognitive processes or a lack of awareness that these or other cognitive and physical deficits exist and impede everyday life (Kennedy et al.
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From page 138... ...
The AIP included educational sessions based on the types of deficits manifested by the patients and functional training sessions, in which patients practiced setting performance goals and then evaluating their own performance against those goals. The conventional rehabilitation program included physical, functional, and cognitive aspects of occupational therapy.
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From page 139... ...
Single Subject, Multiple Baseline Experiment Sohlberg et al. 3 Moderate- Examined three categories N • Caregiver rating of subject Qualitative analysis 1998 Severe of awareness to determine awareness suggested improved optimal outcome measures • Self/Other Rating Form awareness after in awareness interventions ▪ Caregiver rating treatment via for future research (a pilot ▪ Subject rating behavioral measure; no study)
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. ▪ Awareness Questionnaire ▪ Behavior Rating Inventory of Executive Function NON-AWARENESS RCT Constantinidou 35 Moderate- Evaluating the Y • California Verbal Learning Both groups improved at al.
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2010 program for divided ▪ Test for Attention effect shown for attention, i.e., the ability Other CRT Performance (TAP) , subtest for dual task on the TAP to complete dual tasks Content: divided attention (divided attention simultaneously (e.g., Nonspecific ▪ Go–no go, and digit span subtest)
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2000 rehabilitation program, • Dutch version, Rey's 15 Words difference between Time Pressure Management Other CRT Test groups on use of (TPM)
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30 Moderate- Assessed the effects of Goal Y • Paper-and-pencil tasks Treatment group 2000 Severe Management Training to • Proofreading improved significantly improve disorganized, or Non-CRT • Grouping from pre- to post maintenance of goal- Content: Motor • Room layout test compared to directed, behavior. skills training • Neuropsychological tests: control.
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dropped problem orientation as Content: (PSI) out prior to post-test well as problem-solving Conventional ▪ Wisconsin Card Sorting Test measures.
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Fong et al. 33 Moderate Examined the effectiveness Y • Key Search test Significant 2009 of a problem-solving • Means-Ends Problem-Solving improvement was skills training program, Other CRT Measure (MEPSM)
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10 Mild, Examines treatment for Y • Hotel Task Treatment group 2002 Moderate, dysexecutive syndrome, ▪ Compiling individual bills did not perform Severe or challenges in planning Other CRT ▪ Sorting the charity collection significantly different and problem solving for Content: ▪ Looking up telephone than control. everyday life activities, Controls were numbers using a brief auditory tested on task ▪ Sorting conference labels stimuli to interrupt activity without use of ▪ Proofreading and cue patients to consider auditory cues ▪ Opening and closing garage the overall goal.
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Fish et al. 20 Severe Examined use of an alerting N • Cambridge Prospective Significant difference 2007 strategy with a content-free Memory Test reported after cued cue to determine utility for • Cattell Culture Fair Test calls versus non-cued a prospective memory task, • Hotel test days.
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improvement reported Severe Working Memory Training • PASAT from intermediate (WMT) -- to improve • Patient Competency Rating to final for WMT, working memory and Scale as noted by tests for other, dependent cognitive • Rivermead Head Injury working memory, functions by targeting the Follow-Up Questionnaire divided attention, central executive system.
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3 Severe Studies three patients with N • Number of correct steps Number of correct 1998 severe cognitive impairment • Number of correct answers steps increased for all leading to difficulty solving • Number of encoding errors three participants from problems • Number of execution errors baseline to session two. • Time for completion No notable changes • Neuropsychological measures: were recorded on ▪ Munchner Gedachtnis Test neuropsychological ▪ Rey Osterrieth Complex measures.
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Nott et al. 8 Mild, Occupational therapy N PRPP system of task analysis Difference in 2008 Moderate, alternated with a performance across Severe rehabilitation program, phases was statistically Perceive, Recall, Plan, and sig for seven of eight Perform (PRPP)
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2 NR Orientation questions N Frequency of correct answers to Improvement noted 1998 presented to two questions for both individuals individuals with executive from baseline to post deficits. Varied formats treatment, providing included individual support for increasing sessions of flashcards orientation to person, with oral questioning, or place, and time using group sessions with peer questions as well as for questions, written response, fading the prompting and verbal repetition.
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Two groups of outcome measures were used to determine improved awareness in participants: behavioral indicators (e.g., increased independence, decreased interruptive behavior) and perceptions (self and others' [e.g., caregivers']
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Treatment effects show benefit for immediate/ short-term outcomes, such as improvement in self-regulatory skills. NON-AWARENESS The committee reviewed eight RCTs of treatments intended to improve cognitive aspects of executive function (i.e., aspects other than selfawareness)
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(2009) evaluated the effectiveness of a 5-week cognitive– motor dual-tasking training program developed to improve the performance of a group of people with divided attention difficulties arising from brain injury and thought to place demands on executive function.
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(2000) assessed a strategy entitled Goal Management Training (GMT)
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Training lasted 6 weeks, with four, 1-hour sessions per week. Outcome measures included specific divided attention measures, other executive and working memory tasks, nontarget cognitive tasks to assess the specificity of treatment, and the Rating Scale of Attentional Behaviour addressing attentional problems in everyday life.
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Relative improvement between the two groups was impossible to assess because the outcome measures that improved significantly within each group (10 measures in the experimental group, 8 in the comparison group) were reported with effect sizes.
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In addition, the generalizability of some of the studies was limited due to extensive methodological overlap between the intervention and the primary outcome measures (e.g., Constantinidou et al. 2005; Ehlhardt et al.
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. • T he committee found studies of goal management training, inten sive goal setting, familiar tasks as a planning template, TPM, or training in divided attention (Constantinidou et al.
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Thus, although several compensatory strategy training approaches show enhanced executive management of complex tasks on a short-term basis, there is limited evidence from two RCTs to document longer-term change to demonstrate the impact of such treatments on realworld performance (Couillet et al. 2010; Evans et al.
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2002. Rehabilitation of executive function: Facilitation of effective goal management on complex tasks using periodic auditory alerts.
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1994. The effects of direct involvement in goal setting on rehabilitation outcome for persons with traumatic brain injuries.
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