Table Appendices: (Table 7.5)

Reasoning and Problem Solving and Executive Function

Individual Studies

Table 7.5 Treatments Designed to Enhance Reasoning, Problem Solving Skills and Executive Function

Enhancing Executive Function

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

Vas et al.,

(2011)

USA

RCT

PEDro = 6

D&B=19

N=28 Subjects were randomly assigned to 1 of 2 groups: Top down SMART group (exp group) and the information based BHW (control group). A comparison of the benefits of the two groups was conducted. Training was offered for a total of 18 hrs during 12 group sessions over an 8 week period. The first 15 hrs took place over the first 5 week, 10 sessions (2/week). The remaining 2 sessions took place over the remaining 3 weeks (booster sessions). Each SMART session covered various topics which were discussed by participants. Homework assignments were also given to prepare participants for the next session. BHW sessions were designed to be information based sessions covering everything from brain anatomy to health life style and cognitive changes. Reading assignments were also given each week. Pre, Post and Post testing was conducted (3 weeks prior to session beginning, 3 weeks following sessions completing and 6 months post session completion). The examiner was blinded to the group each participant was assigned to.

Following treatment, results indicate that those in the SMART group showed significant improvement on GIST reasoning (p=0.03) on the community integration questionnaire (CIQ) (p=0.02) and the working memory (listening span task) (p<0.001) compared to the BWH group. Pretraining scores were similar for the groups. Those in the SMART group showed significant improvement on 3 executive functions following training (inhibition, nonverbal reasoning, and cognitive flexibility). Overall SMART was found to enhance gist reasoning, of which the benefits were seen in other domains (listening span and increased participation). Six months later the benefits were still evident.

Chen et al.,

(2011)

USA

RCT

PEDro=5

D&B=19

N=12 Participants were randomly assigned to 1 of 2 groups and at the end of the 5th week they began the alternative intervention. Two interventions were used: goals training and education. The goals training protocol was based on a goal management training intervention. Participants attending 10 2 hrs sessions of group based training, 3 individual 1hr training sessions and 20 hrs of home practice over 5 weeks.. The education program was a 5 week didactic educational instruction regarding brain injury.

On the domain of attention and executive functions, all (n=12) in goals training showed an increase from pre to post goals training while only 7 of 12 showed an increase from pre to post education. Performance scores increased significantly after the goals training sessions compared to the education sessions. For the group that began in the education session, scores were also found to improve significantly in the post goals training compared to the education training. Tests of motor speed of processing showed no significant differences between the two interventions.

Rath et al.,

(2003)

USA

RCT

PEDro = 2

D&B = 15

 

N=46Subjects with mild to severe TBI (mean age: 43.6 yrs; mean chronicity: 48.2 mths) with a higher level of functioning were randomized into two groups, the first of which received 1 individualized 2 hr session / week for 24 weeks of a group treatment protocol (emotional self-regulation strategies, problem solving skills) and the second a conventional neuropsychological rehabilitation program.

Treatment group showed significant improvement in problem-solving (WCST, PSI, PSQ) and emotional self-regulation (PSQ), objective observer ratings of role-play scenarios (PSRPT), visual memory (immediate recall- WMS III: p < 0.001), self-esteem (RSES: p< 0.05), fewer perseverative responses (WCST: p< 0.05), gains in PSI total score (p = 0.005), PSQ Clear Thinking and Self-Regulation (p = 0.01 and p< 0.05), and PSRPT (p< 0.005).

 

Group Therapy

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

Novakovic-Agopian et al., (2011)

USA

quasi RCT

PEDro = 5

D&B = 17

 

N=16Participants were assigned to one of two groups (the goals-edu n=8 or the edu-goals group n=8). The goals training (goals-edu) group started with goal orientated attentional self-regulation, while the educational instruction (edu-goals) group began with brain health sessions.  Each group ran for 5 weeks, at which time the goals-edu group began the edu-goals training and vise versa. All participants were assessed at baseline, week 5 and again at week 10. The goals-edu sessions consisted of 10 - 2hour sessions of group training, 3 individual 1 hour training sessions and 20 hours of home practice over 5 weeks.

Results of the first 5 weeks of training, showed those in the goals-edu group showed significant improvement (p<0.0001) on the Attention and Executive Function summary domain and the memory domain (p=0.006), while those in the edu-goals group showed no change or minimal change. Following the change in groups, those in the edu-goals group, once they completed the goals training session showed significant improvement on the Attention and Executive Function Domain (p<0.0001). Those in the goals-edu group who had completed the training session were able to maintain their gains. Following the completion of the goals training sessions all showed a decrease in task failures on complex functional tasks.

Ownsworth et al., (2008)

Australia

RCT

PEDro = 9

D&B = 24

N=31subjects with an ABI were randomly assigned to 1 of 3 groups and each group had a weekly 3 hour session for 8 weeks. Group 1: group based support, Group 2: individual occupation support, Group 3: combined group and individual support interventions. The following measures were used to evaluate participants: Canadian Occupational Performance Measure (COPD); Patient Competency Rating Scale (PCRS); Brain Injury Community Rehab Outcome (BR-CRO 39); level of goal attainment was the primary outcome assessed.

Data was analyzed over three time periods (pre, post and follow-up).  When looking at the results of the pre-assessment data for each intervention group, no significant differences were noted on any of the measures: COPD, PCRS, BR-CRO and level of goal attainment (p>0.05).

 

Looking at the satisfaction self ratings between pre and post assessment, an improvement was noted after each intervention (individual p<0.001; group p<0.025; combined p<0.01). Results indicated that at follow-up an improvement in self-rated satisfaction was noted for the group and combined interventions only (p<0.01). 

 

Results from the CPOM indicate that there was no significant difference between the group intervention pre to post comparison (p<0.028). A significant improvement was noted for the individual and combined interventions (p<0.01 and p<0.025 respectively) pre-post testing.

 

Pre assessment and follow-up assessment for the relatives’ ratings of performance was significant for all three interventions (individual p<0.01; group p<0.01; combined p<0.025). Relatives’ ratings of satisfaction (pre and post) found a significant improvement for the individual (p<0.025) and combined (p<0.01) interventions but not for the group intervention (p<0.117). Pre to post assessment found an improvement for the combined intervention (p<0.025) but not for the other two. A look at the psychosocial outcomes for each intervention group showed few significant differences. Gains made pre to post assessment were not maintained at follow-up; however, gains not significant at post assessment were significant at follow-up.

Goal Management Training

Author/Year/ Country/Study design/PEDro & D&B Score

 

Methods

 

Outcomes

Levine et al., (2000)

Canada

UK

RCT

PEDro=4

D&B = 14

N=30Subjects with moderate to severe ABI as indicated by GCS and PTA were randomized into Goal Management Training (derived from Duncan's theory of goal neglect on disorganized behaviour following TBI) and a Motor Skills Training groups.

Although both groups improved, GMT was associated with significant gains on everyday paper-and-pencil tasks designed by the authors to mimic problematic tasks for patients with goal neglect (p<0.05).

PEDro = Physiotherapy Evidence Database rating scale score (Moseley et al., 2002).

D&B = Downs and Black (1998) quality assessment scale score.