Project Expedition: Executive Function Training Intervention for Chronic Traumatic Brain Injury
Phase: NA
Conditions: Traumatic Brain Injury
Sponsor: The University of Texas at Dallas

 
 
 
 
Executive Function Training Intervention for Chronic Traumatic Brain Injury 
 
October 8, 2018 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Intervention 
 
A. Description of the Interventions 
 
The overall objective of the proposed study is to test the effectiveness of a rehabilitation training program 
(Expedition: Strategic Advantage) combining strategy-based coaching by a clinician with daily practice sessions 
conducted with game-based game based-simulations of tasks of daily living aimed at improving cognitive 
constructs embedded within functional tasks.  This will be compared to a control arm of the intervention 
(Expedition: Informational Advantage). In Informational Advantage the game-based simulations will not be 
escalated fully in cognitive challenge. Informational Advantage is not a purely placebo control intervention, as 
it is matched for virtual interactions between the participant and a clinical intervention specialist, and may boost 
confidence, self-efficacy, and elevate mood. Critically, it will not include the escalating cognitive challenge 
element present in the Strategic Advantage intervention arm. 
Expedition – Strategic Advantage 
We will conduct the Strategic Advantage intervention over a four-week period using a remote telemedicine 
delivery method.  Each participant will be issued a laptop computer loaded with both the game-based software, 
which will be used for each week of the intervention (both arms). Weeks 1-3 will focus on improving strategies 
and efficiency within separate cognitive domains.  These intervention training modules are based tasks which 
focus on packing for a trip, selecting and remembering locations visited, transportation, and money 
management.  During each week of the intervention the game-based simulation will escalate in difficulty, 
increasing the demands upon the participant.  Accompanying the game based training will be virtually delivered 
personal coaching sessions related to each construct.   
Phone Check-in:  
The clinical impact of game-based simulation challenge tasks will be strongly enhanced by coaching sessions 
with a clinical interventionist, who can help to guide and support the participant.   
At the start of each week there will be a phone meeting session, which will be a one-on-one participant meeting 
with a clinical interventionist for 30 minutes.  The focus of this session will be to introduce the game-based 
simulation that will be practiced for the upcoming week.  In Week 2, 3, and 4 emphases will also be placed on 
reviewing the performance from the prior week and working to identify places in which the skills and strategies 
used may be particularly relevant to real life. 
There will be a second session of phone coaching at the midway point of the week.  During this session, the 
coach will check in with the participant and encourage them to continue to work with the game-based 
simulation, discuss challenges, obstacles, and outcomes.  The coach will be able to review game-based 
simulation adherence and performance metrics (errors, completion times, and total time playing the simulation) 
prior to this mid-week session.  This mid-week session will also emphasize trying to meet the new demands of 
the game-based simulation at the end of the week. 
Game-Based Simulation Sessions:  
The clinical impact of game-based simulation challenge tasks will be accomplished through repetition, and 
engaging in “desirable difficulties”, a term coined in the memory literature to describe a situation in which 
coping with challenges and overcoming them will lead to improved skills and abilities in the long run.  Each 
week a participant will be tasked with playing the game-based simulation for a minimum of one hour Monday-
Friday.  The game-based simulation will incorporate an increasing level of challenge to the same module each 
day until the final module on Friday, which will be most difficult and present the most desirable difficulties.  
Below are brief descriptions of the cognitive strategies and performance elements for the game-based 
simulations for each of the four weeks of the Strategic Advantage intervention. 

• 
Week 1 
o Game-based Simulation Module: In a hotel room, participants are presented with a list of items that must 
be maintained while they search through the cabinets and drawers.  Some items in the cabinets and 
drawers will be needed for the goal of the trip the player is taking, while others will be unnecessary.  The 
task requires that participants focus on the available items, determine their relevance, and either place 
them in the correct repository (suitcase, briefcase, or backpack) or, if they are not needed for the trip, 
ignore them.  As the week progresses the sessions will include more items to search for and more 
distracting items to contend with.  Additional distractions will occur in the form of interruptions from 
text messages that must be either responded to or ignored depending on their relevance (travel-related vs. 
non-travel related). 
• 
Week 2 
o Game-based Simulation Module: Participants are presented with a metro subway schedule that includes 
multiple transfers in order to navigate to different points of interest.  At a VR train depot, participants 
view a series of trains, some are relevant and some are irrelevant.  Participants are to catch the correct 
trains to complete their targeted route.  In sessions 3-5 additional complications will arise involving late 
and canceled trains.  Money for travel fare becomes more complex to manage, as well, with multiple 
routes possibly taxing management of money and time.  
• 
Week 3 
o Game-based Simulation Module: In the simulation participants will be asked to navigate to different 
points of interest within a set timeframe. The task calls for the participant to focus on planning to 
virtually visit a manageable number of locations and learn facts about them.  As the week progresses 
participants must focus on attending to text message distractions briefly, establishing their relevance, and 
either rapid blocking or immediate responding and resuming original task focus on the goal of visiting 
and learning about locations.  At the end of each session there will be a delayed memory test.  The test 
will be scored for both number of places visited and number of facts accurately reported. 
• 
Week 4 
o Game-based Simulation Module: Participants play their way through the entire simulation beginning 
with the packing (working memory) task, followed by transit according to a metro train schedule 
(planning), and visiting locations to acquire information (attention and long term memory) with text 
message distractions present (selective attention).  This will be repeated throughout week 4 with 
escalating levels of challenge for the participant to master. 
Expedition – Informational Advantage 
The Informational Advantage intervention will be carried out over a similarly scheduled four-week period in the 
same telemedicine delivery method.  All aspects will be identical, except the game-based intervention will be capped 
at a lower challenge level (approximately ¼ of the difficulty level of the full-scale challenge level available in 
Strategic Advantage). Once this cap is reached, participants will be limited to that challenge level for the remainder 
of the week.