Feasibility Testing of Cognitive Strategy Training in Post-Concussive Syndrome
Condition: Brain Concussion; Post-Concussion Syndrome
MeSH terms: Post-Concussion Syndrome; Brain Concussion; Syndrome
Study type: Interventional

Summary: 
      This study will evaluate the practicality (i.e. acceptability to stakeholders; outcome
      battery feasibility; recruitment, retention, and adherence rates) and the preliminary effect
      of a cognitive strategy training intervention in adults with post-concussive syndrome.
    

Detailed description: 
      Up to 90% of known traumatic brain injuries are classified as mild, with many more injuries
      likely going undetected. While each of these individuals experiences somatic, cognitive,
      and/or affective symptoms acutely following the injury, an estimated 10-15% will continue to
      experience these symptoms for months up to a year post-injury. The persistence of symptoms
      for three months or greater is termed post-concussive syndrome (PCS) and can lead to
      decreases in academics, job performance, leisure, daily life activities, and routines.
      Traditionally, rehabilitation is either not provided to these individuals or has a specific
      focus on alleviating impairments (e.g. sustained attention) instead of mitigating effects on
      daily life function. Transfer of improvements in said impairments is known to be limited.
      Cognitive Orientation to daily Occupational Performance (CO-OP), a type of metacognitive
      strategy training, has known positive effects on activity performance outcomes in acquired
      brain injury (e.g. subacute and chronic stroke; moderate traumatic brain injury)1-5. CO-OP
      has yet to be evaluated in a sample of individuals with PCS. In sum, (1) CO-OP is an
      evidence-based intervention for improving activity performance, and (2) it is reasonable to
      hypothesize that the positive effects of CO-OP may be applied in PCS to overcome similar
      cognitive difficulties to improve activity performance.

      The central research hypothesis is that a functionally-oriented metacognitive strategy
      training intervention, CO-OP, will be feasible and have a positive effect on activity
      performance in individuals with PCS syndrome. A single-group, prospective design with
      outcomes gathered pre-and post-intervention will be used (n=15) to evaluate the acceptability
      and feasibility of CO-OP in PCS. We will also be evaluating effect size on outcome measures
      of activity performance and perceptions of the functional impact of PCS symptoms.

      Specific Aim 1: Determine the feasibility of CO-OP in Post-Concussive Syndrome. Hypothesis
      1.1: Participants will report positive perceptions of the intervention via scores greater
      than 3 on the Client-Satisfaction Questionnaire. Hypothesis 1.2: The study will demonstrate
      acceptable recruitment, retention, and adherence rates. Hypothesis 1.3: The proposed
      assessment battery will be feasible (average completion time <2 hours).

      Specific Aim 2: Explore the preliminary effect of CO-OP in a sample of individuals with PCS
      on activity performance outcomes. Hypothesis 2.1: The CO-OP group will demonstrate
      improvements in activity performance outcomes.
    

Intervention name(s): CO-OP Group
Intervention type(s): Behavioral
Intervention description(s): CO-OP focuses on learning of a global problem-solving strategy, Goal-Plan-Do-Check (GPDC), within the performance of participant-chosen goals. Use of a broadly applicable strategy and meaningful activity ensures the intervention is salient to the participant and increases likelihood of transfer. Uniquely, therapists applying CO-OP use guided discovery methods, such as asking a series of probing questions, to support participants in analyzing their own performance of a given task and generating potential solutions for improving performance. Participants become equipped with these skills through repetitive application of the GPDC process. First, participants identify a specific goal (Goal). Then, participants consider a detailed plan (Plan) for accomplishing the goal. By carrying out the plan (Do) and critically analyzing the results (Check), participants determine how the plan worked. The intervention focuses on learning GPDC with gradual withdrawal of guided discovery methods.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: metacognition; occupational therapy