An Executive/Monitoring Treatment Protocol on Everyday Life Activities
Condition: Brain Damage; Executive Dysfunction; Anosognosia
MeSH terms: Brain Injuries; Agnosia
Study type: Interventional

Summary: 
      Empirical research shows that deficits in executive/monitoring abilities (inhibition, error
      detection, problem solving) following acquired brain injury produce serious impact on
      patient's daily life performance. The authors developed an intervention method aimed at
      improving "on-line" error detection and correction abilities during performance of
      naturalistic action. Patients will be asked to complete two significant everyday activities
      (e.g. making a sandwich and setting the kitchen table for four people) while increasing the
      level of monitoring requirements as their performance improve. Monitoring requirements
      increased by presenting new semantically and physically related distractors and increasing
      the number of conflicting/problem solving situations. The treatment involves a metacognitive
      contextual intervention program based on providing systematic online/offline-feedback on
      their own performance, with emphasis on making the patient aware of how to deal with
      distracting/conflicting situations that were previously failed. The authors predict that
      errors committed and addressed through the feedback sessions (errors, actions towards
      distractors, failures to detect/solve conflicting situations) will be reduced on
      post-intervention performance compared to baseline. The authors also expect behavioral
      improvements to generalize to trained tasks but adding new distractors/conflicting situations
      or even to untrained tasks.
    

Detailed description: 
      This protocol will be applied to several acquired brain damage patients with
      executive/monitoring deficits. Baseline evaluation will take take around 5 sessions, The
      training phase will be done on 6 sessions and post-training evaluation will be completed on
      around 3 sessions. Each patient will be invited to be retested 8/10 weeks after completing
      the training, to evaluate long term effects (secondary outcome). The final number of
      participants enrolled in the study will depend on availability.

      The authors will use a single case A-B changing criterium design: Phase A constitutes the
      base line. Three ADL tasks will be performed by the participant without help, two of them
      will be treated on phase B and the other will not be trained. Each task will be evaluated 3/4
      times to obtain a robust baseline. Apart from ADL, other executive/monitoring measures will
      be obtained pre and post-training through neuropsychological screening.

      The level of monitoring difficulty will be increasing from one training session to the next,
      from level 1 (2 distractors/1 conflicting situation) to level 3 (8 distractors/4 conflicting
      situations). Baseline and post-training performance will be evaluated at level 3.The
      criterion to increase the level of monitoring requirements will be adjusted to each
      individual depending on his/her performance on the previous level. Therefore, only if a given
      participant reduces on at least 75% the amount of errors from initial evaluation on the
      present training session he/she will be confronted with the next level of difficulty on the
      next session. However, if the patient doesn't reach the criterium, the same level of
      monitoring will be repeated and trained on the following session.

      Outcomes measures (post-training phase) will be taken after completing 6 training sessions.
    

Intervention name(s): Video feedback, Feedback online
Intervention type(s): Behavioral
Intervention description(s): The treatment phase have 3 timepoints, 1 the patient is asked to perform an ADL alone, 2. Video feedback is administrated. This requires the participant to watch its own videotaped performance with the therapist while the therapist encourage the participant to identify errors, areas of strength, and to suggest strategies to solve errors in future sessions. 3. feedback online will be provided by the therapist on participant performance. The therapist will wait for the patient to detect and correct their error spontaneously. If the patient does not detect it, the therapist provides unspecified/specific help. This strategy is based on previous work (Schmidt, et al 2013, Ownstorth et al. 2010). The novelty of our procedure is the inclusion of distracting and conflicting/problem solving situations to be inhibited, detected and solved. Feedback will focus on these situations. The level of monitoring requirements will be adjusted to participants performance using a changing criterion design.
Other intervention name(s): Metacognitive Training
Intervention model: Single Group Assignment
Intervention model description: Patients with acquired brain damage and with cognitive deficits on executive/monitoring and self awareness,previously measured through neuropsychological screening
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Activities of Daily Living; Brain Injuries/rehabilitation; Generalization (Psychology); Brain Injuries/psychology; Feedback, Psychological/physiology