Executive function improvement in response to meta-cognitive training in chronic mTBI / PTSD
ObjectiveWe tested Goal Management Training (GMT), which has been recommended as an executive training protocol that may improve the deficits in the complex tasks inherent in life role participation experienced by those with chronic mild traumatic brain injury and post-traumatic stress disease (mTBI...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-07-01
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| Series: | Frontiers in Rehabilitation Sciences |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fresc.2023.1189292/full |
| _version_ | 1827906108964995072 |
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| author | J. Kay Waid-Ebbs Pey-Shan Wen Tyler Grimes Somnath Datta William M. Perlstein Carol Smith Hammond Carol Smith Hammond Janis J. Daly Janis J. Daly Janis J. Daly |
| author_facet | J. Kay Waid-Ebbs Pey-Shan Wen Tyler Grimes Somnath Datta William M. Perlstein Carol Smith Hammond Carol Smith Hammond Janis J. Daly Janis J. Daly Janis J. Daly |
| author_sort | J. Kay Waid-Ebbs |
| collection | DOAJ |
| description | ObjectiveWe tested Goal Management Training (GMT), which has been recommended as an executive training protocol that may improve the deficits in the complex tasks inherent in life role participation experienced by those with chronic mild traumatic brain injury and post-traumatic stress disease (mTBI/PTSD). We assessed, not only cognitive function, but also life role participation (quality of life).MethodsWe enrolled and treated 14 individuals and administered 10 GMT sessions in-person and provided the use of the Veterans Task Manager (VTM), a Smartphone App, which was designed to serve as a “practice-buddy” device to ensure translation of in-person learning to independent home and community practice of complex tasks. Pre-/post-treatment primary measure was the NIH Examiner, Unstructured Task. Secondary measures were as follows: Tower of London time to complete (cTOL), Community Reintegration of Service Members (CRIS) three subdomains [Extent of Participation; Limitations; Satisfaction of Life Role Participation (Satisfaction)]. We analyzed pre-post-treatment, t-test models to explore change, and generated descriptive statistics to inspect given individual patterns of change across measures.ResultsThere was statistically significant improvement for the NIH EXAMINER Unstructured Task (p < .02; effect size = .67) and cTOL (p < .01; effect size = .52. There was a statistically significant improvement for two CRIS subdomains: Extent of Participation (p < .01; effect size = .75; Limitations (p < .05; effect size = .59). Individuals varied in their treatment response, across measures.Conclusions and Clinical SignificanceIn Veterans with mTBI/PTSD in response to GMT and the VTM learning support buddy, there was significant improvement in executive cognition processes, sufficiently robust to produce significant improvement in community life role participation. The individual variations support need for precision neurorehabilitation. The positive results occurred in response to treatment advantages afforded by the content of the combined GMT and the employment of the VTM learning support buddy, with advantages including the following: manualized content of the GMT; incremental complex task difficulty; GMT structure and flexibility to incorporate individualized functional goals; and the VTM capability of ensuring translation of in-person instruction to home and community practice, solidifying newly learned executive cognitive processes. Study results support future study, including a potential randomized controlled trial, the manualized GMT and availability of the VTM to ensure future clinical deployment of treatment, as warranted. |
| first_indexed | 2024-03-13T00:51:53Z |
| format | Article |
| id | doaj.art-0a98be71e2dd4afa86ea02c34d735615 |
| institution | Directory Open Access Journal |
| issn | 2673-6861 |
| language | English |
| last_indexed | 2024-03-13T00:51:53Z |
| publishDate | 2023-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Rehabilitation Sciences |
| spelling | doaj.art-0a98be71e2dd4afa86ea02c34d7356152023-07-07T11:37:10ZengFrontiers Media S.A.Frontiers in Rehabilitation Sciences2673-68612023-07-01410.3389/fresc.2023.11892921189292Executive function improvement in response to meta-cognitive training in chronic mTBI / PTSDJ. Kay Waid-Ebbs0Pey-Shan Wen1Tyler Grimes2Somnath Datta3William M. Perlstein4Carol Smith Hammond5Carol Smith Hammond6Janis J. Daly7Janis J. Daly8Janis J. Daly9Department of Veterans Affairs (VA), Rehabilitation Research and Development, Brain Rehabilitation Research Center, Gainesville, FL, United StatesDepartment of Occupational Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, United StatesDepartment of Mathematics and Statistics, University of North Florida, Jacksonville, FL, United StatesDepartment of Biostatistics, University of Florida, Gainesville, FL, United StatesDepartment of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United StatesAudiology and Speech Pathology Service, Durham VAMC, Durham, NC, United StatesGeneral Internal Medicine, Duke University, Durham, NC, United StatesDepartment of Veterans Affairs (VA), Rehabilitation Research and Development, Brain Rehabilitation Research Center, Gainesville, FL, United StatesDepartment of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United StatesDepartment of Neurology, School of Medicine, Case Western Reserve University, Cleveland, OH, United StatesObjectiveWe tested Goal Management Training (GMT), which has been recommended as an executive training protocol that may improve the deficits in the complex tasks inherent in life role participation experienced by those with chronic mild traumatic brain injury and post-traumatic stress disease (mTBI/PTSD). We assessed, not only cognitive function, but also life role participation (quality of life).MethodsWe enrolled and treated 14 individuals and administered 10 GMT sessions in-person and provided the use of the Veterans Task Manager (VTM), a Smartphone App, which was designed to serve as a “practice-buddy” device to ensure translation of in-person learning to independent home and community practice of complex tasks. Pre-/post-treatment primary measure was the NIH Examiner, Unstructured Task. Secondary measures were as follows: Tower of London time to complete (cTOL), Community Reintegration of Service Members (CRIS) three subdomains [Extent of Participation; Limitations; Satisfaction of Life Role Participation (Satisfaction)]. We analyzed pre-post-treatment, t-test models to explore change, and generated descriptive statistics to inspect given individual patterns of change across measures.ResultsThere was statistically significant improvement for the NIH EXAMINER Unstructured Task (p < .02; effect size = .67) and cTOL (p < .01; effect size = .52. There was a statistically significant improvement for two CRIS subdomains: Extent of Participation (p < .01; effect size = .75; Limitations (p < .05; effect size = .59). Individuals varied in their treatment response, across measures.Conclusions and Clinical SignificanceIn Veterans with mTBI/PTSD in response to GMT and the VTM learning support buddy, there was significant improvement in executive cognition processes, sufficiently robust to produce significant improvement in community life role participation. The individual variations support need for precision neurorehabilitation. The positive results occurred in response to treatment advantages afforded by the content of the combined GMT and the employment of the VTM learning support buddy, with advantages including the following: manualized content of the GMT; incremental complex task difficulty; GMT structure and flexibility to incorporate individualized functional goals; and the VTM capability of ensuring translation of in-person instruction to home and community practice, solidifying newly learned executive cognitive processes. Study results support future study, including a potential randomized controlled trial, the manualized GMT and availability of the VTM to ensure future clinical deployment of treatment, as warranted.https://www.frontiersin.org/articles/10.3389/fresc.2023.1189292/fulltraumatic brain injurypost-traumatic stress disorderexecutive functioncognitioncomplex functional tasksquality of life |
| spellingShingle | J. Kay Waid-Ebbs Pey-Shan Wen Tyler Grimes Somnath Datta William M. Perlstein Carol Smith Hammond Carol Smith Hammond Janis J. Daly Janis J. Daly Janis J. Daly Executive function improvement in response to meta-cognitive training in chronic mTBI / PTSD Frontiers in Rehabilitation Sciences traumatic brain injury post-traumatic stress disorder executive function cognition complex functional tasks quality of life |
| title | Executive function improvement in response to meta-cognitive training in chronic mTBI / PTSD |
| title_full | Executive function improvement in response to meta-cognitive training in chronic mTBI / PTSD |
| title_fullStr | Executive function improvement in response to meta-cognitive training in chronic mTBI / PTSD |
| title_full_unstemmed | Executive function improvement in response to meta-cognitive training in chronic mTBI / PTSD |
| title_short | Executive function improvement in response to meta-cognitive training in chronic mTBI / PTSD |
| title_sort | executive function improvement in response to meta cognitive training in chronic mtbi ptsd |
| topic | traumatic brain injury post-traumatic stress disorder executive function cognition complex functional tasks quality of life |
| url | https://www.frontiersin.org/articles/10.3389/fresc.2023.1189292/full |
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