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A metacognitive contextual intervention to enhance error awareness and functional outcome following traumatic brain injury: A single-case experimental design

Published online by Cambridge University Press:  23 January 2006

TAMARA OWNSWORTH ,
JENNY FLEMING ,
JENNY DESBOIS ,
JENNY STRONG  and
PIM KUIPERS
TAMARA OWNSWORTH
Affiliation:
Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia Dr. Tamara Ownsworth is now at: Griffith University, School of Psychology, Mount Gravatt, 4122, Australia. E-mail: [email protected]
JENNY FLEMING
Affiliation:
Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia Occupational Therapy Department, Princess Alexandra Hospital, Woolloongabba, Australia
JENNY DESBOIS
Affiliation:
Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
JENNY STRONG
Affiliation:
Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
PIM KUIPERS
Affiliation:
CONROD, The University of Queensland, St. Lucia, Australia
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Abstract

Very few empirically validated interventions for improving metacognitive skills (i.e., self-awareness and self-regulation) and functional outcomes have been reported. This single-case experimental study presents JM, a 36-year-old man with a very severe traumatic brain injury (TBI) who demonstrated long-term awareness deficits. Treatment at four years post-injury involved a metacognitive contextual intervention based on a conceptualization of neuro-cognitive, psychological, and socio-environmental factors contributing to his awareness deficits. The 16-week intervention targeted error awareness and self-correction in two real life settings: (a) cooking at home; and (b) volunteer work. Outcome measures included behavioral observation of error behavior and standardized awareness measures. Relative to baseline performance in the cooking setting, JM demonstrated a 44% reduction in error frequency and increased self-correction. Although no spontaneous generalization was evident in the volunteer work setting, specific training in this environment led to a 39% decrease in errors. JM later gained paid employment and received brief metacognitive training in his work environment. JM's global self-knowledge of deficits assessed by self-report was unchanged after the program. Overall, the study provides preliminary support for a metacognitive contextual approach to improve error awareness and functional outcome in real life settings. (JINS, 2006, 12, 54–63.)

Keywords

Self-awarenessErrorsBehaviorExecutive functionObservationRehabilitationTraumatic brain injuryReal-life settingCase study
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 12 , Issue 1 , January 2006 , pp. 54 - 63
Copyright
© 2006 The International Neuropsychological Society

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References

REFERENCES

Agnew, S.K. & Morris, R.G. (1998). The heterogeneity of anosognosia for memory impairment in Alzheimer's disease: A review of the literature and a proposed model. Aging & Mental Health, 2, 7–19.CrossRefGoogle Scholar
Bieman-Copland, S. & Dywan, J. (2000). Achieving rehabilitative gains in anosognosia after TBI. Brain and Cognition, 1, 1–18.Google Scholar
Carney, N., Chesnut, R.M., Maynard, H., Mann, N.C., Patterson, P., & Helfand, M. (1999). Effects of cognitive rehabilitation on outcomes for persons with traumatic brain injury: A systematic review. Journal of Head Trauma Rehabilitation, 14, 277–307.CrossRefGoogle Scholar
Cicerone, K. & Tupper, D. (1986). Cognitive assessment in the neuropsychological rehabilitation of head-injured adults. In B.P. Uzzell & Y. Gross (Eds.), Clinical neuropsychology of intervention (pp. 59–83). Boston: Martinus Nijhoff Publishing.
Cicerone, K. & Tupper, D.E. (1991). Neuropsychological rehabilitation: Treatment of errors in everyday functioning. In D.E. Tupper & K.C. Cicerone (Eds.), The neuropsychology of everyday life: Issues in development and rehabilitation (pp. 271–292). Norwell, MA: Kluwer Academic.
Cocchini, G., Beschin, N., & Della Sala, S. (2002). Chronic anosognosia: A case report and theoretical account. Neuropsychologia, 40, 2030–2038.CrossRefGoogle Scholar
Crowne, D.P. & Marlowe, D. (1960). A new scale of social desirability independent of psychopathology. Journal of Consulting Psychology, 24, 349–354.CrossRefGoogle Scholar
Domholdtz, E. (2005). Rehabilitation research: Principles and applications. St Louis, MO: Elsevier Saunders.
Fleming, J.M., Strong, J., & Ashton, R. (1996). Self-awareness of deficits in adults with traumatic brain injury: How best to measure? Brain Injury, 10, 1–15.Google Scholar
Fleming, J. & Ownsworth, T.L. (2006). A review of awareness interventions in brain injury rehabilitation. Neuropsychological Rehabilitation, 16, (in press).CrossRefGoogle Scholar
Glynn, T., McNaughton, S., Robinson, V., & Quinn, M. (1979). Remedial reading at home: Helping you to help your child. Wellington: New Zealand Council for Educational Research.
Hart, T., Giovannetti, T., Montgomery, M.W., & Schwartz, M.F. (1998). Awareness of errors in naturalistic action after traumatic brain injury. Journal of Head Trauma Rehabilitation, 13, 16–28.CrossRefGoogle Scholar
Hersen, M. (1990). Single-case experimental designs. In A.S. Bellack, M. Hersen, & A.E. Kazdin (Eds.), International handbook of behaviour modification and therapy (pp. 175–209). New York: Plennum Press.
Katz, N. & Hartman-Maeir, A. (1998). Metacognition: The relationships of awareness and executive functions to occupational performance. In N. Katz (Ed.), Cognition and occupation in rehabilitation: Models for intervention in occupational therapy (pp. 323–242). Bethesda, MD: American Occupational Therapy Association.
Levine, B., Stuss, D.T., Milberg, W.P., Alexander, M.P., Schwartz, M., & Macdonald, R. (1998). The effects of focal and diffuse brain damage on strategy application: Evidence from focal lesions, traumatic brain injury and normal aging. Journal of the International Neuropsychological Society, 4, 247–264.Google Scholar
Lezak, M.D. (1993). Newer contributions to the neuropsychological assessment of executive functions. Journal of Head Trauma Rehabilitation, 8, 24–31.CrossRefGoogle Scholar
Loeb, P.A. (1996). The Independent Living Scales manual. San Antonio: The Psychological Corporation.
McGlynn, S.M. & Schacter, D.L. (1989). Unawareness of deficits in neuropsychological syndromes. Journal Clinical Experimental Neuropsychology, 11, 143–205.CrossRefGoogle Scholar
McNaughton, S.S., Glynn, T., & Robinson, V. (1987). Pause, prompt, and praise: Effective tutoring for remedial reading. Birmingham, UK: Positive Products.
Marcel, A.J., Tegner, R., & Nimmo-Smith, I. (2004). Anosognosia for plegia: Specificity, extension, partiality, and disunity of bodily unawareness. Cortex, 40, 19–40.CrossRefGoogle Scholar
Mittenberg, W., DiGiulio, D.V., Perrin, S., & Bass, A.E. (1992). Symptoms following mild head injury: Expectation as aetiology. Journal of Neurology, Neurosurgery, and Psychiatry, 55, 200–204.CrossRefGoogle Scholar
Morris, R.G. & Hannesdottir, K. (2004). Loss of “awareness” in Alzheimer's disease. In R.G. Morris & J.T. Becker (Eds.), The Cognitive Neuropsychology of Alzheimer's Disease (pp. 275–296). Oxford: Oxford University Press.
Ownsworth, T.L. (2005). The impact of defensive denial upon adjustment following traumatic brain injury. Neuro-psychoanalysis, 7, 83–94.Google Scholar
Ownsworth, T.L. & Clare, L. (2005). The role and relevance of self-awareness in achieving rehabilitation gains: Empirical evidence and case illustrations. Paper presented at the Neuropsychological Rehabilitation Conference (July 11–12th), Galway, Ireland.
Ownsworth, T.L., Clare, L., & Morris, R. (2006). A critical review of cognitive neuropsychological models of awareness: An integrated biopsychosocial approach for Alzheimer's disease and brain injury. Neuropsychological Rehabilitation, 10, (in press).CrossRefGoogle Scholar
Ownsworth, T.L. & Fleming, J. (2005). The relative importance of metacognitive skills, emotional status and executive functioning in psychosocial adjustment following acquired brain injury. Journal of Head Trauma Rehabilitation, 20, 315–332.CrossRefGoogle Scholar
Ownsworth, T.L., McFarland, K., & Young, R.McD. (2000). Self-awareness and psychosocial functioning following acquired brain injury: An evaluation of a group support programme. Neuropsychological Rehabilitation, 10, 465–484.CrossRefGoogle Scholar
Ownsworth, T.L., McFarland, K., & Young, R.McD. (2002). Investigation of factors underlying deficits in self-awareness and self-regulation. Brain Injury, 16, 291–309.CrossRefGoogle Scholar
Pia, L., Neppi-Modona, M., Ricci, R., & Berti, A. (2004). The anatomy of anosognosia for hemiplegia: A meta-analysis. Cortex, 40, 367–377.CrossRefGoogle Scholar
Prigatano, G.P. (1999). Principles of neuropsychological rehabilitation. New York: Oxford University Press.
Prigatano, G.P. & Weinstein, E.A. (1996). Edwin A. Weinstein's contributions to neuropsychological rehabilitation. Neuropsychological Rehabilitation, 6, 305–326.CrossRefGoogle Scholar
Reynolds, W.M. (1982). Development of reliable and valid short forms of the Marlowe-Crowne Social Desirability Scale. Journal of Clinical Psychology, 38, 119–125.3.0.CO;2-I>CrossRefGoogle Scholar
Robertson, I.H. & Murre, J.M.J. (1999). Rehabilitation of brain damage: Brain plasticity and principles of guided recovery. Psychological Bulletin, 125, 544–575.CrossRefGoogle Scholar
Schacter, D.L. (1990). Toward a cognitive neuropsychology of awareness: Implicit knowledge and anosognosia. Clinical and Experimental Neuropsychology, 12, 155–178.CrossRefGoogle Scholar
Sherer, M., Bergloff, P., Boake, C., High, W., & Levin, E. (1998a). The Awareness Questionnaire: Factor structure and internal consistency. Brain Injury, 12, 63–68.Google Scholar
Sherer, M., Hart, T., Whyte, J., Nick, T.G., & Yablon, S.A. (2005). Neuroanatomical basis of impaired self-awareness after traumatic brain injury: Findings from early computed tomography. Journal of Head Trauma Rehabilitation, 20, 287–300.CrossRefGoogle Scholar
Sherer, M., Oden, K., Bergloff, P., Levin, E., & High, W.M. (1998b). Assessment and treatment of impaired awareness after brain injury: Implications for community re-integration. NeuroRehabilitation, 10, 25–37.Google Scholar
Snaith, R.P. & Zigmond, A.S. (1994). The Hospital Anxiety and Depression Scale manual. Windsor, Berkshire, UK: NFER-NELSON Publishing Company Ltd.
Sohlberg, M.M., Mateer, C.A., Penkman, L., Glang, A., & Todis, B. (1998). Awareness Intervention: Who needs it? Journal of Head Trauma Rehabilitation, 13, 62–78.Google Scholar
Spreen, O. & Strauss, E. (1998). A compendium of neuropsychological tests (2nd ed.). Oxford, UK: Oxford University Press.
Stone, V.E., Baron-Cohen, S., & Knight, R.T. (1998). Frontal lobe contributions to theory of mind. Journal of Cognitive Neuroscience, 10, 640–656.CrossRefGoogle Scholar
Stuss, D.T., Alexander, M.P., Palumbo, C.L., Buckle, L., Sayer, L., & Pogue, J. (1994). Organizational strategies of patients with unilateral or bilateral frontal lobe injury in word list learning tasks. Neuropsychology, 8, 355–373.CrossRefGoogle Scholar
Stuss, D.T. & Anderson, V. (2004). The frontal lobes and theory of mind: Developmental concepts from adult focal lesion research. Brain and Cognition, 55, 69–83.CrossRefGoogle Scholar
Stuss, D.T., Picton, T.W., & Alexander, M.P. (2001). Consciousness, self-awareness and the frontal lobes. In S. Salloway, P. Malloy, & J. Duffy (Eds.), The frontal lobes and neuropsychiatric illness (pp. 101–109). Washington DC: American Psychiatric Press, Inc.
Tate, R.L. & Broe, G.A. (1999). Psychosocial adjustment after traumatic brain injury: What are the important variables? Psychological Medicine, 29, 713–725.Google Scholar
Toglia, J.P. (1998). A dynamic interactional model to cognitive rehabilitation. In N. Katz (Ed.), Cognition and occupation in rehabilitation: Models for intervention in occupational therapy (pp. 5–50), Bethesda, MD: American Occupational Therapy Association.
Toglia, J. & Kirk, U. (2000). Understanding awareness deficits following brain injury. NeuroRehabilitation, 15, 57–70.Google Scholar
Vilkki, J., Ahola, K., Holst, P., Ohman, J., Servo, A., & Heiskanen, O. (1994). Prediction of psychosocial recovery after head injury with cognitive tests and neurobehavioral ratings. Journal of Clinical and Experimental Neuropsychology, 16, 325–338.CrossRefGoogle Scholar
Wilson, B.A., Alderman, N., Burgess, P.W., Emslie, H., & Evans, J.J. (1996). Behavioural Assessment of the Dysexecutive Syndrome (BADS). Bury St. Edmunds, UK: Thames Valley Test Company.
Ylvisaker, M., Szekeres, S., & Feeney, T. (1998). Cognitive rehabilitation: executive functions. In M. Ylvisaker (Ed.), Traumatic brain injury rehabilitation: children and adolescents (pp. 221–269). Boston: Butterworth-Heinemann.