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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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