Methods: Seventy patients with a verified ABI and executive dysfunction were randomly allocated to GMT (n = 33) or a psycho-educative active control condition, Brain Health Workshop (BHW) (n = 37). In addition, all participants received external cueing by text messages. Neuropsychological tests and self-reported questionnaires of executive functioning were administered pre-intervention, immediately after intervention, and at 6 months followup. Assessors were blinded to group allocation.Results: Questionnaire measures indicated significant improvement of everyday executive functioning in the GMT group, with effects lasting at least 6 months post-treatment. Both groups improved on the majority of the applied neuropsychological tests. However, improved performance on tests demanding executive attention was most prominent in the GMT group. Conclusions:The results indicate that GMT combined with external cueing is an effective metacognitive strategy training method, ameliorating executive dysfunction in daily life for patients with chronic ABI. The strongest effects were seen on self-report measures of executive functions 6 months post-treatment, suggesting that strategies learned in GMT were applied and consolidated in everyday life after the end of training. Furthermore, these findingsshow that executive dysfunction can be improved years after the ABI. INTRODUCTIONExecutive functions (EF) are required for independent, purposive, self-directed behavior and include processes of initiation, planning, purposive action, volition, inhibition, flexibility, as well as self-monitoring and self-regulation (Lezak, 1995;Stuss, 2011). A division between "cold" and "hot" components of EF has been suggested, with "cold" EF corresponding closely to cognitive and logical processes, and the "hot" aspects of EF involving regulation of emotion and motivation (Chan, Shum, Toulopoulou & Chen, 2008).Thus, EF is an umbrella term for a set of interrelated capacities resulting from activity in anatomically and functionally independent, but interconnected networks subserved by widespread brain regions, the prefrontal cortex playing a central role (Stuss & Alexander, 2007).Executive dysfunction (ED) is common following acquired brain injury (ABI) (Stuss & Levine, 2002;Novakovic-Agopian et al, 2011), and may disrupt the ability to effectively use intact functions or compensatory strategies, undermine efficient self-management (Lewis, Babbage & Leathem, 2011), hamper the rehabilitation process (Robertson & Murre, 1999), and is also associated with long-term negative psychosocial and vocational outcome (Draper & Ponsford, 2008; Ylvisaker & Feeney, 2000). Thus, techniques for reducing ED might significantly impact functional outcome (Manly & Murphy, 2012).Most theories describe EF as top-down controlled processes involved in the control and direction of self-regulatory cognition, emotion and behavior (Cicerone et al., 2006;Stuss, 2011). Current theories of cognitive EF bear close resemblance to dominant models of attention (Norman & Shalli...

Executive dysfunction causes significant real-life disability for patients with spina bifida (SB). However, no previous research has been directed toward the amelioration of executive functioning deficits amongst persons with SB. Goal Management Training (GMT) is a compensatory cognitive rehabilitation approach, addressing underlying deficits in sustained attention to improve executive function. GMT has received empirical support in studies of other patient groups. The purpose of the present study was to determine the efficacy of GMT in treating subjects with SB, using inpatient intervention periods. We hypothesized post-intervention changes in scores on neuropsychological measures to reflect improved attentional control, including sustained attention and inhibitory control. Thirty-eight adult subjects with SB were included in this randomized controlled trial. Inclusion was based upon the presence of executive functioning complaints. Experimental subjects (n = 24) received 21 hr of GMT, with efficacy of GMT being compared to results of subjects in a wait-list condition (n = 14). All subjects were assessed at baseline, post-intervention, and at 6-month follow-up. Findings indicated superior effects of GMT on domain-specific neuropsychological measures and on a functional "real-life" measure, all lasting at least 6 months post-treatment. These results show that deficits in executive functioning can be ameliorated in patients with congenital brain dysfunction.

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The study demonstrates the need to interpret BRIEF-A results within a broad differential diagnostic context, where measures of psychological distress are included in addition to neuropsychological tests. Uncertainty about the appropriateness of U.S. normative data in non-U.S. countries adds to the need for interpretive caution. (JINS, 2016, 22, 682-694).