Response to Goal Management Training in Veterans with blast-related mild traumatic brain injury

Abstract

Abstract-Veterans with blast-related mild traumatic brain injury (TBI) experience cognitive deficits that interfere with functional activities. Goal Management Training (GMT), which is a metacognitive intervention, offers an executive function rehabilitation approach that draws upon theories concerning goal processing and sustained attention. GMT has received empirical support in studies of patients with TBI but has not been tested in Veterans with blast-related mild TBI. GMT was modified from 7 weekly to 10 biweekly sessions. Participants included six combat Veterans who reported multiple blast exposures resulting in symptoms consistent with mild TBI. Group analysis showed a significant improvement in measures of executive function derived from performance on the computerized Tower of London. There were no significant changes on self/informant questionnaires of executive function, indicating a lack of generalization of improvement from the clinic to everyday activities. Overall, while the data indicate efficacy of GMT in the rehabilitation of combat Veterans with executive function deficits because of blast-related mild TBI, enhancement of generalization is needed.

Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014

“…The CRTF reviewed 15 Class I [68][69][70][71][72][73][74][75][76][77][78][79][80][81][82] or Class Ia [83][84][85] studies, 3 Class II [86][87][88] Goal Management Training. We reviewed 2 Class I studies, 69,70 1 Class II study, 86 and 1 Class III study 93 addressing the remediation of executive functioning using GMT.…”

Randomised controlled clinical trial of a structured cognitive rehabilitation in patients with attention deficit following mild traumatic brain injury: study protocol

“…Currently, there is no standard cognitive rehabilitation treatment for mTBI population 19. The heterogeneity of cognitive deficits, varied intervention methodology, different reporting style and variable treatment outcomes,6 17 27 28 30–57 challenge professionals in standardising mTBI treatment 19. The early neuropsychological model of attention has already made the assumption that attention should be the focus of rehabilitation, even before more advanced cognitive skills are treated 33.…”

“…In the last 20 years, various cognitive treatment approaches have been reported in the systematic reviews 34–37. These include remediation strategies,38–49 compensatory strategies50–57 and patient education intervention 6 39 53 58. These approaches are usually applied in combination, in order to optimise both cognitive and functional recovery 17 27 28 30 31 33–38.…”

Effectiveness of the Bridge/Adapt Program on Functional Skill Generalization After Acquired Brain Injury

“…Only minimal changes were found from baseline to postintervention results. Therefore, generalization did not occur (Waid-Ebbs et al, 2014).…”

“…A study by the Department of Veterans Affairs addressed the question of generalization by implementing Goal Management Training (GMT), a metacognitive intervention, to increase functional skills in veterans with TBI (Waid-Ebbs et al, 2014). GMT offers an executive function rehabilitation approach that draws upon theories concerning goal processing and sustained attention.…”