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

J Int Neuropsychol Soc. 2006 Jan;12(1):54-63. doi: 10.1017/S135561770606005X.

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.

Publication types

  • Case Reports
  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Adult
  • Awareness / physiology*
  • Brain Hemorrhage, Traumatic / psychology
  • Brain Hemorrhage, Traumatic / rehabilitation*
  • Cognition / physiology
  • Generalization, Psychological
  • Humans
  • Intelligence Tests
  • Male
  • Neuropsychological Tests
  • Psychiatric Status Rating Scales
  • Psychomotor Performance / physiology*
  • Self Concept
  • Social Environment
  • Treatment Outcome