Rehabilitation of executive dysfunction: A controlled trial of an attention and problem solving treatment group

Abstract

In this study, the effectiveness of a group-based attention and problem solving (APS) treatment approach to executive impairments in patients with frontal lobe lesions was investigated. Thirty participants with lesions in the frontal lobes, 16 with left frontal (LF) and 14 with right frontal (RF) lesions, were allocated into three groups, each with 10 participants. The APS treatment was initially compared to two other control conditions, an information/education (IE) approach and treatment-as-usual or traditional rehabilitation (TR), with each of the control groups subsequently receiving the APS intervention in a crossover design. This design allowed for an evaluation of the treatment through assessment before and after treatment and on follow up, six months later. There was an improvement on some executive and functional measures after the implementation of the APS programme in the three groups. Size, and to a lesser extent laterality, of lesion affected baseline performance on measures of executive function, but there was no apparent relationship between size, laterality or site of lesion and level of benefit from the treatment intervention. The results were discussed in terms of models of executive functioning and the effectiveness of domain specific interventions in the rehabilitation of executive dysfunction.

Transfer effects of errorless Goal Management Training on cognitive function and quality of life in brain-injured persons

“…In general, patients reported better executive function in daily living after both treatments, whereas proxies reported a decrease in executive behavioral problems. This is in agreement with the results of previous studies, which also showed that proxies (Miotto, Evans, de Lucia, & Scaff, 2009;Schweizer et al, 2008;Spikman, Boelen, Lamberts, Brouwer, & Fasotti, 2010) and therapists (Spikman et al, 2012) reported less complaints after GMT. However, in our study post-treatment improvements were not found on all subjective cognitive measures.…”

Dysexecutive symptoms and carer strain following acquired brain injury: Changes measured before and after holistic neuropsychological rehabilitation

“…planning and dissociation problems (von Cramon, et al, 1991;von Cramon et al, 1992;Levine et al, 2000). Specifically, this study complements Miotto et al (2009), in supporting the effectiveness of the OZC A&GM group as a stand-alone intervention, in reducing EF impairments. Furthermore, this study adds to past research by assessing the effects of a whole rehabilitation package on perceived EF, rather than a sole targeted-intervention.…”

“…GMT was efficacious compared to motor skills training, through naturalistic observation and self-reported meal preparation performance. In addition, a group intervention combining PST and GMT was compared to an information booklet and traditional treatment (Miotto, Evans, Souza de Lucia & Scaff, 2009). Only the intervention showed significant improvement on target measures, the Multiple Errands Task and the DEX.…”

Neuropsychological Rehabilitation of Executive Functions: Challenges and Perspectives

“…This technique is the replacement of patient's impulsive approach for verbal systematic analyses of goals and means to achieve them. Patients are encouraged to: identify the problem, separate relevant from irrelevant information, draw connections between the relevant items, generate possible solutions and monitor their effectiveness [15][16][17]. The use of problem-solving training has proved very useful in a study with TBI patients with ED: the patients submitted to this training showed improvements in planning tasks and in the therapist's assessments of everyday behavior [15].…”

“…Miotto et al [17] conducted a study with thirty patients presenting frontal lobe lesions using the attention and problem solving approach, which merges two techniques already described (GMT and problem-solving training). This approach is composed of three stages: problem awareness, monitoring and evaluation, and developing, initiating and implementing a plan.…”