Rehabilitation of executive functioning: An experimental–clinical validation of Goal Management Training

Abstract

Two studies assessed the effects of a training procedure (Goal Management Training, GMT), derived from Duncan's theory of goal neglect, on disorganized behavior following TBI. In Study 1, patients with traumatic brain injury (TBI) were randomly assigned to brief trials of GMT or motor skills training. GMT, but not motor skills training, was associated with significant gains on everyday paper-and-pencil tasks designed to mimic tasks that are problematic for patients with goal neglect. In Study 2, GMT was applied in a postencephalitic patient seeking to improve her meal-preparation abilities. Both naturalistic observation and self-report measures revealed improved meal preparation performance following GMT. These studies provide both experimental and clinical support for the efficacy of GMT toward the treatment of executive functioning deficits that compromise independence in patients with brain damage. (JINS, 2000, 6, 299–312.)

Rehabilitation of Executive Functions in Patients with Chronic Acquired Brain Injury with Goal Management Training, External Cuing, and Emotional Regulation: A Randomized Controlled Trial

“…This supports the maintenance of goal-related information essential to managing the sequence of stages needed to accomplish one's goals, and illustrates the top-down approach of GMT, where stages of goal management are trained in order to be applied to a variety of situations (Levine et al, 2000). The greatest GMT-related improvements were seen after 6 months, indicating that participants continued to use the learned strategies and This result can be seen as a contribution to disentangle the non-specific from the GMTspecific training-effects, resulting in fewer but theoretically more important findings, such as GMT possibly being associated with distinct improvement of inhibitory control.…”

“…GMT has received empirical support in studies of patients with neurological conditions (e.g., ABI) and in healthy elderly adults (e.g., Grant, Ponsford & Bennett, 2012;Levine et al, 2000; Miotto et al, 2009;Novakovic-Agopian et al, 2011; van Hooren et al, 2007; Stubberud, Langenbahn, Levine, Stanghelle & Schanke, 2013) The present study addresses the methodological weaknesses of prior studies by having a robust randomized controlled trial design, an active control group, long term follow-up, blinded assessments, and radiological injury descriptions. The study also included a new module addressing emotional dysregulation, and both groups received external cueing by text messages in order to facilitate effective goal management in everyday life.…”

“…GMT has received empirical support in studies of patients with neurological conditions (e.g., ABI) and in healthy elderly adults (e.g., Grant, Ponsford & Bennett, 2012;Levine et al, 2000;Miotto et al, 2009;Novakovic-Agopian et al, 2011;van Hooren et al, 2007;Stubberud, Langenbahn, Levine, Stanghelle & Schanke, 2013). Studies of GMT for patients with ABI have reported improved sustained and executive attention (error reduction, planning and time allocation) (Levine et al, 2000;Metzler-Baddeley et al, 2010;Novakovic-Agopian et al, 2011;Schweitzer et al, 2008), and reduction of ED in daily life (Miotto et al, 2009;Spikman et al, 2010).…”

“…Studies of GMT for patients with ABI have reported improved sustained and executive attention (error reduction, planning and time allocation) (Levine et al, 2000;Metzler-Baddeley et al, 2010;Novakovic-Agopian et al, 2011;Schweitzer et al, 2008), and reduction of ED in daily life (Miotto et al, 2009;Spikman et al, 2010). Imaging studies have suggested that GMT results in functional changes in brain networks supporting sustained attention (Chen et al, 2011;Robertson & Levine, 2013), which in turn may lead to functional improvements that generalize to broader domains of goal-directed behaviors.…”

“…Other studies are single case-studies (Levine et al, 2000;Schweitzer et al, 2008;Metzler-Baddeley et al, 2010), or include small samples and are only partially randomized (Levine et al, 2011). Only two group-based GMT studies (Levine et al, 2011;Novakovic-Agopian et al, 2011) have reported follow-up analyses more than three months post-intervention, limiting the evidence for long-term effects.…”