title: A metacognitive contextual intervention to enhance error awareness and functional outcome following traumatic brain injury: a single-case experimental design.
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.
authors.affiliation: Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia. t.ownsworth@griffit.edu.au
authors.forename: Tamara
authors.initials: T
authors.lastname: Ownsworth
authors.forename: Jenny
authors.initials: J
authors.lastname: Fleming
authors.forename: Jenny
authors.initials: J
authors.lastname: Desbois
authors.forename: Jenny
authors.initials: J
authors.lastname: Strong
authors.forename: Pim
authors.initials: P
authors.lastname: Kuipers
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001364:Awareness / Q000502:physiology*; D020201:Brain Hemorrhage, Traumatic / Q000523:psychology / Q000534:rehabilitation*; D003071:Cognition / Q000502:physiology; D005793:Generalization, Psychological; D006801:Humans; D007361:Intelligence Tests; D008297:Male; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011597:Psychomotor Performance / Q000502:physiology*; D012649:Self Concept; D012931:Social Environment; D016896:Treatment Outcome