Simulation-based executive cognitive assessment and rehabilitation after traumatic frontal lobe injury: a case report.
OBJECTIVE
To investigate whether identifying specific deficits after brain injury can lead to a more focused and potentially effective cognitive rehabilitation technology.


METHODS
Cognitive simulation assessment was undertaken in a 47-year-old man with trauma-related prefrontal damage and persisting occupational and cognitive-behavioral difficulties at 15 months post brain injury.


RESULTS
Results revealed significant difficulties in measured levels of activity, initiative, information utilization, response flexibility, and effective decision-making strategies which accorded well with his real-life complaints despite normal neuropsychological test scores. This profile of findings was then used to design a two-stage intervention program. The first stage focused on participant education and awareness about his simulation-based problem solving difficulties. In the second stage specific goals were formulated to improve problem solving impairments that were then the target of weekly training sessions using pertinent decision-making and problem-solving vignettes. A parallel version of the cognitive simulation assessment was undertaken post-cognitive training (3 months after initial assessment) and revealed significant improvements in targeted executive cognitive-behavioral areas.


CONCLUSIONS
Results of this cognitive rehabilitation probe supported the feasibility and validity of undertaking a cognitive simulation approach to identify residual executive function deficits after traumatic brain injury, even with a normal neuropsychological test profile. Further studies are needed to establish the reliability, generalizability and maintenance of such gains.
Satish
Usha
U
SUNY Upstate Medical University, Department of Psychiatry and Behavioral Sciences, USA.
Streufert
Siegfried
S
Eslinger
Paul J
PJ
D000063:Accidents, Traffic; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000534:rehabilitation*; D003072:Cognition Disorders / Q000209:etiology / Q000534:rehabilitation*; D005240:Feasibility Studies; D005625:Frontal Lobe / Q000293:injuries*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D014057:Tomography, X-Ray Computed