Managing executive dysfunction following acquired brain injury and stroke using an ecologically valid rehabilitation approach: a study protocol for a randomized, controlled trial.
BACKGROUND
We have been investigating an ecologically valid strategy-training approach to enable adults with executive dysfunction to attain everyday life goals. Here, we report the protocol of a randomized controlled trial of the effects of this training compared to conventional therapy in a sample of community-dwelling adults with acquired brain injury and/or stroke.


METHODS
We will recruit 100 community-dwelling survivors at least six months post-acquired brain injury or stroke who report executive dysfunction during a telephone interview, confirmed in pre-training testing. Following pre-training testing, participants will be randomized to the ecologically valid strategy training or conventional therapy and receive two one-hour sessions for eight weeks (maximum of 15 hours of therapy). Post-testing will occur immediately following the training and three months later. The primary outcome is self-reported change in performance on everyday life activities measured using the Canadian Occupational Performance Measure, a standardized, semi-structured interview. Secondary outcomes are objective measurement of performance change from videotapes of treatment session, Performance Quality Rating Scale; executive dysfunction symptoms, Behavioural Rating Inventory of Executive Function - Adult; participation in everyday life, Mayo-Portland Adaptability Inventory Participation Index; and ability to solve novel problems, Instrumental Activities of Daily Living Profile.


CONCLUSIONS
This study is of a novel approach to promoting improvements in attainment of everyday life goals through managing executive dysfunction using an ecologically valid strategy training approach, the Cognitive Orientation to daily Occupational Performance. This study compares the efficacy of this approach with that of conventional therapy. The approach has the potential to be a valuable treatment for people with chronic acquired brain injury and/or stroke.


BACKGROUND
clinicaltrials.gov, Trial Identification Number: NCT01414348.
Rotman Research Institute, Baycrest, 3560 Bathurst Street, Toronto, ON M6A 2E1, Canada. ddawson@research.baycrest.org.
Deirdre R
DR
Dawson
Nicole D
ND
Anderson
Malcolm A
MA
Binns
Carolina
C
Bottari
Thecla
T
Damianakis
Anne
A
Hunt
Helene J
HJ
Polatajko
Merrick
M
Zwarenstein
D000203:Activities of Daily Living; D001930:Brain Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D002985:Clinical Protocols; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D056344:Executive Function; D006801:Humans; D009483:Neuropsychological Tests; D009788:Occupational Therapy; D018579:Patient Selection; D020127:Recovery of Function; D012107:Research Design; D018401:Sample Size; D057566:Self Report; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome; D014741:Video Recording