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Paige Knowles, Sally Gallena, Ph.D.

Effectiveness of Metacognitive Skills Training for Individuals with Traumatic Brain Injury

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Individuals with impairments secondary to traumatic brain injury (TBI) may demonstrate difficulty with cognitive processes such as attention, memory, and executive functioning.  Cognitive rehabilitation provided by speech-language pathologists (SLPs) may be effective for training functional tasks; however, successful carryover is highly dependent on the individual’s level of impairment and awareness of their deficits (Tate et al., 2014).  Because awareness is an integral part of rehabilitation, these individuals must employ metacognitive skills to self-assess and monitor their behaviors. 


Metacognitive skills training (MST) focusing on pre-task prediction, strategy planning, and post-task evaluation has proven to enhance performance for individuals with TBI in functional scenarios such as cooking and work related tasks (Cicerone et al., 2011; Ownsworth, et al., 2006).  These MST strategies can be used during traditional cognitive rehabilitation treatment to train and increase the participants’ performance of attention, memory, and executive functioning.  While research has proven MST to be an effective and recommended treatment option, there is a dearth of validated research concerning MST interventions (Ownsworth, Quinn, Fleming, Kendall, & Shum, 2010).  The purpose of this study is to assess the effect of MST with process-specific cognitive rehabilitation for individuals with TBI.

This prospective, controlled, single-subject study will investigate the performance of three individuals with TBI for the cognitive processes of attention, memory, and executive functioning.  This study will employ an ABA design in which baseline data is collected, treatment is administered, and then withdrawn, for post-treatment data collection.

Spaced Retrieval, N-back task, and Goal-Plan-Do-Review are process-specific cognitive rehabilitation treatment methods used to treat deficits in memory, attention, and executive functioning, respectively (Sohlberg & Mateer, 2001).  These treatment methods alone will be used to baseline performance. Following baseline, MST will be introduced in conjunction with Spaced Retrieval, N-back, and Goal-Plan-Do-Review. MST strategies include prediction of task outcomes, planning of strategy use, and self-evaluation following task completion.   Treatment will be administered over ten weekly sessions, whereby performance (i.e., frequency of errors) will be assessed. Six weeks after treatment is withdrawn, each participant will be again assessed to determine long-range treatment effectiveness.

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