A multicontext approach to promoting transfer of strategy use and self regulation after brain injury: An exploratory study

Abstract

Background/aim: Persons with brain injury frequently demonstrate decreased ability to monitor and apply strategies learned in treatment to everyday situations. The aim of this study is to refine, explore and provide preliminary testing of the multicontext approach in promoting strategy use across situations and increasing self-regulation, awareness and functional performance.

Methods: This study used a single-subject design with repeated measures pre- and post-intervention, with data analysed descriptively and graphically. Four persons with difficulty following multi-step directions, 3–5 years post-TBI, received a nine session intervention programme. Outcome measures included the Awareness Questionnaire, Self-Regulation Skills Interview, Behavior Rating Inventory of Executive Function, Multiple Errands Test and an Executive Function Performance Test sub-task. The process of change within each treatment session was examined with strategy and awareness ratings.

Results: All participants demonstrated positive changes in self-regulatory skills and strategy use that was observed across tasks. As expected, general awareness of deficits remained unchanged. Examination of individual participants revealed important, varying patterns of change in strategy use, learning transfer and self-awareness across intervention.

Conclusions: Results provide preliminary support for the feasibility and efficacy of the multicontext approach in promoting transfer of strategy use to enhance functional performance and selective aspects of awareness. Further investigation, including a larger controlled study, is needed to confirm or limit these observations.

• Self-awareness
• executive function
• metacognition
• rehabilitation
• generalization

Acknowledgements

The authors would like to thank staff members and participants at the Transitional Rehabilitation Center at Helen Hayes Hospital, West Haverstraw, NY. Special thanks to Ms Renee Reichbach, Lori Macleod, Glenn Seliger, MD, and Andrew Hornstein, MD, for their support and assistance as well as to the Graduate OT student research assistants. This study was supported by an Extramural Research Associates Research Development Award (EARDA), Department of Health and Human Services, National Institute of Health # HD035965 awarded to the first author by the ‘Enhancement of Mercy College Office of Research Development’.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper