Incorporation of a working memory strategy in GMT to facilitate serial-order behaviour in brain-injured patients

ABSTRACT

Goal Management Training (GMT) is an effective method for improving disorganised behaviour in multistep real-life tasks after brain damage. In the present study we incorporated Working Memory Training (WMT) in GMT to explore their combined efficacy in facilitating the serial-order maintenance of the steps that had to be learned. GMT+WMT was compared to a control WMT designed for other purposes. For this purpose 18 brain-injured patients (aged 20–54), who were at least 4 months post-onset, were randomly assigned to either the GMT+WMT or the WMT treatment. Inclusion was based on a baseline score of less than six correct steps on each of two multistep everyday tasks. Alternative versions of these tasks were used as primary outcome tasks. Pre-treatment and post-treatment comparisons of scores on these primary tasks and on several secondary neuropsychological measures were collected. The results show that post-treatment the GMT+WMT group performed significantly better than the WMT group on the primary outcome measures and on several ecologically valid executive tests that demanded a step-by-step maintenance of multiple actions. Time effects were found for both groups on the secondary measures. Other measures showed no significant differences. We conclude that our results support the efficacy of the combined GMT+WMT in facilitating performance in everyday multistep tasks.

KEYWORDS:

• Goal Management Training
• Working memory training
• Daily executive dysfunction
• Disorganised behaviour
• Updating subgoals
• Multistep activities of daily living

Acknowledgement

The authors thank all the participants and their therapists as well as the Scientific Directors of the healthcare institutions that participated in this study: Dr. Spiridon Mparoutas, Neurosurgical Department of Papanikolaou General Hospital (Eksochi, Thessaloniki, Greece); Dr. Eirini Mouza, Rehabilitation Centre “Anagennisi” (Nea Redestos, Thessaloniki, Greece); and Dr. Theodoros Loizidis, Rehabilitation Centre “Arogi” (Ano Toumpa, Thessaloniki, Greece).

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Roy P.C. Kessels http://orcid.org/0000-0001-9500-9793