Long-term effects of executive function training among veterans with chronic TBI

ABSTRACT

Objective: To investigate long-term effects of GOALS executive function training in Veterans with chronic TBI. In a recently completed study Veterans with chronic TBI showed improvement immediately post-GOALS but not control training on measures of executive function, functional task performance, and emotion regulation. We now examine the long-term maintenance of post-GOALS training changes in the same sample.

Setting: San Francisco VA Health Care System (SFVAHCS), and VA Northern California Health-Care System (VANCHS) in Martinez.

Participants and Design: 24 Veterans with chronic TBI were assessed at baseline, post-GOALS training, and long-term follow-up 6+ months following completion of training with a structured telephone interview, neuropsychological and complex functional performance measures, and self-report measures of daily and emotional functioning.

Results: Participants reported an increased likelihood of involvement in competitive employment/volunteering at follow-up (61%) compared to baseline (26%; χ2 = 5.66, p < .01, ѱ = .35). Repeated measures MANOVAS indicated improvement on attention/executive function (F = 13.85, p < .01, partial η2 = .42), complex functional task performance (GPS Total: F = 9.12, p < .01, partial η2 = .38) and daily functioning (MPAI Total: F = 3.23, p < .05, partial η2 = .21), and reduction in overall mood disturbance (POMS Total: F = 3.42, p < .05, partial η2 = .22) at follow-up relative to baseline.

Discussion: Training in attention regulation applied to participant-defined goals is associated with meaningful long-term improvement in cognitive skills, emotion regulation, and daily functioning in Veterans with chronic TBI.

KEYWORDS:

• Traumatic brain injury
• Veterans
• cognitive rehabilitation
• long-term follow-up

Acknowledgments

We wish to thank participating Veterans and a number of individuals who made this study possible, in particular: Deborah Binder MS, Gerald Carlin OTR/L, Brian Curran MS, Diane Chao, Fred Loya PhD, Michelle Madore PhD, Jim Muir PhD, Michelle Murphy PhD, Annemarie Rossi OTR/L and Nick Rodriguez for their exceptional work with participant training and evaluations. We are grateful to Brian Levine PhD, Ian Robertson PhD and Tom Manly PhD for providing us with the Goal Management Training material to review during the development of the GOALS training manuals.

Author Disclosure Statement

No competing financial interests exist. This material is based upon work supported by the Department of Veterans Affairs Rehabilitation Research & Development Service Merit Review Awards (VANCHCS Project # B7467I and VA 1IO1RX001111-01A1).

Additional information

Funding

This work was supported by the Department of Veterans Affairs Rehabilitation Research & Development Service [Merit Review Awards: VANCHCS Project # B74,and VA 1IO1RX001111-01A1].