Training to deal with distractions and conflicting situations in activities of daily living after traumatic brain injury (TBI): Preliminary evidence from a single-case experimental design study

ABSTRACT

This study investigated the impact of an occupation-based intervention targeting executive and metacognitive functions to improve participants’ daily performance after traumatic brain injury (TBI). The intervention was designed to challenge participants with activities that require the management of multiple distracting and conflicting situations. Participants receive structured online and offline feedback on their performance, focusing on how to handle distracting and conflicting situations they previously failed and solved (i.e., metacognitive training). This study used a changing-criterion design by increasing the level of executive requirements across each session. A participant with TBI was trained to complete two significant activities (i.e., making a sandwich and setting the table). We found a significant reduction in errors made and addressed through the feedback sessions in post-intervention performance compared with baseline. These improvements were observed along with the intervention sessions, with most of the errors addressed in prior intervention sessions being successfully corrected in the following sessions and generalized to different contexts (i.e., near transfer) and to an untrained task (i.e., far transfer). Several outcomes were maintained one month after completing the intervention. Based on these findings, the present intervention shows promising results as an effective tool to address executive and metacognitive deficits after TBI.

Trial registration

ClinicalTrials.gov identifier: NCT03958487.

KEYWORDS:

• Activities of daily living: Executive functions
• Occupational therapy
• Neuropsychology
• Neuropsychological rehabilitation
• Metacognition

Acknowledgements

The authors would like to thank the collaboration of the participant and his family for their active involvement. Additionally, we express sincere appreciation to the late Mónica Triviño for her invaluable guidance regarding the feedback design of the intervention, as well as for her enriching and inspiring discussions during the study's initial phases.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

DS-F: Methodology; Investigation; Formal analysis; Visualization; Writing – Original Draft; Writing – Review and Editing.

MR-B: Conceptualization; Methodology; Visualization; Writing – Review and Editing; Supervision.

GR: Methodology; Investigation

AN-E: Methodology; Investigation

MS-R: Methodology; Investigation

MJF: Conceptualization; Methodology; Visualization; Writing – Review and Editing; Supervision.

Data availability statement

The data that support the findings of this study are available from the corresponding author, DS-F, upon reasonable request.

Additional information

Funding

This research was funded by the Spanish Ministry of Economy and Competitiveness (MINECO) research project PSI2016-80331-P awarded to MJF. MJF and GR were funded by Junta de Andalucía through a research project (P20.00693). DS-F is supported by the National Council of Science and Technology (CONACYT) scholarship (CVU – 349933).