Cognitive Rehabilitation:ACTION Training for Soldiers With Executive Dysfunction
| Status: | Completed |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 1/13/2018 |
| Start Date: | June 2016 |
| End Date: | September 29, 2017 |
Many Service members (SM) experience executive dysfunction associated with mild traumatic
brain injury symptom complex (mTBI-sc), for which they receive cognitive rehabilitation.
Cognitive rehabilitation (CR) for executive dysfunction often involves metacognitive strategy
instruction (MSI) to help patients self-regulate their behavior though a goal management
process - identifying a goal, anticipating performance problems, generating possible
solutions, self-monitoring performance during the activity, recognizing maladaptive task
strategies, stopping and then modifying real-time task behavior by choosing an alternate
strategy. MSI alone often does not result in improved daily functioning because it requires
conscious cognitive oversight to employ (which is difficult for people with executive
dysfunction) and it presumes that simply establishing goals propels goal-directed action,
when for many people, this is not so. Social psychologists report that people who set
implementation intentions (if-then statements that link specific situational cues with
specific goal actions) are more likely to perform goal actions than those who only set goal
intentions. Implementation intentions are believed to be effective because they enable people
to switch from conscious-effortful reflective action control to automatic, reflexive action
control associated with selected situational cues. A team of researchers from the Courage
Kenny Research Center (CKRC), Traumatic Brain Injury Center at Fort Campbell, KY (TBIC-FC),
and Neurofunctional Research and Consulting has developed a brief CR intervention to teach SM
with mTBI-sc to set implementation intentions called ACTION (AutomatiC iniTiation of
IntentiONs) sequence training. The purpose of this pilot study to evaluate: 1) the
practicality of instructional methods used to teach SM with mTBI-sc to perform the ACTION
sequence and 2) the efficacy of ACTION sequence training in achieving personal goals and
performance on a task that challenges executive function using a small randomized controlled
trial. If the results are positive, a larger study would be conducted to determine the impact
of ACTION sequence training on SM performance on military-relevant tasks and goals.
brain injury symptom complex (mTBI-sc), for which they receive cognitive rehabilitation.
Cognitive rehabilitation (CR) for executive dysfunction often involves metacognitive strategy
instruction (MSI) to help patients self-regulate their behavior though a goal management
process - identifying a goal, anticipating performance problems, generating possible
solutions, self-monitoring performance during the activity, recognizing maladaptive task
strategies, stopping and then modifying real-time task behavior by choosing an alternate
strategy. MSI alone often does not result in improved daily functioning because it requires
conscious cognitive oversight to employ (which is difficult for people with executive
dysfunction) and it presumes that simply establishing goals propels goal-directed action,
when for many people, this is not so. Social psychologists report that people who set
implementation intentions (if-then statements that link specific situational cues with
specific goal actions) are more likely to perform goal actions than those who only set goal
intentions. Implementation intentions are believed to be effective because they enable people
to switch from conscious-effortful reflective action control to automatic, reflexive action
control associated with selected situational cues. A team of researchers from the Courage
Kenny Research Center (CKRC), Traumatic Brain Injury Center at Fort Campbell, KY (TBIC-FC),
and Neurofunctional Research and Consulting has developed a brief CR intervention to teach SM
with mTBI-sc to set implementation intentions called ACTION (AutomatiC iniTiation of
IntentiONs) sequence training. The purpose of this pilot study to evaluate: 1) the
practicality of instructional methods used to teach SM with mTBI-sc to perform the ACTION
sequence and 2) the efficacy of ACTION sequence training in achieving personal goals and
performance on a task that challenges executive function using a small randomized controlled
trial. If the results are positive, a larger study would be conducted to determine the impact
of ACTION sequence training on SM performance on military-relevant tasks and goals.
The primary aims of this feasibility study are as follows:
Aim 1: Finalize ACTION training curriculum; develop manuals; field test .
- Work with implementation intentions research expert and a military consultant to develop
a training task gradation schema which informs the identification and modification of
existing implementation intentions training tasks so that they have military face
validity.
- Finalize the adherence support methods and other training worksheets and materials.
- Field test training tasks and adherence support methods on small cohort of civilians
with mTBI-sc from CKRC to assure feasibility.
- Finalize ACTION sequence training manuals; assure intra-rater and inter-rater
reliability for scoring quality of implementation intentions statements.
Aim 2: Evaluate ACTION sequence training instructional methods (the extent to which SM with
mTBI-sc are able to learn to establish IF-THEN statements that have the potential to trigger
automatic enactment of goal-actions and the extent to which SM with mTBI-sc report the
training experience as satisfactory and beneficial).
- Enroll up to 28 participants in the study (SM with mTBI-sc who are referred to MSI at
TBIC-FC).
- Evaluate whether or not participants can correctly craft implementation intentions by
using a rubric to score implementation intentions developed by participants during
clinic sessions and during home practice; administer participation satisfaction survey
at posttest.
Aim 3: Test the efficacy of ACTION sequence training by evaluating the extent to which
training 1) improves SM's with mTBI-sc ability to perform a complex test of executive
function (e.g. Hotel Test) and 2) advances progress towards self-identified goals in daily
life (via Canadian Occupational Performance measure [COPM] and Goal Attainment Scaling [GAS])
as compared to a control condition. Additionally, determine level of adherence to completing
daily homework practice ans assigned prospective memory tasks.
- Collect pre-post data on the Hotel Test, COPM, GAS on all participants.
- Collect data on completion of homework assignments
- Collect data on completion of prospective memory tasks
Aim 1: Finalize ACTION training curriculum; develop manuals; field test .
- Work with implementation intentions research expert and a military consultant to develop
a training task gradation schema which informs the identification and modification of
existing implementation intentions training tasks so that they have military face
validity.
- Finalize the adherence support methods and other training worksheets and materials.
- Field test training tasks and adherence support methods on small cohort of civilians
with mTBI-sc from CKRC to assure feasibility.
- Finalize ACTION sequence training manuals; assure intra-rater and inter-rater
reliability for scoring quality of implementation intentions statements.
Aim 2: Evaluate ACTION sequence training instructional methods (the extent to which SM with
mTBI-sc are able to learn to establish IF-THEN statements that have the potential to trigger
automatic enactment of goal-actions and the extent to which SM with mTBI-sc report the
training experience as satisfactory and beneficial).
- Enroll up to 28 participants in the study (SM with mTBI-sc who are referred to MSI at
TBIC-FC).
- Evaluate whether or not participants can correctly craft implementation intentions by
using a rubric to score implementation intentions developed by participants during
clinic sessions and during home practice; administer participation satisfaction survey
at posttest.
Aim 3: Test the efficacy of ACTION sequence training by evaluating the extent to which
training 1) improves SM's with mTBI-sc ability to perform a complex test of executive
function (e.g. Hotel Test) and 2) advances progress towards self-identified goals in daily
life (via Canadian Occupational Performance measure [COPM] and Goal Attainment Scaling [GAS])
as compared to a control condition. Additionally, determine level of adherence to completing
daily homework practice ans assigned prospective memory tasks.
- Collect pre-post data on the Hotel Test, COPM, GAS on all participants.
- Collect data on completion of homework assignments
- Collect data on completion of prospective memory tasks
Inclusion Criteria:The sample population at the Traumatic Brain Injury Clinic- Fort
Campbell (TBIC-FC) will consist of active duty army soldiers, reservists, national
guardsmen, airmen, and retirees; the majority of the sample population will be active duty
army soldiers. Study volunteers will be recruited from among service members assessed in
the TBIC-FC and referred to the Cognitive Clinic for performance problems secondary to
reported / suspected combat-related mTBI-sc.
Exclusion Criteria:Not willing to sign consent to participate.
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