ABSTRACT

Self-awareness is commonly impaired after traumatic brain injury and impacts on rehabilitation engagement and community re-integration outcomes. Interventions which incorporate metacognitive strategy instruction have the potential to improve rehabilitation engagement and outcomes. This study aimed to determine whether an occupation-based intervention incorporating metacognitive strategy instruction resulted in goal achievement and improved online awareness and executive function performance during goal-related tasks. A single-case experimental design using a multiple-baseline design across behaviours was used with two participants with severe traumatic brain injury to evaluate the effectiveness of the 6-week intervention. Repeated measures of goal-related performance, percentage of self-corrected errors and executive function were made via independent analysis of video footage and documentation logs. Data analysis involved 2SD bandwidth analysis and overlap data, reliable change index and evaluation of goal achievement across phases. There were improvements in self-corrected errors for one participant, which were maintained. Significant reductions in anxiety (RCI = ±5.98) were evident for both participants, with a significant reduction in stress (RCI = ±7.05) for one participant following the intervention. The occupation-based intervention incorporating metacognitive strategy instruction led to improvements compared to baseline performance in some targeted goals, online awareness and executive function performance during goal-related tasks and reduced stress and anxiety.

摘要

创伤性脑损伤后自我意识通常会受损，并影响康复参与和社区重新融入的结果。包含元认知策略指导的干预措施有可能改善康复参与和结果。本研究旨在确定结合元认知策略指导的基于职业的干预是否会导致目标实现，并在与目标相关的任务中提高在线意识和执行功能表现。使用跨行为的多基线设计的单例实验设计与两名患有严重创伤性脑损伤的参与者一起使用，以评估 6 周干预的有效性。重复测量目标相关的表现，自我纠正错误和执行功能的百分比是通过对视频片段和文档日志的独立分析得出的。数据分析涉及2SD带宽分析和重叠数据、可靠的变化指标和跨阶段目标实现的评估。一名参与者的自我纠正错误有所改善，并保持不变。两名参与者的焦虑明显减少 (RCI = ±5.98)，干预后一名参与者的压力显着减少 (RCI = ±7.05)。结合元认知策略指导的基于职业的干预与目标相关任务期间的某些目标、在线意识和执行功能表现的基线表现相比有所改善，并减少了压力和焦虑。