ABSTRACT

The Multicontext (MC) approach, a metacognitive intervention designed to improve awareness, strategy use, and executive functioning, may be beneficial for individuals with acquired brain injury (ABI) undergoing acute inpatient rehabilitation. The goal of this study was to provide evidence of feasibility and acceptability of the MC approach and to explore clinical outcomes. A case series of eight individuals with acquired brain injury and at least mild executive functioning impairment were recruited from an acute inpatient rehabilitation unit. The MC approach – involving guided questioning and patient self-generation of strategies practiced across everyday functional cognitive tasks – was implemented within routine occupational therapy. Occupational therapists implemented the MC approach with high adherence to the treatment protocol. Therapists’ perceived challenges were the time constraints of inpatient rehabilitation as well as client factors. Participants rated the MC approach as highly satisfying and engaging. They described subjective improvements in their ability to use executive functioning strategies. The MC approach was associated with improvement in awareness, strategy use, and executive functioning at the conclusion of treatment. The MC approach may be a beneficial intervention for individuals with acquired brain injury and executive dysfunction undergoing acute inpatient rehabilitation. Further evaluation with larger samples in controlled trials is warranted.

Trial registration: ClinicalTrials.gov identifier: NCT04363645..

摘要

多情境 (MC) 方法是一种旨在提高意识、策略使用和执行功能的元认知干预，可能对接受急性住院康复的获得性脑损伤 (ABI) 患者有益。本研究的目的是为 MC 方法的可行性和可接受性提供证据，并探索临床结果。从急性住院康复单位招募了 8 名患有获得性脑损伤和至少轻度执行功能障碍的病例系列。MC 方法——包括引导式提问和患者在日常功能性认知任务中自我生成的策略——在常规职业治疗中实施。职业治疗师实施了 MC 方法，并高度遵守治疗方案。治疗师认为的挑战是住院康复的时间限制以及客户因素。参与者认为 MC 方法非常令人满意且引人入胜。他们描述了他们使用执行功能策略的能力的主观改进。MC 方法与治疗结束时意识、策略使用和执行功能的改善有关。对于接受急性住院康复治疗的获得性脑损伤和执行功能障碍患者，MC 方法可能是一种有益的干预措施。有必要在对照试验中对更大样本进行进一步评估。他们描述了他们使用执行功能策略的能力的主观改进。MC 方法与治疗结束时意识、策略使用和执行功能的改善有关。对于接受急性住院康复治疗的获得性脑损伤和执行功能障碍患者，MC 方法可能是一种有益的干预措施。有必要在对照试验中对更大样本进行进一步评估。他们描述了他们使用执行功能策略的能力的主观改进。MC 方法与治疗结束时意识、策略使用和执行功能的改善有关。对于接受急性住院康复治疗的获得性脑损伤和执行功能障碍患者，MC 方法可能是一种有益的干预措施。有必要在对照试验中对更大样本进行进一步评估。

试用注册： ClinicalTrials.gov 标识符：NCT04363645。.