Page 1 Table of evidence for Intervention for executive functions after traumatic brain injury: A systematic review, meta-analysis and clinical recommendations (Kennedy et al., 2008). Type of Evidence Population Sample Characteristics Number of of Number participants (years) age gender (years) education post-onset time etiology criteria exclusion severityinitial severity study at evidence of severity (GCS, PTA, LOC, GOS, imaging) history tx Title retrospective prospective Single case and/or subject single design not controls, random group to random Primary focus Cicerone, K., D. & Wood, J. C. (1987). Planning disorder after closed head injjry: A case study. Class III. Effects of verbal self- LOC, imaging Archives of Physical Medicine & instruction on planning & off-task finished HS (implied) results, 1 Rehabilitation, 68, 111-115. 1 1 behavior 1 20 M after TBI 4 yrs 1 severe test scores hemiparesis 1 Fox, R. M., Martella, R. C., & Marchand-Martella, N. E. (1989). The acquisition, maintenance and generalization of problem-solving Class II. Contrasted effects of skills by closed head injured problem-solving tx (multiple steps Exp=24-31; Exp=3-9 yrs; adults. Behavioral Therapy, 20 , 61- including awareness & self- Controls=2 Controls=7- 2 76. 1 1 instruction) to no tx 6 6-31 M=4; F=2 12 yrs 1 test scores 1 Burke, W. H., Zencius, A. H., Class III. Treatment effects for Ss1=NR; Wesolowski, M. D. & Doubleday, problem solving (study I), self- Ss2=8 yrs; F. (1991). Improving executive initiation (study II) & self- Ss3=22 yrs; function disorders in brain-injured monitoring/regulation (study III) in Ss4=5 yrs; (implied) Coma, imaging 3 clients. Brain Injury, 5 , 241-252. 1 1 6 clients 5 19-40 M=4; F=1 Ss5=NR 1 severe test scores results 1 von Cramen, D. Y., Matthes-von Cramon, G., & Mai, N. (1991). Problem solving deficits in brain injured patients. A therapeutic Class I. Effects of problem-solving approach. Neuropsychological treatment vs memory treatment on mn=44 (18- mn=11 yrs Exp=2-60 4 Rehabilitation, 1, 45-64. 1 1 problem solving skills 37 60) M=24; F=13 (9-18) mos 1 1 1 Cicerone, K. D. & Giacino, J. T. (1992). Remediation of executive function deficits after traumatic Class III. Effects of feedback and brain injury. NeuroRehabilitation, self-instruction & self-monitoring at least 1 yr 5 2, 12-22. 1 1 training on executive functions 8 18 - 44 M post-injury 1 Webb, P. M. & Gluecauf, R. L. (1994). The effects of direct involvement in goal setting on rehabilitation outcome for persons with traumatic brain injuries. mn coma = Rehabilitation Psychology, 39, Class I. Effects of involvement in mn=12.1 mn=8.7 88.9 days 6 179-188. 1 1 1 goal setting on goal achievement 16 M=14; F=2 (SD=1.9) (SD=5.1) 1 1 (SD=76.9) 1 Page 2 Population Sample Characteristics Study Design and Intervention Raters comments post-injury living living post-injury situation function motor tests neuropsych spoken language pool subject other Total Rationale individual - type Tx group - type Tx duration frequency tx generalization tx maintenance setting Tx deliveredWho tx - Replicability reference 12, 1 hr weekly s applying technique to poor planning, slow motorically, everyday out-pt 1 1 impulsive choices 15 1 1 1 hr, 4 wks 3xs wkly situations setting 1 Persons Groups equal in IQ; transitioning to described problem-solving, differed somewhat in rehab 1 1 1 independence motor, & visual impairments 12TPO 1 1 center WAIS & IQ were All in rehab neuropsych measures; I=12 ses; II=25 program, outpts TPO NR for Ss 1 & 5; days, 11 & 14 In setting transitioning to setting unclear for trials after some where work or to descriptions of problem area study 3; educational baseline; III=25 shaping & behaviors 1 independent living focused on 12level NR 1 1 varied by study days & 15 wks fading occurred 18, had TBIs, 13 had CVAs, & 6 other; selection criteria well- Inpatients; 'poor' defined; neuropsych test results No descriptive stats naïve rehab 1 problem solvers reported 12comparing groups 1 1 6 wks 25 ses 1 staff 1 Self-prediction tx (2 Ss)=16 With each type Ss selection based on: family, trials; Self- of intervention, Subjects were therapist resports of poor instruction tx (6 clinicians participating in planning and self-monitoring Ss)=10-20 hrs, explicitly comprehensive AND poor performance on 5-9 wks; Self- applied rehabilitation WSCT, Tinker Toy Test, or WISC- few details of monitoring tx strategy to 1 program R Mazes. 7participants provided 1 1 (1Ss)=? other behaviors 1 little descriptive info on Long-term inclusion based on 80 on GOAT Ss; no residents on BI & intellectual awareness (on validity/reliability info naïve rehab unit or day tx for BI questionnaire) 9on questionnaire 1 1 1 hr; 8 wks 1 ses per wk staff 1 Page 3 Additional methods Treatment Outcomes Design; tx specific; specific; tx Design; comments evidence of evidence of experimental control value p - statistics Raters comments & structure Body function (impairment) or Activity participation Maintenance Generalization Authors conclusions Raters comments Number of incorrect moves Number of incorrect reduced most in stage 1; off moves remained low; Results demonstrate clinical ABCDA design w/ A as baseline & 3 Maintenance task behaviors & errors in accuracy on other test Self-control ratings efficacy of self-instruction for Outcomes @ 2 WHO stages of verbal self-instruction that measured by naïve incorrect moves reduced unchanged but slower improved more during planning; w/ practical levels; suggests that tx to faded to covert self-talk (stg 3); 1 - baselines raters, using Self- most in stage 1 & implying use of self- generalization phase than generalization training, behavior generalize is needed for task=modified Tower of London established NA control rating scale eliminated by stage 3 instruct strategy during self-instruction phase self-control improved generalization Interviews & similar/dissimilar (from A (baseline), B(probes), C(tx), A (post- trained) situations staged ; tx); Ca=problem situations (4 types) 1 - Naïve interview > staged Explicit training resulted in presented in turns & solutions cued trainers; interactions @ 1 mo; improved problem-solving to Experimental control & with printed WH questions; Ss gave staggered tx Good experimental During tx Exp Ss > correct solutions Maintained at 1, 3 & 6 interview solutions at 3, 6 situations similar and dissimilar generalization, solution & others listened/gave topics/stimul;rel control; naïve than @ baseline w/ big gains during mos; Exp S > controls mos > for Exp Ss than to trained situations; Exp Ss maintenance results render alternative solutions; trainer feedback; iability counselors rated Ca, w/ continued gains during Cb; throughout; see controls; staged sit. not scored similar to non-BI controls this a strong study; limited Cb=same sequence w/o cue cards adequate NA PS answers; Exp Ss > controls at posttest generalization obtained at 3, 6 mos. (earlier study) Ss description I = ABCDA multiple baseline across vocational behavior; II = ABA mltp No other behaviors Tx resulted in behavioral change baseline w/ B as checklist or initiation in III; who delivered in various areas of executive cue cards; Ss 5, III = ABCD design w/ tx & TPO not function. Studies I & II involved TPO not reported for 2 Ss; B verbal feedback every 30 min faded consistently All behaviors (problem solving, self- written checklist or cue. Study III other behaviors not to evening to 2xs wkly; Ss2, III = ABA Study II yes, reported; evidence initiation & continuation, self- All behaviors were feedback & monitoring reduced documented in Study III; design w/ B instructed to record sexual Studies I & III of control limited to regulation) improved during tx maintained at various unwanted sexual behavior, by Study II adequate exp urges in notebook questionable NA study II (checklists, cue cards, feedback) times post-tx phase 'teaching' inhibition. control PST Ss improved in 3/5 PST is promising in addressing intelligence subtests & problem solving deficits. PST=identifying & formulating 1 - Naïve Validity Tower of Hanoi vs. 1 MT Ss Generalization validated w/ Experimental control & problems; generating many solutions; trainers used; 3 documented w/ improved (PST>MT); MT Ss rating scale. Tx effects were generalization, decision-making (pros/cons); solution Ss in problem solving > PST Ss on paired Ratings by naïve rehab staff specific = memory tx improved maintenance results render verification (self-check/monitoring). spontaneous rating scale rated associates & faces-names validated generalizations to memory, PST tx improved this a strong study; limited MT=internal memory strategy training recovery 1 by naïve clinicians memory PST Ss > MT on 'planning task' everyday problem situations problem-solving Ss description showed generalization to other tasks. Self-instruction All tx used modified Tower of London tx: some generalization task (TOL). Self-prediction tx: Ss Self-prediction tx: w/ observed when Ss were predicted # of moves on TOL, received feedback, 5 of 6 Ss became instructed in applying self- feedback after. Self-instruction tx: error free. Self-instruction tx: instruction strategies. Self- multiple baseline across subjects in 3 1 - control number of errors & off-task monitoring tx: when directly phases (talk aloud during moves, exhibited in the behavior decreased post tx. applied to a functional whisper, 'talk' to self). Self-monitoring self-monitoring Self-monitoring tx: setting, client generalized Predicting led to improved tx for Ss who did not benefit from self- tx (when error-