A metacognitive contextual intervention to enhance error awareness and functional outcome following traumatic brain injury: A single-case experimental design

Ownsworth, Tamara, Fleming, Jenny, Desbois, Jenny, Strong, Jenny and Kuipers, Pim (2006) A metacognitive contextual intervention to enhance error awareness and functional outcome following traumatic brain injury: A single-case experimental design. Journal of The International Neuropsychological Society, 12 1: 54-63. doi:10.1017/S135561770606005X

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Author Ownsworth, Tamara
Fleming, Jenny
Desbois, Jenny
Strong, Jenny
Kuipers, Pim
Title A metacognitive contextual intervention to enhance error awareness and functional outcome following traumatic brain injury: A single-case experimental design
Journal name Journal of The International Neuropsychological Society   Check publisher's open access policy
ISSN 1355-6177
Publication date 2006
Sub-type Article (original research)
DOI 10.1017/S135561770606005X
Volume 12
Issue 1
Start page 54
End page 63
Total pages 10
Editor K. Haaland
Place of publication United Kingdom
Publisher Cambridge University Press
Collection year 2006
Language eng
Subject C1
321024 Rehabilitation and Therapy - Occupational and Physical
730303 Occupational, speech and physiotherapy
Abstract Very few empirically validated interventions for improving metacognitive skills (i.e., self-awareness and self-regulation) and functional outcomes have been reported. This single-case experimental study presents JM, a 36-year-old man with a very severe traumatic brain injury (TBI) who demonstrated long-term awareness deficits. Treatment at four years post-injury involved a metacognitive contextual intervention based on a conceptualization of neuro-cognitive, psychological, and socio-environmental factors contributing to his awareness deficits. The 16-week intervention targeted error awareness and self-correction in two real life settings: (a) cooking at home: and (b) volunteer work. Outcome measures included behavioral observation of error behavior and standardized awareness measures. Relative to baseline performance in the cooking setting, JM demonstrated a 44% reduction in error frequency and increased self-correction. Although no spontaneous generalization was evident in the volunteer work setting, specific training in this environment led to a 39% decrease in errors. JM later gained paid employment and received brief metacognitive training in his work environment. JM's global self-knowledge of deficits assessed by self-report was unchanged after the program. Overall, the study provides preliminary support for a metacognitive contextual approach to improve error awareness and functional Outcome in real life settings.
Keyword Clinical Neurology
Neurosciences
Psychiatry
Psychology
Self-awareness
Errors
Behavior
Executive Function
Observation
Rehabilitation
Traumatic Brain Injury
Real-life Setting
Case Study
Psychosocial Adjustment
Anosognosia
Deficits
Unawareness
Damage
Scale
Mind
Q-Index Code C1
Additional Notes Fleming was the primary collaborator with Ownsworth on this study published in the leading international neuropsychology journal (IF 2.595). This interdisciplinary study was the first to systematically examine a metacognitive contextual intervention using systematic behavioural observations. Results provide evidence of the effectiveness of joint occupational/neuropsychology intervention. Publication led to Fleming's invitation to be a keynote speaker in Canada.

 
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