Effectiveness of a metacognitive strategy combined with assistive technology to help individuals with traumatic brain injury manage their budgets

Abstract

Cognitive deficits incurred subsequent to a traumatic brain injury (TBI) largely increase the risk of financial mismanagement. It is urgent that optimal therapeutic interventions be identified to optimize independence in the management of one's personal finances. Our research team has recently developed a novel specific intervention for the treatment of these deficits using emerging Assistive Technologies for Cognition (ATC) combined with the use of a metacognitive approach. Objectives: to explore the effects of this intervention on the ability to develop and manage a budget. Five individuals having sustained a severe TBI participated in the study (two female; average age: 45.6 ± 10.8 yrs; average time post injury: 7 ± 7.2 yrs). They received a 5-week training program consisting of 1-hour sessions twice per week. Treatment sessions: metacognitive procedure using the Cognitive Orientation to daily Occupational Performance (CO-OP) approach combined with the use of ATC via the Budget Alert application available on tablet or smartphone; participants had access to the ATC at home and used it between sessions. The Intervention consisted of 5 phases: goal formulation, plan identification, acquisition of ATC, application of ATC in a real-world setting (shopping center) and generalization of ATC use in subject’ s everyday life. Repeated measurements pre-program (T1 and T2) and post-program (T3, T4, up to 4 months) with 5 participants having sustained a severe TBI using the Instrumental Activities of Daily Living Profile (IADL Profile) and the Canadian Occupational Performance Measure (COPM). Using the two standard deviation band method for small n designs, significant differences in pre- and post-program measures were found for the need of assistance (IADL Profile) for 5 participants. The results of the COPM suggest an effect in improving the ability to manage a budget for 4/5 subjects. Between the post-follow-up period and the follow-up, 4/5 participants continued to use the ATC; these 4 participants declared that they would continue to use it afterwards. The combined results from the IADL Profile and the COPM suggest an overall improvement in the activity of “making a budget” post-intervention; this improvement maintained at 4 months.