Abstract
Executive functioning deficits due to brain disease affecting frontal lobe functions cause significant real-life disability, yet solid evidence in support of executive functioning interventions is lacking. Goal Management Training (GMT), an executive functioning intervention that draws upon theories concerning goal processing and sustained attention, has received empirical support in studies of patients with traumatic brain injury, normal aging, and case studies. GMT promotes a mindful approach to complex real-life tasks that pose problems for patients with executive functioning deficits, with a main goal of periodically stopping ongoing behavior to monitor and adjust goals. In this controlled trial, an expanded version of GMT was compared to an alternative intervention, Brain Health Workshop that was matched to GMT on non-specific characteristics that can affect intervention outcome. Participants included 19 individuals in the chronic phase of recovery from brain disease (predominantly stroke) affecting frontal lobe function. Outcome data indicated specific effects of GMT on the Sustained Attention to Response Task as well as the Tower Test, a visuospatial problem-solving measure that reflected far transfer of training effects. There were no significant effects on self-report questionnaires, likely owing to the complexity of these measures in this heterogeneous patient sample. Overall, these data support the efficacy of GMT in the rehabilitation of executive functioning deficits.
Highlights
Deficits in frontal and executive function are among the commonest causes of disability following brain injury
As the Sustained Attention to Response Task (SART) provides reaction time data, we examined the effect of Goal Management Training (GMT) on variability of response time, which is sensitive to frontal brain damage (Stuss et al, 2003) and associated with indices of integrated brain function in healthy individuals (McIntosh et al, 2008)
GMT differs from other training protocols that have shown transfer (e.g., Jaeggi et al, 2008; Persson and Reuter-Lorenz, 2008) in that it is a metacognitive intervention that combines education, narrative, task performance and feedback, and incorporation of participants’ own personal task failures and successes, rather than simple repetitive practice on an automated task
Summary
Deficits in frontal and executive function are among the commonest causes of disability following brain injury. This disability affects planning, strategy application, self-regulation, inhibition, goal-directed behavior, initiation, and insight (Tranel et al, 1994; Stuss and Levine, 2002). 16% of these met criteria for class I evidence sufficient to guide treatment (see Cicerone et al, 2000, 2005; Rohling et al, 2009) Research in this area is limited by heterogeneity of patient samples, lack of control groups, lack of theoretically based intervention protocols, and limited outcome assessment (see Levine and Downey-Lamb, 2002).
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