Journal of the International Neuropsychological Society



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


TAMARA  OWNSWORTH  a1 c1 p1 , JENNY  FLEMING  a1 a2 , JENNY  DESBOIS  a1 , JENNY  STRONG  a1 and PIM  KUIPERS  a3
a1 Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
a2 Occupational Therapy Department, Princess Alexandra Hospital, Woolloongabba, Australia
a3 CONROD, The University of Queensland, St. Lucia, Australia

Article author query
ownsworth t   [PubMed][Google Scholar] 
fleming j   [PubMed][Google Scholar] 
desbois j   [PubMed][Google Scholar] 
strong j   [PubMed][Google Scholar] 
kuipers p   [PubMed][Google Scholar] 

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. (JINS, 2006, 12, 54–63.)

(Received April 19 2005)
(Revised September 7 2005)
(Accepted September 8 2005)


Key Words: Self-awareness; Errors; Behavior; Executive function; Observation; Rehabilitation; Traumatic brain injury; Real-life setting; Case study.

Correspondence:
c1 Address correspondence to: Dr. Tamara Ownsworth, Division of Occupational Therapy, School of Health and Rehabilitation Sciences, Therapies Building (84a), The University of Queensland, St Lucia, Queensland, 4072, Australia. E-mail: t.ownsworth@shrs.uq.edu.au
p1 Dr. Tamara Ownsworth is now at: Griffith University, School of Psychology, Mount Gravatt, 4122, Australia. E-mail: t.ownsworth@griffit.edu.au


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