A metacognitive contextual intervention to enhance error awareness and functional outcome following traumatic brain injury: A single-case experimental design
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.
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: [email protected]
p1 Dr. Tamara Ownsworth is now at: Griffith University, School of Psychology, Mount Gravatt, 4122, Australia. E-mail: [email protected]