TY - JOUR
T1 - Executive functioning in TBI from rehabilitation to social reintegration
T2 - COMPASS goal, a randomized controlled trial (grant: 1I01RX000637-01A3 by the VA ORD RR&D, 2013-2016)
AU - Libin, Alexander V.
AU - Scholten, Joel
AU - Schladen, Manon Maitland
AU - Danford, Ellen
AU - Shara, Nawar
AU - Penk, Walter
AU - Grafman, Jordan
AU - Resnik, Linda
AU - Bruner, Dwan
AU - Cichon, Samantha
AU - Philmon, Miriam
AU - Tsai, Brenda
AU - Blackman, Marc
AU - Dromerick, Alexander
N1 - Funding Information:
This work is supported by Merit Review Award # I 01 RX000637-01A3 from the United States Department of Veterans Affairs Rehabilitation Research and Development Service Program. Partial logistical support for the preparatory phase of the project was provided through the MedStar Health Research Institute, a component of the Georgetown-Howard Universities Center for Clinical and Translational Science, and supported by Grant U54 RR026076-01 from the National Center for Research Resources, a component of the National Institutes of Health. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the views of the United States Government, the Department of Veterans Affairs, the National Center for Research Resources, the National Institutes of Health, or MedStar Health.
Funding Information:
This work was supported by Merit Review Award # I 01 RX000637-01-A3 from the United States (U.S.) Department of Veterans Affairs Rehabilitation Research and Development Service. The contents do not necessarily represent the views of the U.S. Department of Veterans Affairs or the United States Government. Statistical support for this project was provided through the MedStar Health Research Institute, a component of the Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS), and supported in part with Federal funds (UL1TR000101 previously UL1RR031975) from the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through the Clinical and Translational Science Awards Program (CTSA), a trademark of DHHS, part of the Roadmap Initiative, “Re-Engineering the Clinical Research Enterprise”. Tessa Hart, PhD, consulted on self-regulation theory and goal-setting best practices after TBI and led the design of the COMPASS manual. Kelly McCarron, PsyD, and Sheree Gordon, MSN, have provided written permission for the use of their personal communication with the research team.
Publisher Copyright:
© 2016 Libin et al.
PY - 2015/11/30
Y1 - 2015/11/30
N2 - Background: Traumatic brain injury is a major health problem that frequently leads to deficits in executive function. Self-regulation processes, such as goal-setting, may become disordered after traumatic brain injury, particularly when the frontal regions of the brain and their connections are involved. Such impairments reduce injured veterans' ability to return to work or school and to regain satisfactory personal lives. Understanding the neurologically disabling effects of brain injury on executive function is necessary for both the accurate diagnosis of impairment and the individual tailoring of rehabilitation processes to help returning service members recover independent function. Methods/design: The COMPASSgoal (Community Participation through Self-Efficacy Skills Development) program develops and tests a novel patient-centered intervention framework for community re-integration psychosocial research in veterans with mild traumatic brain injury. COMPASSgoal integrates the principles and best practices of goal self-management. Goal setting is a core skill in self-management training by which persons with chronic health conditions learn to improve their status and decrease symptom effects. Over a three-year period, COMPASSgoal will recruit 110 participants with residual executive dysfunction three months or more post-injury. Inclusion criteria combine both clinical diagnosis and standardized scores that are >1 SD from the normative score on the Frontal Systems Rating Scale. Participants are randomized into two groups: goal-management (intervention) and supported discharge (control). The intervention is administered in eight consecutive, weekly sessions. Assessments occur at enrollment, post-intervention/supported discharge, and three months post-treatment follow-up. Discussion: Goal management is part of the "natural language" of rehabilitation. However, collaborative goal-setting between clinicians/case managers and clients can be hindered by the cognitive deficits that follow brain injury. Re-training returning veterans with brain injury in goal management, with appropriate help and support, would essentially treat deficits in executive function. A structured approach to goal self-management may foster greater independence and self-efficacy, help veterans gain insight into goals that are realistic for them at a given time, and help clinicians and veterans to work more effectively as true collaborators.
AB - Background: Traumatic brain injury is a major health problem that frequently leads to deficits in executive function. Self-regulation processes, such as goal-setting, may become disordered after traumatic brain injury, particularly when the frontal regions of the brain and their connections are involved. Such impairments reduce injured veterans' ability to return to work or school and to regain satisfactory personal lives. Understanding the neurologically disabling effects of brain injury on executive function is necessary for both the accurate diagnosis of impairment and the individual tailoring of rehabilitation processes to help returning service members recover independent function. Methods/design: The COMPASSgoal (Community Participation through Self-Efficacy Skills Development) program develops and tests a novel patient-centered intervention framework for community re-integration psychosocial research in veterans with mild traumatic brain injury. COMPASSgoal integrates the principles and best practices of goal self-management. Goal setting is a core skill in self-management training by which persons with chronic health conditions learn to improve their status and decrease symptom effects. Over a three-year period, COMPASSgoal will recruit 110 participants with residual executive dysfunction three months or more post-injury. Inclusion criteria combine both clinical diagnosis and standardized scores that are >1 SD from the normative score on the Frontal Systems Rating Scale. Participants are randomized into two groups: goal-management (intervention) and supported discharge (control). The intervention is administered in eight consecutive, weekly sessions. Assessments occur at enrollment, post-intervention/supported discharge, and three months post-treatment follow-up. Discussion: Goal management is part of the "natural language" of rehabilitation. However, collaborative goal-setting between clinicians/case managers and clients can be hindered by the cognitive deficits that follow brain injury. Re-training returning veterans with brain injury in goal management, with appropriate help and support, would essentially treat deficits in executive function. A structured approach to goal self-management may foster greater independence and self-efficacy, help veterans gain insight into goals that are realistic for them at a given time, and help clinicians and veterans to work more effectively as true collaborators.
KW - Community re-integration
KW - Executive function
KW - Goal-setting
KW - Manualized psychosocial intervention
KW - Randomized controlled trial
KW - Traumatic brain injury
KW - Veterans
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U2 - 10.1186/s40779-015-0061-2
DO - 10.1186/s40779-015-0061-2
M3 - Article
C2 - 26664736
AN - SCOPUS:84966430682
SN - 2095-7467
VL - 2
JO - Military Medical Research
JF - Military Medical Research
IS - 1
M1 - 32
ER -