An Executive/Monitoring Treatment Protocol on Everyday Life Activities
An Executive/Monitoring Treatment Protocol on Everyday Life Activities
Empirical research shows that deficits in executive/monitoring abilities (inhibition, error
 detection, problem solving) following acquired brain injury produce serious impact on
 patient's daily life performance. The authors developed an intervention method aimed at
 improving "on-line" error detection and correction abilities during performance of
 naturalistic action. Patients will be asked to complete two significant everyday activities
 (e.g. making a sandwich and setting the kitchen table for four people) while increasing the
 level of monitoring requirements as their performance improve. Monitoring requirements
 increased by presenting new semantically and physically related distractors and increasing
 the number of conflicting/problem solving situations. The treatment involves a metacognitive
 contextual intervention program based on providing systematic online/offline-feedback on
 their own performance, with emphasis on making the patient aware of how to deal with
 distracting/conflicting situations that were previously failed. The authors predict that
 errors committed and addressed through the feedback sessions (errors, actions towards
 distractors, failures to detect/solve conflicting situations) will be reduced on
 post-intervention performance compared to baseline. The authors also expect behavioral
 improvements to generalize to trained tasks but adding new distractors/conflicting situations
 or even to untrained tasks.
This protocol will be applied to several acquired brain damage patients with
 executive/monitoring deficits. Baseline evaluation will take take around 5 sessions, The
 training phase will be done on 6 sessions and post-training evaluation will be completed on
 around 3 sessions. Each patient will be invited to be retested 8/10 weeks after completing
 the training, to evaluate long term effects (secondary outcome). The final number of
 participants enrolled in the study will depend on availability.

 The authors will use a single case A-B changing criterium design: Phase A constitutes the
 base line. Three ADL tasks will be performed by the participant without help, two of them
 will be treated on phase B and the other will not be trained. Each task will be evaluated 3/4
 times to obtain a robust baseline. Apart from ADL, other executive/monitoring measures will
 be obtained pre and post-training through neuropsychological screening.

 The level of monitoring difficulty will be increasing from one training session to the next,
 from level 1 (2 distractors/1 conflicting situation) to level 3 (8 distractors/4 conflicting
 situations). Baseline and post-training performance will be evaluated at level 3.The
 criterion to increase the level of monitoring requirements will be adjusted to each
 individual depending on his/her performance on the previous level. Therefore, only if a given
 participant reduces on at least 75% the amount of errors from initial evaluation on the
 present training session he/she will be confronted with the next level of difficulty on the
 next session. However, if the patient doesn't reach the criterium, the same level of
 monitoring will be repeated and trained on the following session.

 Outcomes measures (post-training phase) will be taken after completing 6 training sessions.
Inclusion Criteria:

 -  Presence of a chronic DCA (more than 3 months),

 -  Presence of cognitive deficits relative to executive/monitoring functions and/or
 memory evaluated by the team of professionals

 -  Age ≥ 18 years

 Exclusion Criteria:

 -  Visuoperceptual deficits

 -  Attentional neglect

 -  Severe motor or perceptual alterations that impede the realization of activities of
 daily life

 -  Alterations of verbal comprehension

 -  Severe memory disturbances