Visual Thinking Strategies, applied as treatment for people with chronic acquired brain injury.

Many people with chronic acquired brain injury suffer from executive function
deficits. They may be impulsive, have difficulty with initiating actions or
finding different solutions, or draw conclusions that are not supported by the
facts. Treatments for people with executive function deficits mainly aim at
teaching strategies to make plans, solve problems and keep working purposeful.
There is some evidence that this apporach leads to improvement on a practical
executive function task and on a questionnaire filled in by a proxy (Miotto
e.a. 2009)
Visual Thinking Strategies (VTS) is originally a method to teach children with
little experience with art to look at art longer and more intensive, in order
to improve esthetical growth. There is some evidence that VTS can improve
critical thinking in children, also in domains other than art (Housen, 2002)
and that VTS makes medical students observe their patients more critically
during assessment (Naghshineh et al. 2008).
René ter Horst, psychologist in Rehabilitationcenter Amsterdam (RCA),
Department Acquired Brain Injury, wondered whether this method would improve
critical thinking in people who have a deficit in this area as a result of
brain damage. VTS was tried out as small part of a broader cognitive
rehabilitation program and seamed effective, but as it was not given in
isolation, its effect was difficult to investigate.

Investigate whether critical thinking of people with executive function
deficits as a result of brain damage can improve by VTS.

Cross-over design. There are two groups. One group is treated with VTS while
the second group has no treatment. Subsequently the second group is treated
with VTS and the first group has no treatment. Patients are assigned to one of
the groups at random.

VTS. Participants look at an object of art. They are asked three questions.
First they are asked: "What do you see on this painting?" Next: "You say (...),
what makes you say that?" And last: "What else can we find?" This way
participants learn to take time before responding and to base their
observations on evidence. As VTS is given in a group and participants observe
the paintings in different ways, they are thaught that more than one answer is
correct.

There are no risks attached to the treatment or the assessments. The
participant is asked to come to the rehabilitation center three times for
assessments (each time about one hour to one and a half hour) as well as for
treatment. Treatment involves four weeks twice a week a one hour treatment
session (i.e. eight treatment sessions in total).