Evaluation of a Compensatory Brain Game supporting Goal Management Training intervention targeting executive function after Acquired Brain Injury using single-case experimental design methodology

The main cognitive complaint in brain-injured patients is often the everyday
disorganization caused by executive function (EF) deficits. In order to
minimize the everyday disorganization, effective EF interventions are required.
Interventions which incorporate compensatory strategies have the potential to
enable patients to minimize disabilities, minimize participation problems and
to function more independently in daily life. A well-known evidence-based
intervention that incorporates compensatory strategies is Goal Management
Training (GMT). GMT entails learning and applying an algorithm, in which a
daily task is subdivided into multiple steps to handle executive difficulties
of planning, and problem solving. To adopt the GMT strategy and ensure maximal
profitability for patients, they have to learn to use the algorithm in
different situations and tasks. Therefore, GMT is a comprehensive,
time-consuming and thus labour-intensive treatment. Along with this, brain
games become increasingly attractive as an (add-on) intervention, most notably
in an effort to develop home-based personalized care. Until now, however, the
rationale behind brain games is based on what can be considered the restorative
approach (i.e. strengthening of executive problems) rather than practicing
compensatory strategies, with little or no transfer to improvements in daily
life functioning. This study therefore aims to assess the potential of a newly
developed Brain Game, based on compensatory strategies, as an add-on to GMT to
develop a shortened and partly home-based GMT intervention.

The primary objective of this study is to assess whether the use of a
compensatory brain game supported GMT treatment could be of interest in people
with EF deficits after ABI, to improve goal achievement, their executive
function performance during goal-related tasks, and their executive performance
during an ecological valid shopping task.

The study will be a multiple-baseline across individuals single-case
experimental design (SCED).

The investigational treatment is based on the standard GMT treatment, part of
the cognitive rehabilitation intervention at Klimmendaal that is used for ABI
patients with executive problems. The investigational treatment will include
GMT in combination with a compensatory brain game which allows the patient to
learn and apply the algorithm of GMT in a safe and controlled environment. This
means that the multiple steps of GMT will be learned during the treatment
sessions under guidance of a therapist as well as in their own home environment
by using the compensatory strategy game. The investigational GMT treatment will
consist of 6 treatment sessions given twice a week (with a total duration of 3
weeks).

The burden in the study consists of participating in repeated measurements,
therapy sessions, and homework assignments. All tests and methods that are used
are non-invasive and not stressful for the patient. All tests and tasks will be
based on widely-used validated and reliable paper-pencil or computer tasks.
Treatment is non-invasive and scarcely stressful: a therapist will always be
present and assess the patients burden and eventually take appropriate measures
such as inserting a resting break.