Strategy game supporting goal management training intervention

Executive function impairments are one of the most persistent and disruptive consequences of acquired brain injury (ABI), causing significant disabilities in maintaining efficient and independent functioning in daily-life, especially in novel, complex or demanding situations. Goal management training (GMT) is a successful treatment for these impairments and helps maintaining intentions in goal-directed behaviour to structure activities in daily life. GMT entails learning and applying a strategy, in which a daily task is subdivided into multiple steps to handle executive function problems in planning, and goal-directed behaviour. Patients are taught compensatory strategies not to strengthen the executive functions, but to enable them to minimize disabilities and participation problems and to function more independently in daily life. To adopt the GMT strategy and ensure maximal profitability for patients, they have to learn to use the strategy in different situations and tasks, which requires a comprehensive, time-consuming and thus labour-intensive treatment. Along with this, serious games become increasingly attractive as an (add-on) intervention, most notably in an effort to develop home-based personalized care, and because of their machine learning algorithms which tailors the game to the level of the individual player. Until now, however, the rationale behind serious games is based on what can be considered the restorative approach (i.e. strengthening of executive problems) rather than practicing compensatory strategies, with no or little transfer to real-life situations. The present study fills a gap in the literature by combining GMT with a treatment supporting compensatory strategy game, and focusing on transfer of treatment effects to everyday functioning. If the strategy game supported GMT treatment proves to be effective, this may contribute to a shortened evidence based treatment for executive problems.

We expect that the experimental treatment (shortened GMT along with a cognitive strategy game) and control treatment (standard GMT) are equal in effect.

T0 (baseline), T1 (post-treatment), T2 (follow-up)

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 strategy 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 the 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. In standard GMT patients will learn to use the algorithm and the performance of IADL tasks during the treatment sessions and with paper and pencil tasks. The investigational GMT treatment will consist of 7 sessions (max. 60 minutes), whereas the standard GMT treatment consists of 9 sessions. Both types of GMT will be given once a week.