Abstract:
While the concept of using patients' stated goals to determine treatment strategies in neuropsy-chological treatment programs is widely accepted in principle, in practice such "holistic" programs often lack the sensitivity or ability to achieve this. This issue becomes acute as the patients' cognitive deficits interact with goal setting process. Treatment designed predominantly from the professional's perspective can be reviewed by the consumer as irrelevant with resultant poor treatment compliance and premature termination of services.
Value-Driven Cognitive Rehabilitation (VCDR) is a proposed clinical intervention which is hypothesized to improve cognitive remediation programs by allowing for a systematic incorporation of patients' value rankings on life activities (cf. preceding Project R3) into the treatment planning process. This proposed methodology will allow participants to provide evaluative input to goals that are, in turn, linked to outcome domains requiring differential rehabilitation interventions. The domains in this study will be: cognitive/reeducation; productivity/employment, community/self care; and psychosocial.
Objectives
The general objectives of this study are to improve the delivery of cognitive remediation within a comprehensive outpatient TBI treatment center by incorporating client selection and evaluation of desired outcomes. We will evaluate the efficacy of VDCR in contrast to "traditional" holistic cognitive remediation (HCR) programs.
Hypotheses. Patients in VDCR will report greater satisfaction with their rehabilitation program as compared to HCR. They will demonstrate a lower rate of premature dropout, and report a higher percentage of goal attainment than patients in HCR. We will also compare objective functional and community integration outcomes between the experimental VDCR and control HCR groups.
Methods
Design. Randomized pre-post experimental design. Persons with TBI are randomly assigned to a comprehensive, holistic cognitive remediation program or to VCDR.
Sample. 60 Ss are being drawn (30 in each group) from referrals to KIR Cognitive Remediation Program.