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Rehabilitation of Executive Functioning With Training in Attention Regulation Applied to Individually Defined Goals: A Pilot Study Bridging Theory, Assessment, and Treatment

Novakovic-Agopian, Tatjana PhD; Chen, Anthony J.-W. MD; Rome, Scott MD; Abrams, Gary MD; Castelli, Holli OTR/L; Rossi, Annemarie OTR/L; McKim, Ryan PsyD; Hills, Nancy PhD; D'Esposito, Mark MD

Journal of Head Trauma Rehabilitation: September/October 2011 - Volume 26 - Issue 5 - p 325–338
doi: 10.1097/HTR.0b013e3181f1ead2
Original Articles

Objective: To assess feasibility and effects of training in goal-oriented attentional self-regulation for patients with brain injury and chronic executive dysfunction.

Participants: Sixteen individuals with chronic brain injury and mild to moderate executive dysfunction.

Design: Participants were divided into 2 groups: one group completed goal-oriented attentional self-regulation training during the first 5 weeks, followed by a brief (2-hour) educational instruction session as a control midway through the second 5 weeks; the other group participated in reverse order.

Measures: Neuropsychological and functional performance assessed at baseline and at weeks 5 and 10.

Results: Participants found training in goal-oriented attentional self-regulation engaging, incorporated some trained strategies into daily life, and reported subjective improvements in personal functioning. At week 5, participants who completed goals training significantly improved on tests of attention and executive function and had fewer functional task failures, while performance did not change after educational instruction. At week 10, participants who crossed over from educational instruction to goals training also significantly improved on attention and executive function tests. Participants who crossed from goals training to educational instruction maintained their week 5 gains.

Conclusions: Training in goal-oriented attentional self-regulation is theoretically driven and feasible in a research setting. Pilot results suggest improvements in cognitive and functional domains targeted by the intervention.

Veteran's Administration Medical Center, San Francisco, California (Drs Novakovic-Agopian, Chen, Abrams, and McKim, and Ms Rossi); Veteran's Administration Northern California Health Care System, Martinez (Drs Novakovic-Agopian, Chen, and D'Esposito); California Pacific Regional Rehabilitation Center, San Francisco (Drs Novakovic-Agopian and Rome and Mss Castelli and Rossi); University of California, San Francisco (Drs Novakovic-Agopian, Chen, Abrams, and Hills); and University of California, Berkeley (Drs Chen and D'Esposito).

Corresponding Author: Tatjana Novakovic-Agopian, PhD, SFVA Medical Center, 4150 Clement St, Mail Code 127, San Francisco, CA 94121 (

* Dr Chen is the co–first author.

* This material is based upon the work supported by the Office of Research and Development Rehabilitation R&D Service Department of Veterans Affairs, and the California Pacific Medical Center Foundation.

* We thank participating patients and a number of individuals who made this study possible, in particular: Gary Turner, PhD, for helping with the development of the Goal Processing Questionnaire and advice; John Garfinkle, MS, CCC-SLP, for conducting functional evaluations; Sarah Ramsdale, OTR/L, for conducting therapy sessions; Cathy Kennedy, PT, and Byron Morgenroth, MS, for their invaluable help with organizing and managing the study at California Pacific Medical Center, and Deborah Binder for helping with editing portions of this manuscript. We are grateful to Brian Levine, PhD, Ian Robertson, PhD, and Tom Manly, PhD, for providing us with the Goal Management Training material and consultation during the research protocol development process, and to Kevin Barrows, MD, for use of his CD for mindfulness home practice.

* The authors declare no conflict of interest

© 2011 Lippincott Williams & Wilkins, Inc.