Veterans Task Manager

ObjectiveWe tested Goal Management Training (GMT), which has been recommended as an executive training protocol that may improve the deficits in the complex tasks inherent in life role participation experienced by those with chronic mild traumatic brain injury and post-traumatic stress disease (mTBI/PTSD). We assessed, not only cognitive function, but also life role participation (quality of life).MethodsWe enrolled and treated 14 individuals and administered 10 GMT sessions in-person and provided the use of the Veterans Task Manager (VTM), a Smartphone App, which was designed to serve as a "practice-buddy" device to ensure translation of in-person learning to independent home and community practice of complex tasks. Pre-/post-treatment primary measure was the NIH Examiner, Unstructured Task. Secondary measures were as follows: Tower of London time to complete (cTOL), Community Reintegration of Service Members (CRIS) three subdomains [Extent of Participation; Limitations; Satisfaction of Life Role Participation (Satisfaction)]. We analyzed pre-post-treatment, t-test models to explore change, and generated descriptive statistics to inspect given individual patterns of change across measures.ResultsThere was statistically significant improvement for the NIH EXAMINER Unstructured Task (p < .02; effect size = .67) and cTOL (p < .01; effect size = .52. There was a statistically significant improvement for two CRIS subdomains: Extent of Participation (p < .01; effect size = .75; Limitations (p < .05; effect size = .59). Individuals varied in their treatment response, across measures.Conclusions and Clinical SignificanceIn Veterans with mTBI/PTSD in response to GMT and the VTM learning support buddy, there was significant improvement in executive cognition processes, sufficiently robust to produce significant improvement in community life role participation. The individual variations support need for precision neurorehabilitation. The positive results occurred in response to treatment advantages afforded by the content of the combined GMT and the employment of the VTM learning support buddy, with advantages including the following: manualized content of the GMT; incremental complex task difficulty; GMT structure and flexibility to incorporate individualized functional goals; and the VTM capability of ensuring translation of in-person instruction to home and community practice, solidifying newly learned executive cognitive processes. Study results support future study, including a potential randomized controlled trial, the manualized GMT and availability of the VTM to ensure future clinical deployment of treatment, as warranted.

Research Objectives To investigate whether Goal Management Training (GMT) combined with attention drill training improves executive function over GMT alone. Design Quasi-experimental two group comparison, before and after. Setting Veterans' Administration Outpatient Rehabilitation. Participants Veterans with blast-related mild Traumatic Brain Injury (mTBI) previously enrolled to GMT only treatment (n=7) were compared to Veterans with blast-related mTBI treated with GMT plus attention drill training (n=8). Interventions GMT is a metacognitive group intervention, presented in 10-weekly, 2-hour PowerPoint interactive sessions. GMT combined with attention drill training included GMT with 10 additional, 2-hour sessions employing three different types of additional attention training: (1) Attention Process Training version-III; (2) use of a Smartphone application called the Veterans' Task Manager to set functional attention goals in a naturalistic setting; and (3) Brain HQ attention tasks 2-3 hours per week. Main Outcome Measures Executive Composite Score of the National Institutes of Health Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research (NIH EXAMINER). Results GMT alone did not result in a significant pre-/post treatment improvement (p=0.44: effect size 0.12) according to the NIH EXAMINER Executive Composite Score. However, GMT plus attention drill training resulted in a significant improvement with a large Cohen's d effect size (p=.006; effect size?=?2.23) and had a significantly greater improvement than GMT alone (p=.01). Conclusions The addition of attention drill training to GMT significantly improved overall executive function over GMT alone. In a meta-analysis of GMT, effect size was related to the number of sessions (Strenova, 2019), supporting our large effect size findings with the addition of attention training sessions to GMT. A randomized control study is needed to determine whether GMT plus attention drill training improves functioning over GMT alone.