Cook et al. (2014)

USA

RCT

PEDro=7

N=20

Population: TBI; Strategic Memory Advanced Reasoning Training (SMART, n=10): Mean Age=15.4yr; Gender: Male=6, Female=4; Mean Time Post-Injury=4.9yr; Severity: Mild=6, Moderate=1, Severe=3. Memory Group (n=10): Mean Age=15.2yr; Gender: Male=7, Female=3; Mean Time Post-Injury=3.2yr; Severity: Mild=4, Moderate=2, Severe=4.

Intervention: Participants were randomly assigned to one of two interventions; the SMART group which focused on gist (top-down) reasoning training, or the Memory group which was based on bottom-up memory training. Both training groups had 8 sessions of 45 min over 1 mo.

Outcome Measure: Test of Strategic Learning (TOSL), Wechsler Abbreviated Scales of Intelligence (WASI), Behavior Rating Inventory of Executive Function (BRIEF), Digit Span subtest, Letter-Number Sequencing subtest.

1.       There were no significant gains or differences between groups in working memory. However, upon closer inspection, SMART participants outperformed the Memory group on the Letter-Number Sequencing test (p=0.005).

2.       The Memory group was rated as making a significant improvement according to parents’ rating on the BRIEF test (p=0.008).

3.       The SMART group significantly outperformed the Memory group on abstract meaning (TOSL) (p=0.006).

4.       Furthermore, the SMART group demonstrated significant improvements on TOSL in interpretative statements from baseline (p=0.042) whilst the Memory group did not, but no significant difference was observed between the two groups.

Braga et al. (2012)

Brazil

RCT

PEDro=6

N=29

Population: ABI; Metacognitive Dimension Program (MCD; N=14): Mean Age=10.3yr; Gender: Male=9, Female=5; Mean Time Post-Injury=5.5yr; Mean GCS=9.4. Controls (N=15): Mean Age=10.5yr; Gender: Male=12, Female=3; Mean Time Post-Injury=5.1yr; Mean GCS=9.1.

Intervention: Patients randomized to the MCD were paired with psychology students and worked in pairs or small groups to plan and execute art, physical activities, and games utilizing mediational strategies and cooperative learning. The control group continued to be treated according to family-based treatment guidelines. The MCD was provided 2 days/wk for a total of 26 sessions over 3 mo. Assessments were conducted at baseline and post-treatment.

Outcome Measure: Self-Concept Scale for Children (SCSC), Behavioral Rating Inventory of Executive Functions (BRIEF), Evaluation Scale of Elementary School Learning Strategies (ESESLS).

1.       The MCD group scored significantly higher on the SCSC and on the ESESLS post-treatment compared to the control group (p=0.043 and 0.033, respectively).

2.       The ESESLS Metacognitive and Absence of Dysfunctional Strategies subscales were both significantly greater for the MDC group (both p=0.003) but no difference was found between the MDC and control group for the Cognitive Strategies subscale (p=0.660).

3.       The MCD group performed better on parents’ BRIEF scores at baseline and post-treatment but there were no significant difference between groups (no p-values given).

Chan & Fong (2011)

Hong Kong

RCT

PEDro=5

N=32

Population: ABI: TBI=21, Tumour=6, Arteriovenous Malformation=5; Experimental Group (n=16): Mean Age=12.0yr; Gender: Male=11, Female=5; Mean Time Post Injury=3.3yr; Severity: Moderate-Severe=16. Controls (n=16): Mean Age=12.8yr; Gender: Male=9, Female=7; Mean Time Post Injury=3.9yr; Severity: Moderate-Severe=16.

Intervention: Patients participated in a modified problem-solving skills program for 2 days/wk over 7 wk with each session lasting 3 hr. The program consisted of problem-solving heuristics such as thinking aloud, mind-maps, categorization, visual imagery, creative thinking, comparison techniques, and self-evaluation. Assessments were completed at baseline and at post-intervention.

Outcome Measure: Behavior Rating Inventory of Executive Function (BRIEF), Canadian Occupational Performance Measure (COPM), Test of Nonverbal Intelligence-3 (TONI-3), Metacomponential Interview (MI), Interpersonal Negotiation Strategies Interview (INSI).

1.       The experimental group demonstrated a significantly greater improvement in BRIEF and TONI-3 scores (both p<0.000), and on all INSI and COPM measures (all p<0.000) scores at the end of treatment compared to the controls.

2.       Patients in the experimental group also improved to a significantly greater degree on all MI components (all p<0.008) at the end of treatment compared to controls except for the average level of prompting for the Planning component (p=0.390).

Treble-Barna et al. (2016)

USA

PCT

N=24

Population: TBI=13, Healthy Controls=11; TBI Group: Mean Age=13.11yr; Gender: Male=4, Female=9; Mean Time Post-Injury=5.2yr; Severity: Mild=5, Moderate=2, Severe=6. Healthy Controls: Mean Age=13.37yr; Gender: Male=4, Female=7.

Intervention: TBI participants underwent the Attention Improvement and Management program (AIM) combining metacognitive strategy training and attention tasks for approximately 18 wk. Outcomes were assessed at pre and post intervention.

Outcome Measure: The Test of Everyday Attention for Children (TEA-Ch), Delis–Kaplan Executive Function System (D-KEFS), and The Behavior Rating Inventory of Executive Function (BRIEF).

1.       There was no significant difference between groups from pre to post for Sky Search score or walk/don’t walk subscales (all p>0.050) of TEA-Ch; however, the TBI group improved significantly from pre to post treatment compared to the healthy controls on the TEA-Ch code transmission (p=0.014).

2.       There was no significant difference between groups from pre to post in any components of the D-KEFS (all p≥0.157) or in child reported BRIEF (all p≥0.095).

3.       All components of the parent reported BRIEF of the TBI group from pre to post improved significantly compared to healthy controls (all p≤0.001).

Krasny-Pacini et al. (2014)

France

Pre-Post

N_I=5, N_F=4

Population: TBI; Gender: Male=3, Female=2; Mean Age=4.8yr; Mean Time Post-Injury=6.8yr; Mean GCS=5.2.

Intervention: Patients participated in a novel goal-management training intervention with emphasis on the patient’s social network to assist in ‘coaching’. Assessments were completed before and after intervention.

Outcome Measure: Children’s Cooking Task (CCT), Behavior Rating Inventory of Executive Function (BRIEF), Dysexecutive Questionnaire for Children (DEX-C).

1.       3 of the 4 children made improvements on the CCT with the remaining 1 child making more errors.

2.       DEX-C scores decreased for 3 out of the 4 children indicating a reduction in executive dysfunction with continual reductions up to 6mo follow-up for 2 children (large effect sizes of 2.33 and 1.33 for each).

3.       Parental BRIEF scores indicated a reduction in executive dysfunction in 3 children. However, teacher BRIEF scores were stable for 2 children and unreliable for the other 2.

Missiuna et al. (2010)

Canada

Pre-Post

N=6

Population: TBI; Mean Age at Injury=10.53yr; Gender: Male=5, Female=1; Time Since Injury=10.5mo; Severity: Moderate.

Intervention: All participants received the CO-OP intervention consisting of 10 individualized 1 hr sessions provided 1 x/wk by an occupational therapist focusing on executive function. Outcomes were assessed at baseline, post intervention and 4mo follow-up.

Outcome Measure: Canadian Occupational Performance Measure (COPM), Performance Quality Rating Scale (PQRS), and Vineland Adaptive Behavior Scales (VABS).

1.       There was a significant improvement in parent report COPM scores in all categories (performance, satisfaction, PQRS) from baseline to post intervention and 4mo follow-up (all p<0.010).

2.       There was a significant improvement in all VABS scores, Composite (p<0.010), Communication (p<0.010), Activities of Daily Living (p<0.010) and Social (p<0.050) from baseline to post intervention and 4mo follow-up.

Catroppa et al. (2009)

Australia

Pre-Post

N=3

Population: TBI; Mean Age at Injury=10.39yr; Gender: Male=2, Female=1; Time Since Injury=8.64yr; Mean GCS=8.33.

Intervention: All participants underwent six 1 hr sessions 1 x/wk with content consisting of cognitive behavioural and psycho-educational approaches to develop executive functioning skills.

Outcome Measure: Color-Word Trial 4 time Taken, Color Word Total errors, Trails number-letter time taken, Rey Copy–organization, Tower Test–total achievement, Party Planning Task % total errors, Behaviour Rating Inventory of Executive Function (BRIEF), Sydney Psychosocial Reintegration Scale (SPRS), Adaptive Behaviour Assessment System (ABAS).

Case #1

1.       Participant made 60% errors on the party planning task pre-intervention which reduced to 38% post-intervention (p<0.050).

2.       Participant increased ABAS score from 88 to 101 from pre to post intervention and SPRS score from 54 to 68 (all p<0.050).

3.       There was a significant reduction in BRIEF-Behavioural Regulation Index (p<0.050).

4.       All other outcome measures were not significant (p>0.050).

Case #2

1.       There was a significant difference in colour word total errors from pre to post intervention (p<0.050).

2.       All components of the BRIEF were significantly reduced (p<0.050).

3.       All other outcome measures were not significant (p>0.050).

Case #3

1.       There was a significant difference in colour word total errors from pre to post intervention (p<0.05).

2.       All other outcome measures were not significant (p>0.050).

Suzman et al. (1997)

USA

Pre-Post

N=5

Population: ABI: TBI=4, Arteriovenous Malformation=1; Mean Age=8.2yr; Gender: Male=3, Female=2; Time Post Injury=3-9mo; Mean GCS=7.7.

Intervention: Patients participated in a multi-component cognitive-behavioural treatment programme that included self-instruction and self-regulation, metacognition training, attribution training and reinforcement through a token economy. Each session lasted 40 min and was provided 3 days/wk. Patients were assessed at baseline and at post-treatment.

Outcome Measure: Performance on computerised problem-solving task, Rey-Osterreith Complex Figure (ROCF), Porteus Maze Test (PMT), Wisconsin Card Sorting Test (WCST), Word Fluency Test (WFT), Social Validity 10-point Scale Questionnaire.

1.       All patients demonstrated a decrease in errors performed on the computerised problem-solving task. Errors ranged from 75-100% at baseline and decreased to 11-56% at post-treatment.

2.       Significant improvement was revealed from baseline to post-treatment on the ROCF and the WFT (both p<0.040) but not on the PMT (p=0.340) and WCST (p=0.060).

3.       The average ratings for perceived improvement, enjoyment, continued use of problem solving skills, and recommendation of the program were 8.4, 8.9, 7.6 and 9.3 out of 10 respectively among patients, teachers and parents on the social validity questionnaire.