Incorporation of a working memory strategy in GMT tofacilitate serial-order behaviour in brain-injured patients

Abstract

Goal Management Training (GMT) is an effective method for improving disorganisedbehaviour in multistep real-life tasks after brain damage. In the present study weincorporated Working Memory Training (WMT) in GMT to explore their combinedefficacy in facilitating the serial-order maintenance of the steps that had to belearned. GMT+WMT was compared to a control WMT designed for other purposes.For this purpose 18 brain-injured patients (aged 20–54), who were at least 4 monthspost-onset, were randomly assigned to either the GMT+WMT or the WMTtreatment. Inclusion was based on a baseline score of less than six correct steps oneach of two multistep everyday tasks. Alternative versions of these tasks were usedas primary outcome tasks. Pre-treatment and post-treatment comparisons of scoreson these primary tasks and on several secondary neuropsychological measures werecollected. The results show that post-treatment the GMT+WMT group performedsignificantly better than the WMT group on the primary outcome measures and onseveral ecologically valid executive tests that demanded a step-by-stepmaintenance of multiple actions. Time effects were found for both groups on thesecondary measures. Other measures showed no significant differences. Weconclude that our results support the efficacy of the combined GMT+WMT infacilitating performance in everyday multistep tasks.