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Section III: Theories Supporting the Orientation and Training Protocols

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Deficits in executive and memory functions are not uncommon following an acquired brain injury and frequently affect an individual’s level of independence in simple and complex activities of daily living in home and community. As noted in the American Congress of Rehabilitation, Cognitive Rehabilitation Manual, First Edition, the term executive functions refers to integrative cognitive processes which allow the individual to formulate goals, solve problems, anticipate the consequences of actions, plan, initiate and organize behavior, self-monitor, and adapt behavior.  The term memory refers to a complex system of skills beginning with alertness and arousal, sustained, alternating, divided attention and concentration, encoding, storage, and retrieval. Because of memory and executive function impairments, TBI specific training methods, which accommodate these impairments, are necessary to improve the level of engagement and participation, leading to goal attainment and enhanced quality of life. 

Notes from Lance that I need to revisit: 

I think we need a brief section on why we need this section, i.e., because of memory and executive function impairments, we need TBI-specific training methods that accommodate the cognitive consequences that will improve engagement and success.  Also, very brief discussion of types of common memory impairment, preservation of procedural learning and memory

When memory deficits exits, an individual may forget how he/she was functioning, for example, a week ago and as compared to present day, forget concerns, needs, and questions to take to health care professionals, demonstrate an inability to integrate information gained from multiple providers, across multiple, complex systems, and forget prescribed action steps, strategies, and treatment recommendations.

Notes from Lance I need to revisit:  add a little more on types of common executive function impairments and effect on learning, memory and impact on utilization of clinical surveillance

With executive function deficits, such as reduced planning, self-monitoring and goal setting, the treatment team and participant need to connect the reason for using MyBrain to participant’s goals. Participant’s views, needs, and priorities are integrated into the tailoring of the self-management interventions and strategies. Note below, in Section IV – Training, there are specific guidelines designed to enhance collaboration and participant engagement. Participant, caregiver, and care team member participate in goal setting, self-monitoring, treatment, goal adjustment, and plan modification. 

To facilitate utilization of MyBRAIN, participants need:

  • a structured, specific approach to learning MyBRAIN to incorporate use into daily life
  • cueing and prompted assessments for objective measures
  • consistent feedback regarding assessment scores, linked to interventions and a treatment plan, linked to progress, and generalized to assist the individual achieve an improved sense of self-efficacy and positive self-concept

Psychological Issues, Awareness, Coping and Adjustment 

Awareness deficits may exist due:

  • to neurocognitive factors -the location and extent of injury,  
  • psychological factors such as perceived threats to ego/identity, 
  • and social/environmental factors such as reduced desire to have deficits exposed to others (family, friends, or in public settings).  

Limited awareness affects a participant’s expectations, goal setting, engagement, relationship with care team, and functional outcomes. Therefore, the care team needs an approach that initiates, fosters, and sustains a therapeutic alliance.  A positive and trusting therapeutic relationship can reduce anxieties and distress, set the stage for safe learning, inspire collaboration, engender hope, and facilitate client engagement and active participation in assessments and care planning via clinical surveillance methods, all supporting  progress. 

Notes from Lance I need to revisit: And a statement on impact on utilization of clinical surveillance

MyBRAIN and MyBRAIN Now offer participants an increased sense of control via self-management strategy usage. Participant collaboration w/the care team influences the assessment schedule and self-management strategies, as well as care team follow-up, all while participants try out and adjust to new ways of accomplishing tasks. 

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