Simulation-based executive cognitive assessment and rehabilitation after traumatic frontal lobe injury: a case report.

Abstract

To investigate whether identifying specific deficits after brain injury can lead to a more focused and potentially effective cognitive rehabilitation technology. Cognitive simulation assessment was undertaken in a 47-year-old man with trauma-related prefrontal damage and persisting occupational and cognitive-behavioral difficulties at 15 months post brain injury. Results revealed significant difficulties in measured levels of activity, initiative, information utilization, response flexibility, and effective decision-making strategies which accorded well with his real-life complaints despite normal neuropsychological test scores. This profile of findings was then used to design a two-stage intervention program. The first stage focused on participant education and awareness about his simulation-based problem solving difficulties. In the second stage specific goals were formulated to improve problem solving impairments that were then the target of weekly training sessions using pertinent decision-making and problem-solving vignettes. A parallel version of the cognitive simulation assessment was undertaken post-cognitive training (3 months after initial assessment) and revealed significant improvements in targeted executive cognitive-behavioral areas. Results of this cognitive rehabilitation probe supported the feasibility and validity of undertaking a cognitive simulation approach to identify residual executive function deficits after traumatic brain injury, even with a normal neuropsychological test profile. Further studies are needed to establish the reliability, generalizability and maintenance of such gains.