What is the Effect of Personalized Cognitive Strategy Instruction on Facilitating Return-to-Learn for Individuals Experiencing Prolonged Concussion Symptoms?

Abstract

Experimental and retrospective research has suggested the treatment components of psychoeducation and cognitive strategy instruction show promise to treating individuals with cognitive deficits following mild to severe traumatic brain injury; however, there is lacking experimental evidence to support these interventions for the treatment of adolescents with prolonged concussion symptoms (PCS). The purpose of this study aimed to address the knowledge gap of adolescent PCS treatment by evaluating the degree to which the implementation of personalized cognitive strategy instruction assisted students to achieve functional and academic-related goals. This study utilized a single case experimental design (SCED) to investigate the effect of personalized cognitive strategy instruction on facilitating the achievement of functional goals. A noncurrent, multiple-baseline design was used across three female, adolescent participants ages 13-16. The primary measurement analyzed to determine the existence of a functional relation between the addition of personalized cognitive strategy instruction to psychoeducation and the achievement of participant outcome was the weekly status tracking measurement of participant performance corresponding to their treatment goal. Three pre/post outcome measurements were additionally administered at three separate time points. Selected responses to the first administration assisted in the treatment selection process, and these selected responses were compared across the three collection points to determine if positive change was achieved with the implementation of personalized cognitive strategy instruction. Visual analysis of the plotted status tracking data did not support the existence of a functional relation as there was not a demonstration of an effect across three points in time. Further, a Tau-U analysis obtained a small treatment effect size, while the obtained multilevel modeling (MLM) effect size was not significant. However, it is noteworthy that two participants did demonstrate a treatment response, and all three participants achieved their treatment goal suggesting the potential viability of the intervention. I discuss the results in terms of the emergence of three response profiles as well as the benefits and challenges to the types of measurements collected. I provide further discussion on contextual and methodological limitations to the study and provide future steps to improve design methodology.