Effects of interactive strategy modelling training on problem-solving by persons with traumatic brain injury

Background: Problem-solving skills may be affected by traumatic brain injury (TBI). Because the ability to solve problems is integral to the social, educational, and vocational reintegration of persons who have sustained a TBI, interventions to improve this executive function have become an important part of rehabilitation. Aims: This Phase I study examined the effects of a behavioural intervention, interactive strategy modelling training (ISMT), on problem solving by individuals who had incurred a TBI. Methods & Procedures: Study participants were 20 individuals recruited from TBI support groups. All lived at home and were several months post-injury. Participants received a period of ISMT intended to train them to use meta-cognitive strategies to solve 20-questions problems. RAPS (Rapid Assessment of Problem Solving), a clinical test of problem solving was used to assess the effects of ISMT (Marshall, Karow, Morelli, Iden, & Dixon, 2003a). RAPS was administered before (Pre-training), after (Post-training), and 1-month after training (Follow-up). Outcomes & Results: Participants improved in problem solving significantly on RAPS from the Pre- to the Post-training tests. Specifically, they (a) solved problems with fewer questions, (b) asked more constraint-seeking questions, and (c) increased their question-asking efficiency scores. These improvements were maintained on the Follow-up test. Conclusions: Improved problem solving on RAPS was associated with better planning and strategy use, less impulsivity, and strategy shifting. Results suggest that IMST had a therapeutic effect and indicate a need to develop further hypotheses for testing ISMT in functional contexts.