Research Program

Research Project 2: Improving Executive Functions after TBI - A Randomized Clinical Trial of the "Executive Plus" Program

Overview

R2 compares a standard day treatment program with the "Executive Plus" program; the latter emphasizes training of attention, emotional self-regulation and problem solving. The goal of the Executive Plus program is to maximize executive functioning, as well as the long-term outcomes of community participation and satisfaction with daily life.

Goals

• Demonstrate the efficacy of Executive Plus in comparison with a standard comprehensive day treatment rehabilitation program in improving executive function and other related areas of functioning (e.g., work and community participation, life satisfaction).
• Explore characteristics of participants that predict greater or lesser benefit from the Executive Plus program.
• Maximize potential application to clinical practice by:
  • Implementing the Executive Plus program in a clinical context so that its utility is demonstrated in a setting that maximizes ecological validity.
  • Creating and disseminating a treatment manual detailing the Executive Plus program.

R2 is a randomized clinical trial comparing two approaches to post-TBI comprehensive day treatment. Executive Plus offers systematic treatment of post-TBI executive function deficits, through a focus on problem solving and emotional self-regulation, as well as systematic treatment of post-TBI attention deficits. It relies on modular, contextual, and embedded approaches to treatment. It is being compared to Mount Sinai's currently operating day treatment program. The 26-week programs are running concurrently and potential participants are randomly assigned to Executive Plus or the standard program, using rolling admissions. Program staffs are separate, and research assistants blind to participants' assigned program will implement all assessments. Outcomes are assessed using measures that focus on functioning within cognitive domains, across domains and in everyday life, and that assess long-term outcomes. Detailed manuals have been developed to guide the implementation of each program's operation. Assuming positive results, the manual for the Executive Plus program will be disseminated to professionals, through training workshops and via the RRTC Web site.