A Randomized Controlled Trial of Assisted Intention Monitoring for the Rehabilitation of Executive Impairments Following Acquired Brain Injury

Neurorehabil Neural Repair. 2017 Apr;31(4):323-333. doi: 10.1177/1545968316680484. Epub 2016 Dec 13.


Background: Acquired brain injury (ABI) can impair executive function, impeding planning and attainment of intentions. Research shows promise for some goal-management rehabilitation interventions. However, evidence that alerts assist monitoring and completion of day-to-day intentions is limited.

Objective: To examine the efficacy of brief goal-directed rehabilitation paired with periodic SMS text messages designed to enhance executive monitoring of intentions (assisted intention monitoring [AIM]).

Methods: A randomized, double-blind, controlled trial was conducted. Following a baseline phase, 74 people with ABI and executive problems were randomized to receive AIM or control (information and games) for 3 weeks (phase 1) before crossing over to either AIM or no intervention (phase 2). The primary outcome was change in composite score of proportion of daily intentions achieved. A total of 59 people (71% male; 46% traumatic brain injury) completed all study phases.

Results: Per protocol crossover analysis found a significant benefit of AIM for all intentions [ F(1, 56) = 4.28; P = .04; f = 0.28; 3.7% mean difference; 95% CI = 0.1%-7.4%] and all intentions excluding a proxy prospective memory task [ F(1, 55) = 4.79; P = .033; f = 0.28, medium effect size; 3% mean difference; 95% CI = 0.3%-5.6%] in the absence of significant changes on tests of executive functioning. Intention-to-treat analyses, comparing AIM against control at the end of phase 1 revealed no statistically significant differences in the attainment of intentions.

Conclusion: Combining brief executive rehabilitation with alerts may be effective for some in improving achievement of daily intentions, but further evaluation of clinical effectiveness and mechanisms is required.

Keywords: brain injuries; executive function; rehabilitation.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Brain Injuries / psychology*
  • Brain Injuries / rehabilitation*
  • Cell Phone
  • Cognitive Behavioral Therapy*
  • Cross-Over Studies
  • Double-Blind Method
  • Executive Function*
  • Female
  • Games, Experimental
  • Goals
  • Humans
  • Intention*
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Severity of Illness Index
  • Treatment Outcome