Incorporation of a working memory strategy in GMT to facilitate serial-order behaviour in brain-injured patients

Neuropsychol Rehabil. 2020 Jun;30(5):888-914. doi: 10.1080/09602011.2018.1517369. Epub 2018 Oct 1.


Goal Management Training (GMT) is an effective method for improving disorganised behaviour in multistep real-life tasks after brain damage. In the present study we incorporated Working Memory Training (WMT) in GMT to explore their combined efficacy in facilitating the serial-order maintenance of the steps that had to be learned. GMT+WMT was compared to a control WMT designed for other purposes. For this purpose 18 brain-injured patients (aged 20-54), who were at least 4 months post-onset, were randomly assigned to either the GMT+WMT or the WMT treatment. Inclusion was based on a baseline score of less than six correct steps on each of two multistep everyday tasks. Alternative versions of these tasks were used as primary outcome tasks. Pre-treatment and post-treatment comparisons of scores on these primary tasks and on several secondary neuropsychological measures were collected. The results show that post-treatment the GMT+WMT group performed significantly better than the WMT group on the primary outcome measures and on several ecologically valid executive tests that demanded a step-by-step maintenance of multiple actions. Time effects were found for both groups on the secondary measures. Other measures showed no significant differences. We conclude that our results support the efficacy of the combined GMT+WMT in facilitating performance in everyday multistep tasks.

Keywords: Daily executive dysfunction; Disorganised behaviour; Goal Management Training; Multistep activities of daily living; Updating subgoals; Working memory training.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Activities of Daily Living*
  • Adult
  • Behavior Therapy* / methods
  • Brain Injuries / rehabilitation*
  • Cognitive Remediation / methods
  • Executive Function* / physiology
  • Female
  • Goals*
  • Humans
  • Male
  • Memory, Short-Term* / physiology
  • Middle Aged
  • Outcome Assessment, Health Care
  • Serial Learning* / physiology
  • Young Adult