This article was downloaded by: University College London

On: 14 Aug 2018

Access details: subscription number 11237
Publisher:Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: 5 Howick Place, London SW1P 1WG, UK

Neuropsychological Rehabilitation
The International Handbook
Barbara A. Wilson, Jill Winegardner, Caroline M. van Heugten, Tamara
Ownsworth

Goal Setting in Rehabilitation

Publication details
https://www.routledgehandbooks.com/doi/10.4324/9781315629537.ch5
Jonathan J. Evans, Agata Krasny-Pacini
Published online on: 20 Jun 2017

How to cite :- Jonathan J. Evans, Agata Krasny-Pacini. 20 Jun 2017 ,Goal Setting in Rehabilitation
from: Neuropsychological Rehabilitation,The International Handbook Routledge.
Accessed on: 14 Aug 2018
https://www.routledgehandbooks.com/doi/10.4324/9781315629537.ch5

PLEASE SCROLL DOWN FOR DOCUMENT

Full terms and conditions of use: https://www.routledgehandbooks.com/legal-notices/terms.

This Document PDF may be used for research, teaching and private study purposes. Any substantial or systematic reproductions,
re-distribution, re-selling, loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden.

The publisher does not give any warranty express or implied or make any representation that the contents will be complete or
accurate or up to date. The publisher shall not be liable for an loss, actions, claims, proceedings, demand or costs or damages
whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.
Downloaded By: University College London At: 22:52 14 Aug 2018; For: 9781315629537, chapter5, 10.4324/9781315629537

5
GOAL SETTING IN
REHABILITATION
Jonathan J. Evans and Agata Krasny-Pacini

Introduction
Goal setting, or goal planning, is a core component of most rehabilitation services, including
neuropsychological rehabilitation programmes. A recent survey of 437 community-based stroke
rehabilitation services in the UK found that 91 per cent of services reported using goal setting with
most or all of their clients (Scobbie et al., 2015) and others have found similar high levels of use of
goal setting in neurorehabilitation services (Holliday et al., 2005; Pagan et al., 2015). Goal setting, as
used in rehabilitation services, can be broadly and simply defined as a process by which the goals to
be achieved during a rehabilitation programme are established. However, it is clear from many
reviews, surveys and commentaries that the actual process by which goals are set, how they are used
during a rehabilitation programme, and how progress towards goal achievement is monitored varies
widely among services (Playford et al., 2009; Scobbie et al., 2015; Wade, 2009). This chapter will
begin with a brief review of why goal setting is important in neuropsychological rehabilitation. It
goes on to outline the core components of goal setting and how they are implemented. Several
common issues that present challenges for rehabilitation teams are highlighted, with potential
solutions offered.

Why set goals?

In some areas of medicine the goal of treatment is simple – to be free of disease or illness. A person
with a bacterial infection is treated with antibiotics and the infection goes away. There is no real need
for the doctor to address how someone is functioning in everyday life – the person simply returns to
his or her usual activities once the period of illness is over. But in many areas of medicine and
psychology, including rehabilitation, and particularly neuropsychological rehabilitation, people have
conditions that are chronic – they have some form of impairment that is permanent, which may
impact on their functioning in many different aspects of their life. In this situation the goal of
treatment is not for a person to be free of the impairment. Instead, the goal of rehabilitation is to
maximise the person’s ability to participate in activities that are valued by that individual and to
maximise well-being despite the presence of some form of impairment (Hart and Evans, 2006). If we
accept this broad definition of rehabilitation, then we accept that the goals of a rehabilitation
programme will depend on what is valued by the individual being treated. This means that treatment

49
Downloaded By: University College London At: 22:52 14 Aug 2018; For: 9781315629537, chapter5, 10.4324/9781315629537
Jonathan J. Evans and Agata Krasny-Pacini

goals will be individual to each person – goals will vary even in people with the same impairment.
Hence one reason for setting rehabilitation goals is simply so that everyone (i.e. the client, his/her
family, the rehabilitation team, and whoever is funding the rehabilitation programme) is clear about
the aim of the rehabilitation intervention. Thus, at the most basic level, setting goals serves an
administrative purpose: clients know whether they got what they wanted from the service; the
rehabilitation team knows whether they have succeeded in their task; and hospital managers, insurers,
and so on, know whether their funding has achieved what was intended.
But the purpose of setting goals is not just administrative. Goal setting has a long history in the
worlds of business and sport, where its purpose is to increase productivity and performance
respectively. Locke and Latham (2002) summarised findings from more than 30 years of studies of
goal setting, principally in commerce, education and sport. They concluded that there is strong
evidence that goal setting improves performance. They suggested that goals serve a directive function,
directing attention towards goal-relevant activities and away from goal-irrelevant activities. Goals
have an energising effect, affect persistence, and are thought to lead to the discovery and use of task-
relevant knowledge and strategies. So goals serve a motivational function, meaning more is achieved
than if goals are not set. Self-regulation theorists (Carver and Scheier, 1990) have suggested that
behaviour can be seen as a dynamic process of moving towards goals, and away from threats, with
faster than expected progress towards goals leading to positive affect, slower than expected progress
leading to negative affect, and expected progress being associated with neutral affect. Accomplishment
is also a component of Seligman’s PERMA model of well-being (Seligman, 2011), which defines
well-being as arising from Positive emotion, Engagement, positive Relationships, Meaning and
Accomplishment. In terms of engagement, Csikszentmihályi’s (1990) concept of ‘flow’ refers to a
state of engagement in which a person is using his/her character strengths to meet the demands of an
activity that has clear goals and is challenging, but within the ability of the person to achieve.
So, goal setting may be used to motivate people to achieve more than they would without goals
being set, leading to greater engagement and accomplishment, hence increasing well-being.
An important question in rehabilitation in relation to the motivational aspect of goal setting is
whose goals are they? Who are we aiming to motivate to achieve more? It may be that the goals
relate to what a client will be able to do, but one might argue, using a business analogy, that the
rehabilitation client is the ‘product’ and the rehabilitation team are the workers who we want to be
more productive. But of course rehabilitation is not a one-way process of a team ‘rehabilitating’ the
client. It is a dynamic, interactive process that relies on the collaboration of the rehabilitation team
and client (and family and others) to achieve the desired outcomes. Hence we might argue that goal
setting serves a motivating, directive function for both the rehabilitation team and the client. For
people with cognitive impairment there are many reasons why it may be difficult to self-motivate,
self-direct and self-regulate and therefore a goal-setting process might contribute to motivation and
help people stay focused on achieving the things they want to achieve. Deficits in executive function
may mean that it is difficult to spontaneously formulate goals and monitor progress towards goals;
difficulties with memory may impair the ability to remember personal goals and intentions; deficits
in awareness may make it difficult to identify realistic goals or appreciate what needs to be done in
order to achieve goals; and difficulties with affect and emotional regulation may impact a person’s
ability to feel a sense of energy or drive towards achieving goals. Hence a goal-setting process that
supports a client to identify and remember personally relevant goals, to monitor progress and to
record success in achieving goals would seem to be an important feature of the rehabilitation process.
But the other partner in the rehabilitation process is the rehabilitation team. Here too one might
argue that the motivating effect of clearly defined goals, with regular feedback on progress and the
opportunity to contribute to achievement of the client’s goals, could also have a motivating effect for
team members.

50
Downloaded By: University College London At: 22:52 14 Aug 2018; For: 9781315629537, chapter5, 10.4324/9781315629537
Goal setting in rehabilitation

Core components of goal setting in neuropsychological rehabilitation

Wilson and colleagues (2009) set out the process of goal setting used in a comprehensive
neuropsychological rehabilitation programme, noting that their approach is consistent with that of
Houts and Scott (1975) and McMillan and Sparkes (1999). These accounts are also broadly consistent
with the Goal setting and Action Planning (G-AP) framework of Scobbie and colleagues (Scobbie et
al., 2011, 2013), which includes processes of goal negotiation, goal setting, action planning,
developing coping plans, appraisal and feedback. The G-AP framework is adopted here as it provides
a helpful structure for thinking about the various stages of goal setting and goal review in rehabilitation.

Goal negotiation
Prescott et al. (2015) conducted a comprehensive review of goal setting in the acquired brain injury
rehabilitation literature to identify the approaches used and the key practice principles. They
identified 62 studies describing a goal-setting approach and 24 studies that evaluated goal setting in
some way. The two most commonly stated principles were that the process should be collaborative
(involve the client in setting the goals) and client-centred (focus on goals relevant and important to
the client to promote ownership). The argument that, wherever feasible, the client should be
involved in setting goals is overwhelming. If we are to use goal setting as a means of motivating a
client to achieve the most from rehabilitation, then it follows that the goals set need to be as relevant
and meaningful to the client as possible. It makes sense that this is more likely to be the case if the
client sets, or contributes very significantly to, the goals. Holliday et al. (2007) examined the impact
of increased participation in goal setting compared with usual practice. In usual practice, goals were
discussed by rehabilitation team members and patients during an assessment week, but goals would
then be set by the team in the absence of the patient. The new procedure involved providing patients
about to attend a rehabilitation programme with a workbook that introduced goal setting and invited
the patient to begin to identify priority areas and possible goals. These were then discussed in an
interview with a key worker. There was then a goal-setting meeting, which provided an opportunity
for therapists to discuss with patients the projected outcome and the reasons for this and then support
the patient to set realistic goals. A long-term goal would be set that specified the patient’s anticipated
level of performance at discharge and a set of short-term goals that were expected to lead to the long-
term goal. These short-term goals were reset on two- or three-week cycles.
Holliday et al. (2007) found that compared to usual practice, enhanced patient involvement
resulted in greater perceived autonomy in the rehabilitation process. In addition, goals were more
likely to relate to participation in important life areas (i.e. be at the ‘participation’ level of the World
Health Organization International Classification of Functioning [ICF]), which in turn meant that
goals were perceived as more personally relevant. The number of goals achieved did not differ
between the two methods. Other studies, however, have found that goal-setting methods that
increase patient participation have led to greater goal achievement – Webb and Glueckauf (1994)
found significantly higher levels of goal attainment for a group with higher involvement in goal
setting. Holliday et al. (2007) noted that their patients had relatively mild cognitive deficits, so their
results may not generalise to all patients. They argued that previous research suggests that even
patients with significant cognitive impairments can set realistic goals, but identifying goals may be
challenging for many people after brain injury. In the context of the cognitive, physical and emotional
consequences of brain injury, when one’s sense of identity is threatened (Ownsworth, 2014) it may
not be easy to identify what you want to achieve from rehabilitation, let alone what is possible to
achieve. Several methods have been described that aim to support clients in identifying personally
meaningful goals through discussion of values. Nair and Wade (2003) describe use of the Rivermead
Life Goals Questionnaire (RLGQ), which provides clients with a list of life goal areas and asks them

51
Downloaded By: University College London At: 22:52 14 Aug 2018; For: 9781315629537, chapter5, 10.4324/9781315629537
Jonathan J. Evans and Agata Krasny-Pacini

to rate which are the most important to them. This study showed that the most consistently endorsed
life goal areas related to relationships with a partner, family and friends, with personal care next.
Others have also found a similar emphasis on improving relationships (McGrath and Adams, 1999).
Using a tool such as the RLGQ allows clients to reflect on what is most important to them, which
can be used in discussion with rehabilitation team members when negotiating goals.
Identity-oriented goal setting (McPherson et al., 2009; Ylvisaker et al., 2008) involves asking the
client to identify activities of interest and then to identify an individual related to those activities who
is admired. The client is asked to think about what the role of that person is, what his/her
characteristics and values are, and what goals the client may have if s/he were more like that person.
The idea is really to stimulate discussion to encourage engagement in the goal-setting process and
may be helpful if a client is stuck and feeling unable to generate ideas for goals. Cullen et al. (2016)
describe a psychological therapy intervention based on principles of positive psychology. In the
PoPsTAR intervention participants were asked to identify their character strengths from a set of 24.
Character strengths are not ‘skills’ or ‘talents’, but are described as valued aspects of a person’s
personality. Examples include creativity, love of learning, appreciation of beauty, perseverance,
kindness, teamwork and gratitude. In the PoPsTAR intervention, having identified their top five
character strengths, clients are asked to identify activities that enable them to use their character
strengths in new ways, and this forms the basis of goal setting. This approach is consistent with an
idea that discussion of values may shift a focus on unachievable goals to goals that are achievable but
still consistent with values. It has been found that being able to disengage from unachievable goals
and re-engage with new goals improves well-being (Wrosch et al., 2003). When identity is threatened
by a discrepancy between current self and pre-injury self (Gracey et al., 2009), a values-based goal-
setting approach may allow the client to engage in new activities, and at the same time reduce some
of the felt discrepancy between old and new self, such that life goals are adjusted but remain consistent
with core values.
Some people undergoing rehabilitation will be too impaired to participate effectively in the goal
negotiation process. This includes not only people in coma, those who are minimally conscious, but
also many people with severe brain injury. Here the goals are set by the team, ideally in conjunction
with the client’s family, rather than the client, and the aim must be to set goals that are considered
to be in the client’s best interests and, as far as possible, consistent with the values of the client, which
may have to be gleaned from relatives, friends, and so on.

Goal setting
Having identified personally relevant goals, the next task is to turn these into clear, specific and
measurable goals. It is worth noting that if one is taking a client-centred approach, the goals are best
set by the client together with the team as a whole, or with a representative of the team (e.g. key
worker), rather than setting goals with each member of the team separately. In many teams it is the
case that each discipline within the team sets goals for the client, so clients have ‘Occupational
Therapy goals’, ‘Physio goals’, ‘Psychology goals’, and so on. This approach may result in goals that
are less personally relevant to the client, and less likely to be at the participation level of the ICF
framework (Holliday et al., 2007).
The challenge at this stage is to develop SMART goals. The SMART acronym has various
explanations, but most frequently refers to goals that are Specific, Measurable, Achievable (but
challenging), Relevant/Realistic and with a Time frame (Wade, 2009). The reason for goals needing
to be SMART is that literature has suggested that specific, challenging goals tend to lead to better
outcomes than goals framed in terms of just doing one’s best, at least in the business and sports worlds
(Locke and Latham, 2002). Although the evidence for this effect in brain injury rehabilitation is
limited, there are suggestions that the same principle might apply (Gauggel and Fischer, 2001;

52
Downloaded By: University College London At: 22:52 14 Aug 2018; For: 9781315629537, chapter5, 10.4324/9781315629537
Goal setting in rehabilitation

Gauggel and Billino, 2002). For some goals it is relatively easy to make them specific and measurable
and to define what would be challenging. However, for other goals this can be much more
challenging and trying to make them specific means that rather arbitrary targets are set, which do not
really reflect the abstract nature of the goal. Wade (2009) notes that, in some complex situations,
setting ‘learning goals’ rather than specific outcome goals may lead to better generalisation of skills.
This does not mean that the goals are not specific and measurable; it is just that the actual goal is
framed as learning a skill or specific set of knowledge. In rehabilitation settings, the danger is that if
a very specific but rather arbitrary goal is set, the rehabilitation team may be tempted to work
towards that very specific target and neglect the broader aim of the goal. For example, if James has a
memory impairment and needs to learn to use a mobile phone as a reminding system to prompt him
to get to appointments, one approach to a SMART goal would be to set the goal in terms of
attending a specified number of appointments on time (e.g. James will attend all appointments on
time during the final two weeks of his programme), but this may lead the team to focus too much
on just ensuring that James uses his phone to attend these specific appointments. One alternative is
to set a broad learning goal (James will demonstrate the ability to use his phone to set reminders by
the end of his programme) although this does not guarantee he actually does use it. So another
alternative is to combine these – James will demonstrate the ability to independently use his phone
to set reminders and use his phone reminders in order to attend all appointments on time in the final
two weeks of his programme.
Having identified the long-term goals for the rehabilitation programme, it is often helpful to
break these long-term goals down into a set of short-term goals. If someone is going to be in a
rehabilitation programme for weeks or months, and may have quite ambitious broad goals (e.g.
Emily will return to work on a part-time basis, working at least two days per week by the end of her
programme), it is helpful to break this goal down into the short-term goals that will lead towards the
long-term goal. There is evidence that a combination of long-term and associated short-term goals
leads to greater goal achievement than just having a long-term goal, albeit this evidence comes from
outside rehabilitation (Latham and Seijts, 1999).
One approach to goal setting is Goal Attainment Scaling (GAS). GAS was first described by
Kiresuk and colleagues (Kiresuk and Sherman, 1968; Kiresuk et al., 1994) and is a method of writing
personal scales to measure progress/outcome in relation to personal goals. GAS has been used in a
wide variety of health-care settings, including in neurorehabilitation (Schlosser, 2004; Steenbeek et
al., 2007; Turner-Stokes, 2009) and specifically in brain injury rehabilitation (Bouwens et al., 2009;
Grant and Ponsford, 2014; Malec, 1999; Wilson et al., 2002). GAS involves setting a rehabilitation
goal and then setting levels of performance outcome that reflect both better than expected
performance and worse than expected performance. Typically, five levels of performance are defined
and these different levels are assigned a score. Most often, –2 is the initial pre-treatment (baseline)
level, –1 represents progression towards the goal without goal attainment, 0 is the expected level
after intervention, +1 represents a better outcome than expected, and +2 is the best possible outcome
that could have been expected for this goal (Krasny-Pacini et al., 2016). Some authors have proposed
an additional –3 level to score deterioration (Steenbeek et al., 2010). Others have used this scale in
slightly different ways; for example, setting baseline level at –1, so –2 represents deterioration, or
adding a –0.5 level to score progress when the goal is not attained (Turner-Stokes and Williams,
2010). Several papers provide guidance on the process of writing goals (Bovend’Eerdt et al., 2009;
Krasny-Pacini et al., 2013; Turner-Stokes, 2009). One of the features of GAS is that goals are also
weighted and then the level of overall goal achievement is calculated by summing the weighted
scores and then deriving a T-score as a means of representing goal achievement with a single
standardised score. However, several authors have cautioned against deriving T-scores because they
imply that GAS data are normally distributed (which they may not be) and also that intervals between
points on the scale are equal, which they often are not (Tennant, 2007). Krasny-Pacini et al. (2016)

53
Downloaded By: University College London At: 22:52 14 Aug 2018; For: 9781315629537, chapter5, 10.4324/9781315629537
Jonathan J. Evans and Agata Krasny-Pacini

have proposed a set of criteria for appraising goal attainment scales used as outcome measures in
rehabilitation research. It is undoubtedly the case that writing several levels of goal performance can
be more challenging for some goal areas. Bouwens et al. (2009) provide some helpful examples of
scales in relation to dealing with impaired memory, acceptance of the consequences of injury and
coping with aggression.

Action planning and developing coping plans

Having set goals, the next stage of Scobbie et al.’s G-AP framework refers to action planning or the
process of specifying the plans of action that will lead to achievement of the short-term goals. Plans
of action specify who will do what and when. This includes what members of the rehabilitation team
will do, as well as what the client will do. When a client and team set participation level goals that
are not discipline specific, the specific role of each discipline is recorded in the process of documenting
action plans. This has the big advantage that it often encourages team members to work together
towards helping the client achieve the goals. Without this (when goals are discipline specific) it may
be more difficult for the client to integrate what s/he is learning from each discipline into functional
situations. Of course there may be specific goals that really only require input from one discipline,
but this is relatively rare in neuropsychological rehabilitation programmes that focus on setting ICF
‘participation’ level goals.
Scobbie et al. (2011) recommend spending time thinking about possible challenges to implementing
plans and developing coping plans. This seems like a sensible suggestion and most teams are experienced
in recognising the aspects of action plans that might present difficulties in terms of implementation.
One potential barrier to goals having the motivating and directing effect for clients is if goals are
not remembered. In Scobbie et al.’s (2015) survey of goal setting practice in community stroke teams
in the UK, only 39 per cent of teams reported routinely providing patients with a copy of their goals.
Given that memory problems are common in clients undergoing neuropsychological rehabilitation, if
we want goal setting to influence behaviour, clients need to be able to remember their goals. Studies
by Hart et al. (2002) and Culley and Evans (2010) have shown that providing prompts about
rehabilitation goals may improve memory for the goals. Culley and Evans evaluated the use of SMS
text messages as a means of supporting recollection of rehabilitation goals in both inpatient and
outpatient settings in a single blind randomised controlled trial. Each patient had six rehabilitation
goals. Three goals were randomly selected and for these goals patients were sent SMS text reminders
about their goals three times a day for 14 days. Memory for goals was examined at baseline, seven and
14 days. One of the most striking findings from this study was that despite participants being in
inpatient and community rehabilitation programmes that were strongly committed to goal setting,
and goals were set collaboratively with clients, at baseline (relatively soon after goals had been set)
recall of goals was almost zero. Over a period of 14 days, recall improved significantly more in the
SMS condition compared to the control condition. Teams should therefore consider how to support
memory for goals – providing regular reminders of goals via smartphones is one approach, or recording
goal-setting sessions on phones and prompting clients to review sessions would be another option.

Appraisal and feedback

The final components of the G-AP framework refer to monitoring performance in relation to goal
achievement. It also highlights the importance of feedback on progress as being a key feature of the
use of goals. Locke and Latham (2002) suggest that feedback is a key moderator of goal achievement.
As noted above, for clients in neuropsychological rehabilitation programmes, common cognitive
deficits in memory, attention and executive functions are going to reduce the likelihood of being
aware of progress towards goals. Most rehabilitation teams meet regularly to review progress of

54
Downloaded By: University College London At: 22:52 14 Aug 2018; For: 9781315629537, chapter5, 10.4324/9781315629537
Goal setting in rehabilitation

clients, though the actual frequency that goals are reviewed will depend on the number of clients in
the service. Every 1–2 weeks is probably ideal and is what is done in the intensive neuropsychological
rehabilitation programmes (Wilson et al., 2009). As well as teams meeting to review goals, it is
important that feedback is also provided for clients.
In terms of overall evaluation of goal outcomes, some teams will simply record whether the goal
is achieved or not. Others may use a ‘partially achieved’ category for goals towards which some
progress has been made but which cannot be said to be as fully achieved as the goal was previously
defined. For those using goal attainment scales, these provide a quantitative means of evaluating level
of goal attainment, although, as noted, one needs to be cautious about treating aggregated GAS
scores as precise, given the limitations in scaling that are inherent in the GAS process. Scobbie et al.
(2015) reported that around half of all services that use goal setting reported using a formal goal-
setting procedure (such as GAS or use of the Canadian Occupational Performance Measure
[COPM]), whilst the other half report using informal methods only.

Challenges, solutions and conclusions

There are many challenges associated with using goal setting in neuropsychological rehabilitation. It is
often said that the problem with goal setting is that it takes up too much clinician time, taking people
away from delivering interventions. The counter to that is that there is a danger without a client-
centred goal-setting approach that rehabilitation team members will spend too much time focusing on
activities and interventions that are not a priority for the client. We have seen from surveys that the
level of involvement of clients, both in the goal-setting process and the ongoing monitoring of progress
towards goals, varies hugely among teams. If we accept that goal setting is not just an administrative
tool, but a clinical intervention (Evans, 2012), then we need to maximise the potential therapeutic
benefits of a goal-setting process. Wherever possible clients should be involved in the process of setting
goals in order to maximise goal importance and goal commitment. In rare situations where goals are set
by teams with little involvement of the client, the goals should be explained to clients if this is feasible.
The extent to which goal setting is client-centred can be evaluated with a scale referred to as the
C-COGS (Client-Centredness of Goal Setting) scale (Doig et al., 2015). The C-COGS scale has three
subscales evaluating: (1) goal alignment, which explores clients’ perceptions concerning how important
goals are to them, their therapist and significant others; (2) goal planning participation, which measures
clients’ perceived participation in goal planning and decision-making on goals, as well as the extent of
involvement and inclusion in goal planning; and (3) client-centredness of goals, which measures the
meaningfulness, relevance and ownership of the individual goals, as well as clients’ motivation to work
towards them. Where possible goals should be SMART, but sometimes learning goals may be more
useful than specific performance goals. Use of reminding systems may help people remember their goals
and regular feedback regarding progress should be provided to maximise a sense of self-efficacy and,
ultimately, achievement.
A strong emphasis has been placed on engaging the client in the goal-setting process in order to
benefit from the motivational elements of goal setting, although it should be remembered that client
goals are also team goals – the client’s goals provide a target for members of the rehabilitation team
to try to achieve. But all the reasons why goals should be SMART, challenging but achievable, and
include regular monitoring, review and feedback apply equally in relation to team members using
goal setting to improve outcomes. What is important to note of course is that badly done goal setting
is likely to have a negative effect on team members – if unrealistic goals are set that cannot be
achieved, or progress towards goals is not recorded, then team members would experience no sense
of progress or achievement. This highlights the importance of the skill of the team in setting goals
and monitoring progress and goal achievement.

55
Downloaded By: University College London At: 22:52 14 Aug 2018; For: 9781315629537, chapter5, 10.4324/9781315629537
Jonathan J. Evans and Agata Krasny-Pacini

In conclusion, goal setting is a core component of neuropsychological rehabilitation. If done

correctly, goal setting will not only define the hoped-for outcome of a rehabilitation process, it
should also improve goal achievement. We do, however, need more research on how to maximise
the impact of goal setting in rehabilitation.

References
Bouwens, S.F.M., van Heugten, C.M. and Verhey, F.R.J. (2009). The practical use of goal attainment scaling for
people with acquired brain injury who receive cognitive rehabilitation. Clinical Rehabilitation, 23(4), 310–320.
Bovend’Eerdt, T.J.H., Botell, R.E. and Wade, D.T. (2009). Writing SMART rehabilitation goals and achieving
goal attainment scaling: a practical guide. Clinical Rehabilitation, 23(4), 352–361.
Carver, C.S. and Scheier, M.F. (1990). Origins and functions of positive and negative affect – a control-process
view. Psychological Review, 97(1), 19–35.
Csikszentmihályi, M. (1990). Flow: The Psychology of Optimal Experience. New York: Harper and Row.
Cullen, B., Pownall, J., Cummings, J., Baylan, S., Broomfield, N., Haig, C., Kersel, D., Murray, H. and Evans, J.J.
(2016). Positive PsychoTherapy in ABI Rehab (PoPsTAR): A pilot randomised controlled trial. Neuropsychological
Rehabilitation, 1–17.
Culley, C., and Evans, J.J. (2010) SMS text messaging as a means of increasing recall of therapy goals in brain injury
rehabilitation: a single-blind within-subjects trial. Neuropsychological Rehabilitation, 20(1), 103–119. (doi:10.1080
/09602010902906926).
Doig, E., Prescott, S., Fleming, J., Cornwell, P. and Kuipers, P. (2015). Development and construct validation of
the Client-Centredness of Goal Setting (C-COGS) scale. Scandinavian Journal of Occupational Therapy, 22(4),
302–310.
Evans, J.J. (2012). Goal setting during rehabilitation early and late after acquired brain injury. Current Opinion in
Neurology, 25(6), 651–655.
Gauggel, S. and Billino, J. (2002). The effects of goal setting on the arithmetic performance of brain-damaged
patients. Archives of Clinical Neuropsychology, 17(3), 283–294.
Gauggel, S. and Fischer, S. (2001). The effect of goal setting on motor performance and motor learning in brain-
damaged patients. Neuropsychological Rehabilitation, 11(1), 33–44.
Gracey, F., Evans, J.J. and Malley, D. (2009). Capturing process and outcome in complex rehabilitation interventions:
a ‘Y-shaped’ model. Neuropsychological Rehabilitation, 19(6), 867–890.
Grant, M. and Ponsford, J. (2014). Goal Attainment Scaling in brain injury rehabilitation: strengths, limitations and
recommendations for future applications. Neuropsychological Rehabilitation, 24(5), 661–677.
Hart, T. and Evans, J. (2006). Self-regulation and goal theories in brain injury rehabilitation. Journal of Head Trauma
Rehabilitation, 21(2), 142–155.
Hart, T., Hawkey, K.. and Whyte, J. (2002). Use of a portable voice organizer to remember therapy goals in
traumatic brain injury rehabilitation: a within-subjects trial. Journal of Head Trauma Rehabilitation, 17(6), 556–
570.
Holliday, R.C., Antoun, M. and Playford, E.D. (2005). A survey of goal-setting methods used in rehabilitation.
Neurorehabilitation and Neural Repair, 19(3), 227–231.
Holliday, R.C., Cano, S., Freeman, J.A. and Playford, E.D. (2007). Should patients participate in clinical decision
making? An optimised balance block design controlled study of goal setting in a rehabilitation unit. Journal of
Neurology Neurosurgery and Psychiatry, 78(6), 576–580.
Houts, P.S. and Scott, R.A. (1975). Goal Planning with Developmentally Disabled Persons: Procedures for Developing and
Individual Client Plans. Pennsylvania State University College of Medicine: Hershey.
Kiresuk, T.J. and Sherman, R.E. (1968). Goal attainment scaling – general method for evaluating comprehensive
community mental health programs. Community Mental Health Journal, 4(6), 443–453.
Kiresuk, T.J., Smith, A. and Cardillo, J.E. (1994). Goal Attainment Scaling: Applications, Theory, and Measurement.
Hillsdale, NJ: Lawrence Erlbaum Associates Inc.
Krasny-Pacini, A., Evans, J., Sohlberg, M.M. and Chevignard, M. (2016). Proposed criteria for appraising goal
attainment scales used as outcome measures in rehabilitation research. Archives of Physical Medicine and
Rehabilitation, 97(1), 157–170.
Krasny-Pacini, A., Hiebel, J., Pauly, F., Godon, S. and Chevignard, M. (2013). Goal Attainment Scaling in
rehabilitation: a literature-based update. Annals of Physical and Rehabilitation Medicine, 56(3), 212–230.
Latham, G.P. and Seijts, G.H. (1999). The effects of proximal and distal goals on performance on a moderately
complex task. Journal of Organizational Behavior, 20(4), 421–429.
Locke, E.A. and Latham, G.P. (2002). Building a practically useful theory of goal setting and task motivation – a
35-year odyssey. American Psychologist, 57(9), 705–717.

56
Downloaded By: University College London At: 22:52 14 Aug 2018; For: 9781315629537, chapter5, 10.4324/9781315629537
Goal setting in rehabilitation

Malec, J.F. (1999). Goal attainment scaling in rehabilitation. Neuropsychological Rehabilitation, 9(3–4), 253–275.
McGrath, J.R. and Adams, L. (1999). Patient-centered goal planning: a systemic psychological therapy? Topics in
Stroke Rehabilitation, 6(2), 43–50.
McMillan, T.M. and Sparkes, C. (1999). Goal planning and neurorehabilitation: The Wolfson Neurorehabilitation
Centre approach. Neuropsychological Rehabilitation, 9(3–4), 241–251.
McPherson, K.M., Kayes, N., Weatherall, M. and Goals, S.R.R.G. (2009). A pilot study of self-regulation informed
goal setting in people with traumatic brain injury. Clinical Rehabilitation, 23(4), 296–309.
Nair, K.P.S. and Wade, D.T. (2003). Life goals of people with disabilities due to neurological disorders. Clinical
Rehabilitation, 17(5), 521–527.
Ownsworth, T. (2014). Self-Identity After Brain Injury. Hove: Psychology Press.
Pagan, E., Ownsworth, T., McDonald, S. and Togher, L. (2015) A survey of multidisciplinary clinicians working in
rehabilitation for people with traumatic brain injury. Brain Impairment, 16(3), 173–195.
Playford, E.D., Siegert, R., Levack, W. and Freeman, J. (2009). Areas of consensus and controversy about goal
setting in rehabilitation: a conference report. Clinical Rehabilitation, 23(4), 334–344.
Prescott, S., Fleming, J. and Doig, E. (2015). Goal setting approaches and principles used in rehabilitation for people
with acquired brain injury: a systematic scoping review. Brain Injury, 29(13–14), 1515–1529.
Schlosser, R.W. (2004). Goal attainment scaling as a clinical measurement technique in communication disorders: a
critical review. Journal of Communication Disorders, 37(3), 217–239.
Scobbie, L., Dixon, D. and Wyke, S. (2011). Goal setting and action planning in the rehabilitation setting:
development of a theoretically informed practice framework. Clinical Rehabilitation, 25(5), 468–482.
Scobbie, L., Duncan, E.A., Brady, M.C. and Wyke, S. (2015). Goal setting practice in services delivering
community-based stroke rehabilitation: a United Kingdom (UK) wide survey. Disability and Rehabilitation,
37(14–15), 1291–1298.
Scobbie, L., McLean, D., Dixon, D., Duncan, E. and Wyke, S. (2013). Implementing a framework for goal setting
in community based stroke rehabilitation: a process evaluation. BMC Health Services Research, 13.
Seligman, M. (2011). Flourish. London: Nicholas Brearley Publishing.
Steenbeek, D., Ketelaar, M., Galama, K. and Gorter, J.W. (2007). Goal attainment scaling in paediatric rehabilitation:
a critical review of the literature. Developmental Medicine and Child Neurology, 49(7), 550–556.
Steenbeek, D., Ketelaar, M., Lindeman, E., Galama, K. and Gorter, J.W. (2010). Interrater reliability of goal
attainment scaling in rehabilitation of children with cerebral palsy. Archives of Physical Medicine and Rehabilitation,
91(3), 429–435.
Tennant, A. (2007). Goal attainment scaling: current methodological challenges. Disability and Rehabilitation, 29(20–
21), 1583–1588.
Turner-Stokes, L. (2009). Goal attainment scaling (GAS) in rehabilitation: a practical guide. Clinical Rehabilitation,
23(4), 362–370.
Turner-Stokes, L. and Williams, H. (2010). Goal attainment scaling: a direct comparison of alternative rating
methods. Clinical Rehabilitation, 24(1), 66–73.
Wade, D.T. (2009). Goal setting in rehabilitation: an overview of what, why and how. Clinical Rehabilitation, 23(4),
291–295.
Webb, P.M. and Glueckauf, R.L. (1994). The effects of direct involvement in goal-setting on rehabilitation
outcome for persons with traumatic brain injuries. Rehabilitation Psychology, 39(3), 179–188.
Wilson, B.A., Evans, J.J. and Gracey, F. (2009). Goal setting as a way of planning and evaluating neuropsychological
rehabilitation. In B.A. Wilson, F. Gracey, J.J. Evans and A. Bateman (Ed.), Neuropsychological Rehabilitation:
Theory, Therapy and Outcomes. Cambridge: Cambridge University Press.
Wilson, B.A., Evans, J.J. and Keohane, C. (2002). Cognitive rehabilitation: a goal-planning approach. Journal of Head
Trauma Rehabilitation, 17(6), 542–555.
Wrosch, C., Scheier, M.F., Miller, G.E., Schulz, R. and Carver, C.S. (2003). Adaptive self-regulation of unattainable
goals: goal disengagement, goal reengagement, and subjective well-being. Personality and Social Psychology
Bulletin, 29(12), 1494–1508.
Ylvisaker, M., McPherson, K., Kayes, N. and Pellett, E. (2008). Metaphoric identity mapping: facilitating goal
setting and engagement in rehabilitation after traumatic brain injury. Neuropsychological Rehabilitation, 18(5–6),
713–741.

57
Downloaded By: University College London At: 22:52 14 Aug 2018; For: 9781315629537, chapter5, 10.4324/9781315629537.ch5