Towards an Integrated Model of

Cognitive Rehabilitation with a Focus

on Functional Outcome
McKay Moore Sohlberg PhD
Communication Disorders & Sciences
University of Oregon
Disclosure

• My travel to this conference was supported by First

Colombian Conference of Neuropsychology
• I receive royalties on the Attention Process Training program
that I reference in my talk
Learning Objectives

• Understand rationale and foundational principles of

functional cognitive rehabilitation

• Be able to describe 6 evidence-based approaches to

functional cognitive rehabilitation

• Understand the principles and techniques for patient-

centered goal setting and outcomes measurement
Factors Affecting Outcome

Postinjury Contextual Factors:

Life Roles; Types of Supports for Roles

HOW DO WE
Therapeutic Services for Injury-Related Impairments
OPTIMIZE?
Premorbid Individual

Social Communication
Cognition

OUTCOME
Factors

Psychoemotional Physical & Sensory

Functioning Abilities

Injury-Related Factors
Traditional Approach to Cognitive Rehabilitation

• Assess cognition at the impairment level

• Identify the cognitive impairments that serve

as greatest barriers to valued everyday
activities

• Apply drills and exercises that target those

specific cognitive skills with the expectation
that therapy will translate to function
Early Cognitive Rehabilitation

Mid 70s to Mid 80s treatment focused primarily on ‘drill &

practice’ approaches to cognitive rehabilitation
• Memorizing lists
• Retaining information from paragraphs
• “Restoring” reasoning using reasoning drills

No evidence that drills restored general cognitive processes.

Improvements tend to be limited to near transfer
Unfortunate carryover from earlier times

Proliferation of cognitive rehabilitation workbooks and

computer programs with decontextualized,
nonadaptive exercises

• Sequencing and Executive Functions: “Ask patient to tell you

the steps involved in making an omelette”
• Problem solving: “Ask patient for a solution if they went to the
grocery store and had all their groceries in their cart but had
forgot their wallet”
• Memory: Computer drills with word list and figure recall tasks

Drill and practice on decontextualized activities

A Welcome Paradigm Shift (Sohlberg & Mateer, 2001)
Forces that have moved our field forward in important ways

• Findings with regard to plasticity

(Kleim & Jones, 2008; Sohlberg & Turkstra, 2011)

• Advances in technology
(Gillespie et al., 2011)

• Emphasis on empowerment and self determination

(Deci & Ryan, 2017)

• Focus on function and integrated therapies

(Dams-O’Connor & Gordon, 2013)
Functional Change Requires Functional Treatment

If you want people to learn something,

teach it to them.

Don’t teach them something else and

expect them to figure it out later.

(Detterman 1993)
Our roadmap for teaching functional cognitive
rehabilitation

• Six guiding principles based on evidence and

peer reviewed expert consensus that ensures
your therapy is patient-centered and optimizes
outcome.

• Four stages of rehabilitation critical to

assessment and treatment process

• Six distinct approaches to cognitive rehabilitation

 Guiding Principles
1. Focus on Function
2. Cultivate Partnerships
3. Acknowledge Multifactorial
complexities
4. Use the team
5. Recruit Resilience
6. Promote Realistic Expectations
for Recovery
Roadmap for Functional Cognitive Rehabilitation
Rehabilitation Stages
Getting Started
Six Cognitive Interventions
Setting Stage For
Functional Change
Personalized education
Making Functional Change Cognitive strategy training
Direct training
Transition to self Assistive technology for cognition
management
Task specific training
Environmental management
TOOLS: Motivational interviewing; goal
attainment scaling, promoting self regulation
CAVEAT

• Cultural context matters

• The models and techniques I am describing may not fit Latin
American culture
Collaborators

Douglas B. Cooper PhD, ABPP-CN Leslie Nitta, MS CCC-SLP

Micaela Cornis-Pop PhD, CCC-SLP Linda M. Picon M.C.D., CCC-SLP

Leslie Freeman Davidson, PhD OTR/L Mary Vining Radomski, PhD., OTR/L

Shari Goo-Yoshino, M.S., CCC-SLP Melissa Ray M.S., CCC-SLP

Carol Smith Hammond, PhD, CCC-SLP Carole R. Roth PhD CCC-SLP, BC-ANCDS

Mary Kennedy, PhD, CCC-SLP, BC-ANCDS Maile Singson MS, CCC-SLP

Don MacLennan, MA CCC-SLP McKay Sohlberg, PhD, CCC-SLP

R. Kevin Manning, PhD, CCC-SLP Lyn Turkstra PhD CCC-SLP, BC-ANCDS

Pauline Mashima, PhD, CCC-SLP Rodney D. Vanderploeg, PhD., ABPP-CN

Six Guiding Principles

1. Recruit Resilience
• Identify & incorporate values of patient into therapy
• Promote self-efficacy, positive expectation, sense of meaning

2. Cultivate the Therapeutic Alliance

• A strong partnership provides the foundation for the therapeutic process
• Listen carefully to the patient and resist the impulse to be the expert

3. Acknowledge multifactorial complexities

• Cognition is a complex construct and can be impacted by comorbid
conditions – depression, anxiety, pain, sleep disturbance
Six Guiding Principles

4. Use the team

• Be intentional about how you involve and collaborate with family, natural
supports, friends, coworkers, teachers etc.

5. Focus on function
• Overarching goal of cognitive rehabilitation after TBI is to help people resume
valued activities
• This is best accomplished when therapy itself is integration-focused and directed
at functional activities in a community context

6. Promote positive expectations for recovery

• Positive expectation for recovery is critical for developing self-efficacy and
self-determination
• Provide education about nature of TBI and expected recovery, highlight abilities
and strengths, and demonstrate effectiveness of strategies in resuming everyday
activities
Overview

Get Started
• Establishing the therapeutic alliance, information gathering, engage & motivate

Set the Stage for Functional Change

• Collaborative goal and treatment selection, measurement plan

Make Functional Changes

• Engage in therapy, 6 approaches to cognitive rehabilitation, monitor
progress, goal attainment

Transition to Self-Management
• Plan for discharge, evaluate outcomes
 Getting Started

Get Started:
1. Establish therapeutic alliance • Motivational Interviewing
2. Gather information • Self-Report Measures
3. Engage and motivate • Establish a ‘Quick Win’

Set the Stage for Functional Change

Make Functional Changes

Transition to Self-Management
Getting Started: Motivational Interviewing
Getting Started: Self-Determination Theory

The following principles are required to move people toward

volitional behavior that is sustained over time:

Autonomy – a sense that actions are self-endorsed and

consistent with one’s values and interests

Competence – a sense that one is effective and has the

ability, knowledge, or skill to do something
successfully

Relatedness – a feeling of being cared for and connected, a

sense of belonging
Getting Started:
Self-Determination Theory in Rehabilitation

We refer to these psychological needs everyday, however, we

use different terminology

Autonomy – Patient-centered care, collaborative care

Competence – Self-efficacy

Relatedness – Therapeutic alliance

Getting Started:
What is Motivational Interviewing?

One Part Philosophy

• Client autonomy
• Resist the ‘righting reflex’

One Part Communication Technique

• OARS
• Open-ended questions
• Affirmations
• Reflections
• Summaries
Getting Started:
Motivational Interviewing Techniques (OARS): (Miller & Rollnick, 2012)
Open-Ended Questions vs. Yes/No Questions
• How can I help you? How do memory challenges affect you at work?
• As opposed to: Can you remember the things you need to do at work?

Affirmations vs. A simple compliment

• Even though you didn’t always use your strategy on vacation, you did
remember to use it twice in very difficult situations.
• As apposed to: Nice job

Reflections vs. More Questions

•You are frustrated reading textbooks because your mind wanders.
• As opposed to: Do you think you are distracted?

Summaries – The Opportunity for Collaboration

Summaries collect a number of things said by the client presented
back to the client for validation “Do I have this right?”
Getting Started:
Tension When Selecting Tests

Person-centered
focus (meaningful,
Person-centered
ecologically valid)
focus (meaningful,
ecologically valid)

Hard to achieve a balance

In a review of 31 tests assessing cognitive-linguistic skills

None of the tests were predictive of performance in contexts relevant

to daily life (ecological validity) Turkstra et al, 2005
 Getting Started:
Limited Time for Evaluation

Typical evaluation: Test  Infer Function  Plan Treatment

• Give a standardized, impairment-level test

• Infer the degree to which impairments will likely

impact everyday activities

• Plan treatment accordingly – often in traditional

therapy with drill & practice activities
Getting Started:
Can we test everything?
Areas to test for Assistive Technology for Cognition
(Sohlberg & Turkstra, 2011)

Episodic Memory remembering daily events and personal experience

Semantic Memory remembering facts & knowledge-based information

Prospective Memory remembering to initiate future intentions

Procedural Memory remembering procedures and steps

New Learning ability / rate of learning new information

Attention holding and processing information in mind

Executive Functions initiation, planning, organization etc.

Problem Solving ability to solve problems

Getting Started:
Self-Report & Validate with Self-Report Measures

Makes true client-centered goals achievable

• Standardized, objective, impairment- level test

• Repeatable Battery of Neuropsychological Status (RBANS)

• Standardized, self-report measure

• Self-Awareness of Deficit Interview (Fleming, Strong, & Ashton, 1996)
• Can use Motivational Interviewing techniques to facilitate
collaborative, client-centered goals
 Getting Started: Sample self-report measures

Memory College Needs Assessment

• Everyday Memory Questionnaire • College Survey for Students with Brain Injury
(Kennedy, Krause, & Turkstra, 2008)
(Sunderland, Harris, & Baddeley, 1983)

• Good Samaritan Memory Questionnaire • UW-Madison College Concussion Clinic case

(Mateer, Sohlberg, & Crinean, 1987) history & academic needs assessment
(Krug & Turkstra, 2015)
Executive Functions • LASSI: Learning & Study Strategies Inventory
• Behavioral Rating Inventory of Executive (Weinstein 1987)
Function (BRIEF-A), (Gioia et al, 2000)
• Dysexecutive Questionnaire (DEX) (Wilson et al, 1996)

ATC Needs Assessment

Pragmatic Communication • Assistive Technology Outcome Measure
• LaTrobe Communication Questionnaire
ATOM (Scherer, 2005)
(Douglas, O’Flaherty, & Snow, 2000)
Getting Started: Set the Hook

Find a ‘quick win’ at the end of the session that

addresses an area of concern
• Medication reminder system

• Help prepare a list of questions for talking to physician

• Describe an attention strategy to improve conversational focus

• Review steps to open Facebook and make a reminder card

Set the Stage for Functional Change
 Set the Stage for Functional Change
Therapeutic alliance, motivation, • Motivational Interviewing
Get Started gathering information

Set the Stage for Functional Change

1. Set goals • Using MI to develop goals
• GAS / SMART goals
2. Select tx approaches/strategies • 6 approaches to Cog Rehabilitation
3. Create measurement plan

Make Functional Changes

Transition to Self-Management
Setting Goals: The Drive behind Rehabilitation
Setting the Stage for Functional Change
Goals: The Mismatch Between Clinicians & Patients
Why does therapy work?
Cicerone, 2006
Why does therapy fail?

Clinicians: When therapy works: It’s because of the quality of the therapy
When therapy fails: It’s because the patient wasn’t motivated

Patients: When therapy works: It’s because of the effort they put into therapy
and the support of their family
When therapy fails: It’s because the therapy was ineffective
Setting the Stage for Functional Change
Why Rehabilitation Fails (van den Broek, 2005)
Failure often arises from a mismatch between the goals of the
treatment team and the patient’s aspirations

Clinicians vulnerable to the “Expert Trap”

• Especially when patients are perceived to have poor judgment
and reasoning

Clinicians are experts at assessing deficits —> pt needs

• May be a mismatch between pt needs and what pt wants
Setting the Stage for Functional Change:
Operational Definition of a Collaborative Goal
Operational definition of a collaborative goal using
Motivational Interviewing

A goal in which
1. The functional context, functional activity, and
cognitive context for that goal are identified through
client responses to open ended questions or
reflections by the clinician

2. And validated by the patient in response to a

clinician summary of that information.
Setting the Stage for Functional Change
An Option: Goal Attainment Scaling
Definition:
A measurement methodology that allows clients & clinicians to
develop and monitor progress on individualized goals.
Characteristics:
• Collaboratively identified goals
• Criterion referenced
• Individualized, functional outcome measure
Caveat:
Works best with an interview style that is collaborative & facilitates
patient-centered goals – such as Motivational Interviewing
Setting the Stage for Functional Change
Characteristics of Goal Attainment Scaling (GAS)

• Divide overarching goals into 5 discrete levels

• Allows clinicians and clients to identify a range

of outcomes

• Can measure longitudinal change

• Can measure degree to which intervention is

effective
Setting the Stage for Functional Change
SMARTED Criteria for Goal Attainment Scaling
Specific What specifically will be accomplished?

Measurable How to quantify progress & goal attainment?

Achievable Is it feasible, does person have control of

relevant aspects of the goal?
Relevant Is it important and meaningful to the person?

Time-bound Is it feasible and is time frame defined?

Equidistant Are intervals equidistant?

UniDimensional Is there just one measurement domain?

 Much Better than
+2 Client independently initiates reading his textbook 7 days a week Expected Outcome
--------------------------------------------------------------------------------------

Better than
+1 Client independently initiates reading his textbook 5-6 mornings a week Expected Outcome
--------------------------------------------------------------------------------------

0 Client independently initiates reading his textbook 3-4 mornings a week Expected Outcome
------------------------------------------------------------------------------------------------------

Less than
-1 Client independently initiates reading his textbook 1-2 mornings a week Expected Outcome
--------------------------------------------------------------------------------------------------------
Much Less than
-2 Client does not independently initiate reading his textbook in the morning Expected Outcome
--------------------------------------------------------------------------------------------------------

Functional Domain: School Cognitive Domain: Executive Functions-Initiation

Functional Activity: Initiation of Intervention Approach: ATC + Cognitive Strategy

reading in the morning

35 yo combat-injured veteran in community college program

 Goal Attainment Scaling
Goal: Get rid of behavioral attendant
Goal 1 Goal 2
Level of Attainment Safety: Independence:
Get rid of 1:1 attendant Independently Go to Therapy
Uses call light

Much more than I can navigate to four of my therapies independently

expected Uses call light 5 of 5 opportunities
+2 during the day

I can navigate to three of my therapies

Somewhat more than independently
expected Uses call light 4 of 5 opportunities
+1 during the day

I can navigate to two of my therapies independently

Expected level of
outcome Uses call light 2-3 of 5 opportunities
0 during the day

I can navigate to one of my therapies independently

Somewhat less than
expected Uses call light 1 of 5 opportunities
-1 during the day

I am unable to navigate to any of my therapies

Much less than expected Uses call light 0 of 5 opportunities independently
-2 during the day
6 Approaches to Cognitive Rehabilitation
Setting the Stage for Functional Change
Six Approaches to Therapy
Set the Stage for Functional Change:
1. Set Goals
2. Select Tx Approaches/Strategies
• Personalized Education and Understanding
• Cognitive Strategy Training
• Direct Training of Cognitive Impairments
• Selection and Training the Use of an Assistive
Technology Device
• Training Specific Task
• Environmental Management
Setting the Stage for Functional Change
Review of 6 Approaches

Options for treatment

1. A variety of methods are available to treat attention, memory,
executive functions and pragmatic communication

2. There is no single ”right” intervention in cognitive rehabilitation

3. Selection of a specific approach depends on a number of factors

• Research Evidence
• Previous treatment received
• Timelines for treatment
• Specific needs of the person with TBI
• Patient preference
Setting the Stage for Functional Change: Education
Personalized Education: Part of Every Program
Clinician Reminders: Primary Tools:
• Discussion
• Need clear understanding of the
PURPOSE of any education exercises • Handouts
or discussions • YouTube
• Balance strengths and weaknesses • Experiential Tasks
• Risk Communication
Common Targets:
• Increased insight/awareness Part of every approach to treatment
• Behavioral change Most effective if personalized
Setting the Stage for Functional Change: Education
Personalize the Education

• Have the person with cognitive challenges highlight

information most relevant to the person’s experience

• Keep a log of cognitive challenges, behaviors, or

feelings that relate to the educational goal

• Design an experiment comparing performance with a

compensatory strategy with typical performance
Setting the Stage for Functional Change: Education
Primary Tools
Discussion
• Providers educate person with TBI on the nature of the
injury and the range of treatment options
• Person with TBI educates providers regarding strengths,
weaknesses, prior use of strategies
Handouts - Case Studies
YouTube
Experiential Tasks
• Comparing predict vs actual performance on task

Risk Communication
• The language we use
 Setting the Stage for Functional Change:
Cognitive Strategy Training
Clinician Reminders:
Primary Tools:
• Strategy selection and introduction based
on collaborative interview and any testing • General vs specific strategies
• Training should include Knowledge • Internal vs external strategies
Assessment (why, how, when to use
strategy)
• Training should provide adequate practice Common Targets:
for fluency and generalization
• Goal completion
• Evaluation includes measure of strategy
knowledge, use and impact • Self-monitoring
• Attentional focus
• Prospective memory
• Retrospective memory
• Learning
Making Functional Changes
Training Cognitive Strategies - categories
Activity Specific Strategies
• Remembering names
• Prevention of lost items
• Academic strategies (study skills, writing, reading, assignment management)
• Social communication strategies (conversation starters, question templates)
• Navigation strategies

Internal Memory Strategies

• Imagery
• Verbal elaboration
• Retrieval (alphabet searching, mental retracing)
• Encoding (acronym, story method)

Generalized Metacognitive Strategies (self monitoring/goal completion)

• Goal Management Training
• Problem Solving Therapy
• WSTC
• Self talk/verbal mediation
 Setting the Stage for Functional Change
Training Use of Assistive Technology for Cognition
Clinician Reminders:
• Device selection and introduction based
on collaborative interview and any
testing
• Training should include Knowledge
Assessment (why, how, when)
• Training should provide adequate
practice for fluency and generalization
• Evaluation includes measure of ATC
knowledge, use and impact
Primary Tools:
• Knowledge of ATC options
• Knowledge of apps and resources
for evaluating [http://id4theweb.com/]
• Measurement: Usage logs/GAS
Common Targets:
• Automatic fluent use of a device
• Improvements on specific functional
tasks
Setting the Stage for Functional Change: ATC
Clinician Reminders
Strategy selection is based on collaborative interview
and test results
Critical elements of device training

• Knowledge:
• Why – How - When
• Application:
• Practice to fluency (mastery) – Generalize to functional
contexts
• Measurement:
• Knowledge – Use – Impact
 Setting the Stage for Functional Change: Direct Tx
Direct Training of Cognitive Processes
Clinician Reminders: Primary Tools:
• Candidacy • Programs with evidence-
• Theoretical grounding base
• Sufficient Repetition
• Patient-centered outcome
measures that capture
• Patient Performance drives
generalization
clinical regimen
• Combine drills with strategy
training
Common Targets:
• Increased working memory
• Identify and Measure Functional
• Increased sustained attention
Goals
• Improvements on specific
Examples: functional tasks
• Attention Training
• Goal Management Training
Setting the Stage for Functional Change: Direct Tx
Direct Training of Cognitive Processes
Training specific cognitive processes with a goal of improving
processes at the impairment level

• Drills focus on specific cognitive processes

• Drills are repeated over time and level of difficulty is increase as

performance improves

• Tasks are not functional but are intended to improve processing

of specific cognitive networks to improve function

• Weak evidence with this approach in isolation, stronger

evidence for this approach when used in conjunction with
strategy training
Setting the Stage for Functional Change: Skills Training
Training Specific Skills
Clinician Reminders: Primary Tools:
• Focuses on a single skill • Patient-centered goal
• Not expected to generalize selection with MI
• Task Analysis
• Involve natural supports
• Practice regimen –
instructional methodologies
• Repetition
• Errorless learning
Examples:
• Bus riding
• Cooking task
• Using mobility device
Setting the Stage for Functional Change: Task Training
Clinician Reminders - Focus on a Specific Life Skill
Define the task, steps, and context & apply instructional
methodology methods to train the task

• Task Analysis: Break the task into steps

• Identify contexts where the task will be done
• Identify natural supports that may be needed for
successful task completion
• Provide sufficient practice doing the task in the context
where it will be used
• Train until task becomes automatic (train to mastery)
 Setting the Stage for Functional Change
Environmental Management
Clinician Reminders: Primary Tools:
• Home Assessment
• Requires home/community
• Collaboration with
assessment and collaboration significant others
with relevant others • Monitoring Plan
• Can be “low hanging fruit”
• May require support to implement
and training to attend to modification
Examples:
• Setting up dedicated
study space
• Change in lighting to
reduce headache
Setting the Stage for Functional Change: Skills Training
Examples
Setting up a dedicated study space
• Quiet part of the house
• Minimal clutter – filing system
• Prominent calendar -

Headache – softer, indirect lighting

Severe memory difficulty – reduced learning

• Labels on cupboards and drawers, identifying contents
 Setting the Stage for Functional Change:
Measurement
Who will measure?
• Client
• Another significant person - spouse, supervisor

What will be measured?

• As strategy is introduced focus might be on strategy use.
• Will use verbal mediation strategy at least 3x this week.
• As strategy is used consistently, measurement focuses on impact of the strategy.
• Frustration Ratings and Task Completion Count will improve by 20% over the
course of two weeks

When will measurement occur?

• For relatively low-frequency activities (reading the newspaper), may measure each
an activity occurs
• For high-frequency activities (conversation), may measure specific examples of
the activity
• For global ratings of impact (caregiver burden), may seek ratings at specified
intervals.
Setting the Stage for Functional Change
Measurement: the biggest challenge
Initiate
Strategy
& Measure
Strategy

Evaluate Challenge Select

Strategy ----- Strategy
Goal

Awareness of Strengths & Weaknesses

 Transition to Self-Management
Therapeutic alliance, motivation, • Motivational Interviewing
Get Started
gathering information
• Using MI to develop goals
Set the Stage Set goals; select tx • Goal Attainment Scaling/SMART
for Functional approaches and strategies goals
• 6 approaches to Cognitive
Change Rehabilitation
• Measurement plan
Make Implement tx approaches & • Personalized education
Functional strategies • Training cognitive strategies
• Assistive Technology for Cognition
Changes • Direct training of cognitive processes
• Training Specific Tasks
• Environmental management

Transition to Self-Management • Promote self regulation

• Consider discharge scenario
1. Plan Discharge
• Anticipate needs
2. Evaluate Outcomes • Types of outcome
A Patient-Centered Functional Approach Facilitates
Self Management

Mary Kennedy, 2012, used with permission

Self-Regulation of Complex Activities (Kennedy, 2013)

1. Identify potential goals 6. Initiate strategy steps

2. Select a doable goal 7. Check: strategy use

3. Identify potential strategies 8. Check: track performance

or solutions
4. Select optimal strategy;
have backup
5. Create steps & materials
9. Compare to goal & review
10. Adjust goal and / or
Adjust strategy

Mary Kennedy, 2012, used with permission

Planning for Discharge: Discharge Scenarios

Discussion regarding discharge should occur early in therapy

Discharge
• Discharge outright with no additional follow-up

• Discharge with scheduled follow-up to verify maintenance of goals

• Discharge with client-initiated follow-up within a specified period

related to changes in life context: taking more difficult course
load, promotion at work or within military
Anticipate Needs

• Community resources?
– Support groups?
– Other providers?
– Classes, recreation?
• Self evaluation surveys
• Phone follow up
• Reminder handouts for family, friends, patient
 Planning for Discharge: Why Assess Outcomes?

• Demonstrating to clients and their families that they have made important and
significant improvements

• Demonstrating to administrators the need for additional resources to expand

successful services and programs

• Program evaluation and improvement: If changes are made, outcomes can be

evaluated before and after the change to see if expected improvements were
achieved.
Types of Outcomes

Patient: Assessing outcomes at the level of the patient is

generally the most important measure.
o decrease in symptoms
o increase in day-to-day functioning
o increase in participation in work, school, social, or
other activities
o number of treatment goals achieved
o satisfaction with different aspects of the treatment.
o change in standardized test relevant to therapy
Types of Outcomes

Provider: Outcome assessment at the provider level

might include:
o access issues such as wait times for an initial
appointment or time before treatment sessions can be
scheduled
o effectiveness outcomes such as number of sessions
needed to achieve various treatment goals
o satisfaction outcomes such as satisfaction with service
provided, professional demeanor,
information/education provided, treatment goals
achieved, involvement of family or significant others,
etc..
 Guiding Principles
1. Focus on Function
2. Cultivate Partnerships
3. Acknowledge Multifactorial
complexities
4. Use the Team
5. Recruit Resilience
6. Promote Realistic Expectations
for Recovery
Rehabilitation Stages
Getting Started
Six Cognitive Interventions
Setting Stage For
Functional Change
Personalized education
Making Functional Change Cognitive strategy training
Direct training
Transition to self Assistive technology for cognition
management Specific task training
Environmental management
TOOLS: Motivational interviewing; goal
attainment scaling, encouragement of self
monitoring and self regulation
How Did We Do?