Donders Institute for Brain, Cognition and Behaviour
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Thesis defense Dirk Bertens (Donders Series 199)

8 January 2016
Promotors: prof. dr. R.P.C. Kessels, prof. dr. L. Fasotti, copromotor: dr. D.H.E. Boelen
Doin’ it right: Assessment and errorless learning of executive skills after brain injury

Many brain-injured patients referred for outpatient rehabilitation have executive deficits, notably difficulties with planning, problem-solving and goal directed behaviour.

Even subtle executive deficits can provoke difficulties in learning and performing daily life activities. Goal Management Training (GMT) has proven to be an efficacious cognitive treatment for these problems. GMT entails learning and applying an algorithm, in which daily tasks are subdivided into multiple steps.

The main aim of this thesis was to examine whether using an errorless learning approach (preventing the occurrence of errors during the acquisition phase of learning) contributes to the efficacy of GMT in the performance of complex daily tasks. Results showed that everyday task performance in brain-injured patients with executive impairments improved significantly more after the experimental errorless GMT compared to conventional GMT. These finding show that errorless learning is not only beneficial for amnesic patients but for executively impaired patients as well.

A second aim was to further improve the assessment of executive impairments by investigating an adapted version of an existing executive function test, the Modified Six Elements Test (MSET). The investigated adaptations to the MSET contributed to better possibilities to detect mild executive deficits and to evaluate executive function over the course of time.

The adapted MSET and the investigated errorless GMT contribute to a better assessment and treatment of executive function and can be implemented in cognitive rehabilitation settings in clinical practice.