Treating Problem Solving Deficits in Traumatic Brain Injury by Amit S. Kelkar July, 2014 Director of

128 Pages·2014·5.05 MB·English

Treating Problem Solving Deficits in Traumatic Brain Injury
by
Amit S. Kelkar
July, 2014
Director of Thesis/Dissertation: Heather H. Wright, Ph.D.
Major Department: Department of Communication Sciences and Disorders
Abstract
Cognitive deficits following TBI are multidimensional. Current treatment programs approach
problem solving training in a top-down approach with problem solving skill perceived as
independent of attentional control and working memory. Also, these treatment programs lack
sufficient evidence-based data to support maintenance and generalization. The purpose of the
current study was to assess the applicability of the bottom-up approach targeting set-shifting
(attention), updating (working memory), and inhibition to improve complex problem solving
skills in individuals with moderate-severe TBI. The aims of the study were to identify if a
bottom-up treatment approach improves, maintains and generalizes complex problem solving
skills in familiar and novel problem solving tasks. Three participants with a history of moderate-
severe TBI participated in the multiple-probe ABA design study. The multiple probe design
included baseline, treatment, and generalization probes administered through the course of the
study. Several cognitive measures and problem solving measures were administered to obtain
pre-treatment performance. Twenty treatment sessions of 1-hour duration were conducted across
five weeks to improve working memory, attention and inhibition skills using paper-pencil and
computer training tasks. Post-treatment probes were obtained 1-month after treatment to assess
maintenance of learned skills. Results indicate large treatment effects for all participants with
significant improvement in pre-post treatment measures of problem solving, memory, attention,
and inhibition skills. Treatment probe scores for problem solving skills were higher than the
baseline mean and trend for all participants. These positive trends provide preliminary data to
support using a bottom-up approach to improve problem solving skills in adults with moderate-
severe TBI. Targeting working memory, attentional and inhibition skills resulted in concurrent
improvement in problem solving skills. Positive maintenance data and generalization results
further strengthen this novel approach and paradigm shift in treating problem solving deficits.

Treating Problem Solving Deficits in Traumatic Brain Injury

A Dissertation

Presented To Heather H. Wright, Ph.D. of the
Department of Communication Sciences and Disorders

East Carolina University

In Partial Fulfillment of the Requirements for the Degree

Ph.D. in Communication Sciences and Disorders

by

Amit S. Kelkar

July, 2014
© Amit S. Kelkar, 2014
Treating problem solving deficits in traumatic brain injury

by

Amit S. Kelkar

APPROVED BY:

DIRECTOR OF
DISSERTATION/THESIS: _______________________________________________________
Heather H.Wright, Ph.D.

COMMITTEE MEMBER: ________________________________________________________
D. Erik Everhart, Ph.D.

COMMITTEE MEMBER: _______________________________________________________
Xiangming Fang, Ph.D.

CHAIR OF THE DEPARTMENT
OF Communication Sciences and Disorders: __________________________________________
Gregg Givens, Ph.D.

DEAN OF THE
GRADUATE SCHOOL: _________________________________________________________
Paul J. Gemperline, PhD
Dedication

This project is dedicated to my wife Purnima, my daughter Sara,
my brother Anand and my parents Neeta and Satish Kelkar.
I owe them what is best in me.

I also dedicate this project to members of the Brain Injury Support Group
Fayetteville, North Carolina.
They are a lesson in resilience of the human spirit.
ACKNOWLEDGEMENTS
Sincerest gratitude to my professors for guiding me through this learning process. A
special thank-you to Dr.Heather Wright without whom, this endeavor would have remained
incomplete. It was an honor to work with her as my mentor.
Words cannot describe the heartfelt gratitude to my parents and in-laws for giving me this
wonderful opportunity. And above all, thank-you to Purnima for her endless patience and
everlasting love. Her words of encouragement in moments of self-doubt carried me through this
project.
TABLE OF CONTENTS
LIST OF TABLES ............................................................................................................v
LIST OF FIGURES ............................................................................................................vii
CHAPTER 1: TRAUMATIC BRAIN INJURY (TBI) ..........................................................1
Introduction to TBI ....................................................................................................1
Cognitive functions ....................................................................................................7
Executive functions ........................................................................................7
Problem solving .............................................................................................10
Executive dysfunction in TBI ....................................................................................12
Attentional control and working memory deficits .........................................12
Inhibition deficits ..........................................................................................14
CHAPTER 2: PROBLEM SOLVING DEFICITS IN TBI ...................................................17
Cognitive rehabilitation .............................................................................................19
Statement of the problem ...........................................................................................26
Method……… ...........................................................................................................28
Results ………............................................................................................................41
Discussion ............................................................................................................48
Conclusion ............................................................................................................62
REFERENCES ……. ...........................................................................................................66
APPENDIX A: Problem solving probes for baseline and treatment .....................................76
APPENDIX B: Paper pencil and computer training tasks ....................................................101
APPENDIX C: Intervention tasks and strategies ..................................................................108
APPENDIX D: IRB consent forms ......................................................................................110
LIST OF TABLE
Pre- and post-treatment measures on standardized measures of problem solving, updating,
inhibition and shifting skills ………………………………………………………............44