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Long-term compensatory treatment of organizational deficits in a patient with bilateral frontal lobe damage
Journal of the International Neuropsychological Society, 14(1), 154-163
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Evans et al. (1998) described compensatory strategy use in RP, a patient with executive dysfunction following bilateral frontal lobe damage who had difficulty acting upon her intentions. A pager was used to remind RP of regularly scheduled activities, along with a checklist which aimed to moderate a perseverative routine. Although successful, ten years after the original intervention, the strategies were no longer used, and considerable everyday problems were evident. In the current study, we conducted a follow-up assessment in order to examine potential reasons for this deterioration. No change in neuropsychological functioning was evident. Whereas the previous study introduced the two strategies together, and examined effects upon separate goals, in the current study we re-introduced the two strategies separately, and examined effects on three common goals. In addition to prompting specific activities, we aimed to support completion of more general goals (those that could be enacted within a wider window of time). The paging intervention had a dramatic effect on all three measured behaviors, at a much more consistent level than the checklist. We suggest that, in addition to direct reminders, the pager can cue a process of goal monitoring that bridges the gap between intention and action.