Preliminary Efficacy of Combining Internal and External Cognitive Strategy Training in a Case of Anoxia

Research Objectives: To determine the effect of combining internal and external cognitive strategy training techniques on functional outcomes in a case of anoxic brain injury. The purpose of cognitive rehabilitation is to train skills necessary for completion of daily cognitive tasks and to train compensatory strategies as a means for restoring lost functioning. According to our knowledge, to date, clinical treatment, and outcomes for cases of anoxic injuries due to near drowning are inconsistent for both treatment and prognostic outcomes. We seek to contribute to current research in this preliminary study, by examining use of combined supportive clinical techniques.

Design: This was a retrospective case study design. Data was collected onsite from the electronic clinical records for speech sessions conducted from April 2021 until July 2021.

Setting: Private institution. College campus speech clinic.

Participants: Case study for a 21-year-old male with a diagnosis of anoxic brain injury due to drowning.

Interventions: This study examined the use of compensatory strategies, internal (mental self-talk, association and organizational) techniques and external (alarms, notes, oral self talk) technqiues, for improved functioning, carryover of skills to daily life.

Main Outcome Measures: Client accuracy of trained techniques and self-report of follow through and carryover.

Results: The client benefitted from effective combining of internal and external techniques due to residual initiation, attention, and planning and forethought difficulties. In addition, the client responded positively to questions relating to self-perception of satisfaction of carryover and level of functioning.

Conclusions: Case study findings revealed overall improvement in both internal and external compensatory strategy use for each identified cognitive deficit. This included skills of attention, memory recall, speed of processing, and executive skill functioning. Most important for this case was that although all diagnosed deficits were within a mild range of severity level, the need for external systems persists. Residual initiation problems, external alarms, reminders, and task guided systems seemed to trigger internal strategy use for improved functioning.

Author(s) Disclosures: No conflicts