OBJECTIVE\nThe objective of this NIH Consensus Statement is to inform the biomedical research and clinical practice communities of the results of the NIH Consensus Development Conference on Rehabilitation of Persons with Traumatic Brain Injury. The statement provides state-of-the-art information regarding effective rehabilitation measures for persons who have suffered a traumatic brain injury (TBI) and presents the conclusions and recommendations of the consensus panel regarding these issues. In addition, the statement identifies those areas that deserve further investigation. Upon completion of this educational activity, the reader should possess a clear working clinical knowledge of the state of the art regarding this topic. The target audience for this statement includes, but is not limited to, pediatricians, family practitioners, internists, neurologists, physiatrists, psychologists, and behavioral medicine specialists.\n\n\nPARTICIPANTS\nParticipants were a non-Federal, nonadvocate, 16-member panel representing the fields of neuropsychology, neurology, psychiatry, behavioral medicine, family medicine, pediatrics, physical medicine and rehabilitation, speech and hearing, occupational therapy, nursing, epidemiology, biostatistics and the public. In addition, 23 experts from these same fields presented data to the panel and a conference audience of 883.\n\n\nEVIDENCE\nThe literature was searched through Medline and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. A compendium of evidence was prepared by the panel which included a contribution from a patient with TBI, a report from an Evidence Based Practice Center of the Agency for Health Care Policy and Research, and a report from the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention. Scientific evidence was given precedence over clinical anecdotal experience.\n\n\nCONSENSUS PROCESS\nThe panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately following its release at the conference and was updated with the panel's final revisions.\n\n\nCONCLUSIONS\nTraumatic Brain Injury (TBI) results principally from vehicular incidents, falls, acts of violence, and sports injuries, and is more than twice as likely in males as in females. The estimated incidence rate is 100 per 100,000 persons with 52,000 annual deaths. The highest incidence is among persons 15 to 24 years of age and 75 years and older, with an additional less striking peak in incidence in children ages 5 and younger. Since TBI may result in lifelong impairment of an individual's physical, cognitive, and psychosocial functioning and prevalence is estimated to be 2.5 million to 6.5 million individuals, TBI is a disorder of major public health significance. Furthermore, mild TBI is significantly under diagnosed and the likely societal burden therefore even greater. Given the large toll of TBI and absence of a cure, prevention is of paramount importance. However, the focus of this conference was the evaluation of rehabilitative measures available for the cognitive and behavioral consequences of TBI. Although studies are relatively limited, available evidence supports the use of certain cognitive and behavioral rehabilitation strategies for individuals with TBI. This research needs to be replicated in larger, more definitive clinical trials. (ABSTRACT TRUNCATED)

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Rehabilitation of persons with traumatic brain injury

Although goal theorists have speculated about the causes and consequences of making progress at personal goals, little longitudinal research has examined these issues. In the current prospective study, participants with stronger social and self-regulatory skills made more progress in their goals over the course of a semester. In turn, goal progress predicted increases in psychological well-being, both in short-term (5-day) increments and across the whole semester; At both short- and long-term levels of analysis, however, the amount that well-being increased depended on the "organismic congruence" of participants' goals. That is, participants benefited most from goal attainment when the goals that they pursued were consistent with inherent psychological needs. We conclude that a fuller understanding of the relations between goals, performance, and psychological well-being requires recourse to both cybernetic and organismic theories of motivation.

Pursuing Personal Goals: Skills Enable Progress, but Not all Progress is Beneficial

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(08)60342-6.pdf

Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis.

Goal attainment scaling is a mathematical technique for quantifying the achievement (or otherwise) of goals set, and it can be used in rehabilitation. Because several different approaches are described in the literature, this article presents a simple practical approach to encourage uniformity in its application. It outlines the process of setting goals appropriately, so that the achievement of each goal can be measured on a 5-point scale ranging from -2 to +2, and then explains a method for quantifying the outcome in a single aggregated goal attainment score. This method gives a numerical T-score which is normally distributed about a mean of 50 (if the goals are achieved precisely) with a standard deviation of around this mean of 10 (if the goals are overachieved or underachieved). If desired, the approach encompasses weighting of goals to reflect the opinion of the patient on the personal importance of the goal and the opinion of the therapist or team on the difficulty of achieving the goal. Some practical tips are offered, as well as a simple spreadsheet (in Microsoft Excel) allowing easy calculation of the T-scores.

Goal attainment scaling (GAS) in rehabilitation: a practical guide

Objective: The authors quantified nonverbal synchrony—the coordination of patient's and therapist's movement—in a random sample of same-sex psychotherapy dyads. The authors contrasted nonverbal synchrony in these dyads with a control condition and assessed its association with session-level and overall psychotherapy outcome. Method: Using an automated objective video analysis algorithm (Motion Energy Analysis; MEA), the authors calculated nonverbal synchrony in (n = 104) videotaped psychotherapy sessions from 70 Caucasian patients (37 women, 33 men, mean age = 36.5 years, SD = 10.2) treated at an outpatient psychotherapy clinic. The sample was randomly drawn from an archive (N = 301) of routinely videotaped psychotherapies. Patients and their therapists assessed session impact with self-report postsession questionnaires. A battery of pre- and postsymptomatology questionnaires measured therapy effectiveness. Results: The authors found that nonverbal synchrony is higher in genuine interactions contrasted with pseudointeractions (a control condition generated by a specifically designed shuffling procedure). Furthermore, nonverbal synchrony is associated with session-level process as well as therapy outcome: It is increased in sessions rated by patients as manifesting high relationship quality and in patients experiencing high self-efficacy. Higher nonverbal synchrony characterized psychotherapies with higher symptom reduction. Conclusions: The results suggest that nonverbal synchrony embodies the patients' self-reported quality of the relationship and further variables of therapy process. This hitherto overlooked facet of therapeutic relationships might prove useful as an indicator of therapy progress and outcome.

Nonverbal synchrony in psychotherapy: Coordinated body movement reflects relationship quality and outcome.

There is an extensive literature on Goal Attainment Scaling (GAS), but the publications are widely scattered and often inaccessible, covering several foreign countries and many professional disciplines and fields of application. This book provides both a user manual and a complete reference work on GAS, including a comprehensive account of what the method is, what its strengths and limitations are, how it can be used, and what it can offer. The book is designed to be of interest to service providers, program directors and administrators, service and business organizations, program evaluators, researchers, and students in a variety of fields. No previous account of GAS has provided an up-to-date, comprehensive description and explanation of the technique. The chapters include a basic "how to do it" handbook, step-by-step implementation instructions, frequently occurring problems and what should be done about them, methods for monitoring the quality of the goal setting process, and a discussion of policy and administration issues. There are many illustrations from actual applications including examples of goals scaled for the individual, the specific program, the agency, or the total system. Procedures for training and estimates of training costs are also provided.

Goal Attainment Scaling : applications, theory, and measurement

Goal Attainment Scaling is emerging as one of the most frequently utilized methods of evaluating mental health programs. However, little material is available on the practical problems encountered in training mental health clinicians to use Goal Attainment Scaling. This report details some of the difficulties encountered and the training program that evolved when a large scale research program used Goal Attainment Scaling as the criterion of outcome.

Aaron Smith

Papers

Goal Attainment Scaling : applications, theory, and measurement

Training in the use of Goal Attainment Scaling.

Illustrations of Goal Setting

Goal Setting, Follow-Up, and Goal Monitoring

Reliability of Goal Attainment Scores