Metacognitive occupation-based training in traumatic brain injury

Clients with impaired self-awareness following brain injury may benefit from an occupation-based approach to metacognitive training that uses real-life meaningful occupations in a supported therapy context. Metacognitive training aims to improve clients' intellectual awareness by demonstrating the impact of impairments on activities and participation, and thereby facilitate realistic collaborative goal setting and strategy use. Occupational performance takes place in real-life contexts to provide familiar structured experiences that allow for error recognition and error correction. Training strategies include the use of self-prediction before occupational performance; self-monitoring and self-checking during performance; and self-evaluation, verbal or video feedback, and education following performance. The occupational therapist plays a supportive role and monitors the client's emotional responses. A small but growing body of research evidence supports the use of occupation-based metacognitive training