1. The document describes research conducted on Goal-Oriented Attentional Self-Regulation (GOALS) training for veterans with traumatic brain injury (TBI). 2. Pilot and randomized controlled studies found GOALS training improved attention, executive function, daily functioning and goal attainment more than active controls. 3. Long term follow-ups found many participants maintained gains and increased return to work/school rates compared to before training. Ongoing research examines GOALS for comorbid TBI/PTSD.

1. Presented by:
Tatjana Novakovic-Agopian & Gary Abrams
PNS Teleconference 11/23/15
Support: VA R&D
SFVA Brain Injury Rehabilitation Research
Strengthening Cognitive Control
Functions
Attentional Regulation and Problem Solving
Applied to Individual Goals

2. SFVA Brain Injury Rehabilitation Research
Gary Abrams, M.D.
Katelyn Begany, BS
Debra Binder, MS
Joaquin Burciaga, PhD
Gerald Carlin, OTR/L
Holli Castelli, OTR/L
Anthony Chen, MD
Mark D’Esposito, M.D.
Rich Fitzsimmons, MS
John Garfinkle, M.S.
Cathy Kennedy, PT
Erica Kornblith, PhD
Audrey Kossman, MS
Melissa Loughlin, PT
Karen Lau, PhD
Fred Loya, PhD
Michelle Madore, PhD
Charles Mayer
Kacey Marton, MA
John McQuaid, PhD
James Muir, PhD
Michelle Murphy, PsyD
Thomas Neylan, MD
Tatjana Novakovic-Agopian, PhD
Erica Pool, BS
Sarah Ramsdale, OTR/L
Nick Rodriguez, BS
Scott Rome, MD
Annemarie Rossi, OTR/L
Gary Turner, PhD

3. 1. Brain injury rehabilitation interventions targeting
executive control functions
2. Multi-level behavioral outcome assessments,
including ecologically valid functional outcome
measurements
3. Long term outcome assessment
4. Determination of neural mechanisms of plasticity
SFVA Brain Injury Rehabilitation Research

4. .
Cognitive Training Method:
Group and individual manualized (therapist and participant) training.
Participants’ practice applying attention regulation and problem solving
strategies on progressively more challenging tasks and situations in
their daily life, and on selection and execution of feasible individual and group projects.
Duration/intensity: 5 weeks: 20hrs (10 group mtgs), 3 hrs individual training, 20hrs of homework
Goal-Oriented Attentional Self-regulation - GOALS
Training in attention regulation and problem
solving applied to individually defined goals.
Multi level outcomes assessed (some variation depending on study) :
Neuropsychological measures of attention/executive function and memory;
Performance on complex ‘real life’ functional task
assessing subcomponents of executive functioning;
Self-report on measures of daily functioning and
emotional regulation
Goal-directed control over neural processing;
Populations studied: Adults with mild to
moderate functional deficits in executive control
(concentration, multitasking, planning, organization)
2 to: chronic ABI; TBI; co-morbid mTBI/PTSD;
healthy aging

5. .
1) Completed: Pilot study with 16 individuals with chronic ABI showed significant
improvements post GOALS but not brief control on (Novakovic-Agopian, et.al
JHTR, 2011; Chen, Novakovic-Agopian, et al Brain, 2011):
Neuropsychological measures of attention/executive function and memory;
Performance on complex functional task;
Goal-directed control over neural processing;
Long term follow-up (6 months - 2 yrs; 16/16 completed): 50% (8/16 reported
returning to work (6 work for pay; 2 volunteer), as compared to 13% (2/16) prior
to training. 87% reported continuing using some trained strategies
GOALS Studies

6. .
2) Recently Completed: Randomized control study with Veterans with chronic
TBI. Preliminary results from 32 Veterans indicate significant improvements post
GOALS, but not matched control Brain Health EDU training on (Novakovic-Agopian,
et al., ACRM , 2015):
Neuropsychological measures of attention/executive function;
Performance on complex ‘real life’ functional task (Novakovic-Agopian, et.al
JHTR, 2014)
Self report measures of emotional regulation and daily functioning
Ongoing Long Term Follow-up (6 ms -18ms; 22 /28 completed): Participants
continued to demonstrate significant post -training improvements relative to
baseline on all above assessed domains.
45% (10/22) reported returning to competitive work, as compared to 23% (5/22)
prior to training .
GOALS as preparation for return to work/school?
GOALS Studies

7. .
3) Ongoing: Randomized control study of GOALS vs matched Brain Health
EDU training in Veterans with co-morbid PTSD/mTBI.
Does strengthening cognitive control functions improves functioning in other functional
domains such as emotional regulation?
Preliminary results from 12 Veterans indicate significant improvements
post GOALS, but not matched control Brain Health EDU training on
(Novakovic-Agopian, Abrams. et al., to be presented at INS , 2016):
Neuropsychological measures of attention/executive function;
Performance on complex ‘real life’ functional task
Self report measures of emotional regulation and daily functioning
GOALS Studies

8. Novakovic-Agopian, T., Abrams G., Chen, A., et.al. Executive Function Training in
Veterans with Chronic TBI: Short and Longer Term Outcomes. Presentation at the
ACRM Conference, Dallas, TX, October 2015
Novakovic-Agopian, T., Abrams G., Chen, A., et.al Goal-Oriented Attentional Self-
Regulation Training in Veterans with Chronic TBI- Long Term Outcomes.
Presentation at the International Neuropsychological Conference, Denver CO, February
2015
Novakovic-Agopian, T., Chen, A., Abrams G., et.al Goal-Oriented Attention and
Problem Solving Training in Veterans with Chronic TBI. Presentation at the National
Academy of Neuropsychology Conference, Puerto Rico, November, 2014.
Novakovic-Agopian, T., Chen, A., Abrams G., et.al. Goal-Oriented Executive Function
Training in Veterans with Chronic TBI: Short and Longer Term Outcomes. Paper
presentation at the 10th World Congress on Brain Injury, March 2014, San Francisco,
CA
Novakovic-Agopian, T., Chen, A. Goal-Directed Attention Regulation and Problem
Solving. VA Cyber seminar, March 2014.
Novakovic-Agopian, T., Chen, A., Abrams G., et.al. Short and Long Term Outcomes
of GOALS Executive Function Training in Veterans with Chronic TBI. International
Neuropsychological Conference, Seattle WA, February 2014
GOALS Studies- Presentations 2014-2015