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Struggling to plan and organise after a brain injury?
Losing track halfway through a task, struggling to plan the day, or starting lots of things and finishing none. These are some of the most common, and least visible, effects of brain injury.
What are executive difficulties?
Executive functions are the thinking skills we use to manage everyday life: planning, organising, starting tasks, keeping track, switching between things, and noticing and correcting mistakes. After a brain injury or stroke these skills can be affected, even when memory and intelligence seem fine.
It can look like:
- forgetting what you went into a room for
- starting a meal and losing track of the steps
- struggling to prioritise at work
- missing appointments, or double-booking
- finding it hard to get started, or to stop
Because people often appear well, these difficulties can be mistaken for lack of effort, which is frustrating for the person and their family.
What is Goal Management Training?
Goal Management Training is a structured approach that teaches people to regularly stop, check what they’re trying to achieve, break the goal into steps, and check progress as they go. It’s based on theory about how attention and goals can drift, and it’s practised on real-life tasks.
What the research shows
In early studies, people with traumatic brain injury who received Goal Management Training made significant gains on everyday paper-and-pencil tasks compared with people given motor-skills training, and a separate case study showed improved meal preparation after training.1 A later study with 19 people in the chronic phase after brain injury, mostly stroke, supported its effectiveness for executive difficulties,2 and a randomised controlled trial in chronic acquired brain injury also evaluated it alongside external cueing.3
As with all rehabilitation, it works best when strategies are practised in the person’s own daily life.
How OT helps
- Assessing how executive difficulties affect real tasks at home, work or study
- Teaching structured strategies such as Goal Management Training
- Setting up external supports like planners, phone reminders and checklists
- Practising on meaningful tasks: cooking, finances, work routines, appointments
- Supporting family members to help without taking over
- Planning a graded return to work or education
How NexGen can help
We provide cognitive rehabilitation for children, young people and adults after brain injury and stroke, practised on the tasks that matter in daily life, and liaise with schools, employers and case managers.
Questions
Can executive function improve years after a brain injury?
Many people can improve how they manage daily tasks, even years later, by learning and practising strategies. An assessment will help set realistic goals.
Is this the same as memory problems?
Not exactly. Memory and executive function often overlap, but executive difficulties are about managing and organising tasks. We assess both.
Can cognitive rehabilitation be done virtually?
Some of it can, particularly strategy learning and planning. Practising real tasks at home is often most effective.
References
- Levine B, Robertson IH, Clare L, et al. Rehabilitation of executive functioning: an experimental–clinical validation of Goal Management Training. J Int Neuropsychol Soc 2000;6:299–312.
- Levine B, Schweizer TA, O’Connor C, et al. Rehabilitation of executive functioning in patients with frontal lobe brain damage with Goal Management Training. Front Hum Neurosci 2011;5:9. Link
- Tornås S, Løvstad M, Solbakk AK, et al. Rehabilitation of executive functions in patients with chronic acquired brain injury with Goal Management Training, external cuing, and emotional regulation: a randomized controlled trial. J Int Neuropsychol Soc 2016;22(4):436–452.
This article is general information, not a substitute for individual clinical advice. If you have new or worsening symptoms, speak to your GP or NHS 111.
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