Long-term compensatory treatment of organizational deficits in a patient with bilateral frontal lobe damage

Evans et al. (1998) described compensatory strategy use in R.P., a patient with executive dysfunction following bilateral frontal lobe damage who had difficulty acting upon her intentions. A pager was used to remind R.P. of regularly scheduled activities, along with a checklist that aimed to moderate a perseverative routine. Although successful, 10 years after the original intervention, the strategies were no longer used, and considerable everyday problems were evident. In the current study, we conducted a follow-up assessment to examine potential reasons for this deterioration. No change in neuropsychological functioning was evident. Whereas the previous study introduced the two strategies together, and examined effects upon separate goals, in the current study we reintroduced the two strategies separately, and examined effects on three common goals. In addition to prompting specific activities, we aimed to support completion of more general goals (those that could be enacted within a wider window of time). The paging intervention had a dramatic effect on all three measured behaviors, at a much more consistent level than the checklist. We suggest that, in addition to direct reminders, the pager can cue a process of goal monitoring that bridges the gap between intention and action.