Planning disorder after closed head injury: a case study.

Disturbances of executive functioning after traumatic brain injury represent significant obstacles to social and vocational recovery and may require specific remedial intervention. We report the treatment of a client with impaired planning ability and poor self-control after closed head injury. Intervention consisted of a self-instructional procedure that required him to verbalize a plan of behavior before and during execution of the training task and gradually faded overt verbalization. There was systematic reduction of off-task behaviors and problem-solving errors over the eight weeks of training. Pre- and postmeasures showed significant changes consistent with increased planning ability. Self-control ratings of everyday behaviors improved with explicit training to promote generalization. Training of plan-ahead and self-verbalization strategies appears effective for remediation of executive functioning after traumatic brain injury. Generalization to real-life situations can be observed with extended training.