Metacognitive Strategies for Training of Daily Living Skills in People with Brain Damage: The Self-Regulation and Mental Imagery Program


Daily tasks for training

Week 1

Put clothes on hanger
Fold the laundry
Prepare a cup of tea
Wash the dishes
Carry out a money transaction

Week 2

Prepare fruit
Make the bed
Take medication
Use the telephone
See the doctor

Week 3

Sweep the floor
Tidy the table after a meal
Fry vegetables with meat
Go to a park/outdoors
Go to the canteen

Mental imagery is the platform with which clients rehearse the processes of analyzing the task, identifying problems, generating solutions, and mentally practicing the self-rectified performance on the task. Each of the steps of this process is listed in Table 31.2.

Table 31.2
Use of mental imagery in occupational performance training of clients suffering from brain damage

Task analysis enhancement

Tell the participant the task to be trained
Get the participant to identify the steps in the task through mentally imagining the task
Present the participant with the computer-generated task steps for verification of self-identified steps

Problem identification

Get the participant to visualize his or her own performance with the help of the steps shown in the computer program on the steps of the task
Get the participant to identify the problems encountered and solutions in each step by going through the mental process

Task performance

Get the participant to imagine his or her own task ­performance with the rectified steps
Get the participant to actually perform the task and ­videotape the performance
Get the participant to evaluate the performance on the ­videotape so as to adjust the problems and solutions
Repeat the above steps until the participant learns the tasks with the proper method

The Self-Regulation and Mental Imagery Intervention Program

This program focuses on clients’ active self-learning for performing daily living tasks that they performed smoothly before the brain damage occurred. The client learns to perform the daily tasks (Table 31.1) by using the strategies of self-regulation and mental imagery . The OT guides the client to develop appropriate strategies to overcome the problems.

The program takes 3 weeks. The clients receive training in five 1-h sessions each week. The client performs the specific daily tasks included in each session. These tasks include, for example, functioning of mobility , balance, and upper limb coordination. The level of difficulty of each set of tasks is organized in a demand-ascending order (Table 31.2). However, among these tasks, the demands are overlapping. The training of the easiest task set (e.g., folding laundry) is practiced in the first week, while the most difficult task set (e.g., shopping and use of transportation) is practiced in the third week. This design aims to enhance generalization of skills learned from one stage to another (Liu 2009; Liu et al. 2009).

The first week is used for training of the clients’ skills in using self-regulations. The client identifies the deficits in performing the various sequential steps of a task (e.g., for tearing the tea bag). Once identified, the client would need to generate the best alternatives to complete the task. Examples of the best alternatives would be stabilizing the tea bag with the weaker arm or using the better hand to manipulate the tea bag while tearing the tea bag. Tasks used in the program are presented in Table 31.1.

The second and third weeks are used for training the clients’ ability to perform tasks based on mental imagery. Here, the clients mentally rehearse the solutions generated from the self-regulation, as if the task is to be executed with the process. The work process for use of mental imagery is presented in Table 31.1.

Previous studies indicate that mental imagery was composed of sequential mental processes, which include attention, memory, and visualization of images and generalization (Chow et al. 2007).

Evidence-Based Practice

The self-regulation is widely applied (1) in the field of education for behavioral management and problem solving (Post et al. 2006), (2) to enhance self-awareness of impairments (Ownsworth and Clare 2006), and (3) for conducting occupational performance tasks for a client with brain damage (Liu et al. 2002; Liu and Chan 2014). Mental imagery is most often used in training of motor function (moving blocks, reaching for and grasping an object) . An audiotape (Page et al. 2005) or occupational performances (Liu 2009; Liu et al. 2004a, b, 2009) were used to guide the imagery process. The results of a recent meta-analysis showed positive effects on recovery of upper extremity motor function after stroke (Kho et al. 2013). Liu and colleagues (Liu 2009; Liu et al. 2004a, b, 2009) showed that using metacognitive strategies had positive effects on improving performance on tasks learned in the program and generalization effects to other occupations apart from those used during the training sessions. This positive effect lasted 1 month after discharge from the program.


People with brain damage participate in rehabilitation programs. The role of OTs is to teach clients to relearn occupational performance of daily living tasks. Here, various teaching methods are used.

The most common method is demonstration and then practice. After analyzing the clients’ behavioral problems, OTs generate ways of rectifying the problem and demonstrate the rectified behavior for the client, who learns through imitation. The effectiveness of this teaching method is called into question.

Instead, metacognition, using the strategies of the self-regulation and mental imagery , that is, the clients’ active awareness of the process of learning, is a critical ingredient in successful learning. This learning approach initiates the clients’ ways of solving the problems and planning for the action. The results last over time and even generalize to new tasks.

Mental imagery is more effective if those who practice the technique have a thorough understanding of their own body capacity. This principle is applied when the strategy of the self-regulation is used to help clients to recapture their own capabilities and become familiar with their “new” body functioning.

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May 21, 2017 | Posted by in GENERAL | Comments Off on Metacognitive Strategies for Training of Daily Living Skills in People with Brain Damage: The Self-Regulation and Mental Imagery Program
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