Prospection and its relationship to instrumental activities of daily living in patients with mild traumatic brain injury with cognitive impairment

Objective: Prospection is the ability to plan ahead by creating a series of intentions and sequential steps to achieve a particular goal. The current study examined whether prospection was compromised in patients who had sustained a mild traumatic brain injury (mTBI) and who claimed to be disabled because of their chronic cognitive impairment, as operationalized by an inability to achieve goals (e.g. return to work) well after their expected recovery.Method: This study employed the Tower of London (TOL) to measure prospection and compared two groups of patients who sustained a mTBI who both presented with cognitive impairment, but were or were not disabled in terms of their real world functioning (as defined by their instrumental activities of daily living, IADLs).Results: The results revealed that the TOL could reliably discriminate between these two groups. In subsequent structural equation modelling, TOL scores were used to create a prospection model that was able to predict IADLs functioning.Conclusions: This study demonstrates that prospection is a critical component of one's ability to function independently following the onset of a mTBI when chronic cognitive impairment is evident and that clinicians should routinely investigate prospection in this context.