OBJECTIVES. The use of cognitive strategies optimizes performance in complex everyday tasks such as shopping. This exploratory study examined the cognitive strategies people with traumatic brain injury (TBI) effectively use in an unstructured, real-world situation. METHOD. A behavioral analysis of the self-generated strategic behaviors of 5 people with severe TBI using videotaped sessions of an ecological shopping task (Instrumental Activities of Daily Living Profile) was performed. RESULTS. All participants used some form of cognitive strategy in an unstructured real-world shopping task, although the number, type, and degree of effectiveness of the strategies in leading to goal attainment varied. The most independent person used the largest number and a broader repertoire of self-generated strategies. CONCLUSION. These results provide initial evidence that occupational therapists should examine the use of self-generated cognitive strategies in real-world contexts as a potential means of guiding therapy aimed at improving independence in everyday activities for people with TBI.
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