Abstract
Purpose There is currently a large scope of unmet need in addressing persistent cognitive difficulties after mild traumatic brain injury (mTBI) affecting higher order aspects such as reasoning, strategic learning, and other executive functions (EFs), with potential lasting impacts on academic and everyday life functioning. This study sought to explore the potential for cognitive training delivered via telepractice to enhance cognitive performance after mTBI in adolescence, a critical stage for frontal lobe maturation and EF development. Method This nonrandomized pilot intervention study explored the effects of telepractice delivery of a top-down, strategy-based cognitive training approach, namely, Strategic Memory Advanced Reasoning Training, on higher order strategic learning skills, along with related executive processes and real-life EF behaviors. Twelve adolescents (ages 12–18 years) who were at least 3 months post-mTBI completed 10 individual sessions over 4–6 weeks, delivered using Skype. Results After training, participants exhibited significant improvements in their ability to abstract meanings and recall facts from complex information. They also demonstrated generalized gains in untrained EFs of working memory and cognitive flexibility as well as potential gains in real-life EF behaviors, per parent report. Conclusions Whereas the findings need to be replicated in a larger, randomized study, the preliminary data suggest the clinical utility of training metacognitive strategies to improve top-down cognitive control functions after mTBI that are adaptable and adoptable across academic and real-life domains. Furthermore, leveraging an interactive telepractice communication platform has the potential to maximize the reach of cognitive training/intervention delivery while minimizing costs as well as time and travel demands.
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