Article 10: Effect of cognitive retraining on reorganization of attention network in patients with traumatic brain injury

Abstract

Objective: To identify the areas of reorganization in the neural network for attention after cognitive retraining in the patients with traumatic brain injury (TBI) using functional MRI (fMRI). Design: Controlled clinical trials. Setting: Department of physical medicine and rehabilitation in general hospital. Participants: Ten TBI patients and 12 healthy volunteers participated. Interventions: Patients had received computer-assisted cognitive retraining to practice diverse attention skills for 3 to 4 weeks. Main Outcome Measures: fMRI was performed on a 3T ISOL Forte scanner with single-shot echoplanar imaging sequences before and after the intervention using a modified Posner paradigm as an activation task. Data were analyzed using Statistical Parametric Mapping 99. Results: The accuracy was lower and reaction time was slower in the patient group ( P<.001). fMRI results showed more activation in the right prefrontal and less activation in the cingulate, occipitotemporal, and cerebellar regions in the patients than in the normal group. After cognitive retraining, reaction time improved significantly ( P<.05). fMRI analysis showed a decrease in activation of the bilateral frontal and an increase in activation of the medial frontal areas after cognitive retraining. Conclusion: The effect of cognitive retraining was accompanied by reorganization of attention networks in frontal areas.