Brain stimulation in attention deficits after traumatic brain injury: a literature review and feasibility study

Ève Boissonnault,Dorothy Barthélemy,Geneviève Lagarde,Johanne Higgins,Céline Lamarre,Jehane H Dagher

doi:10.1186/s40814-021-00859-3

Abstract

BackgroundAfter a traumatic brain injury, disturbances in the attentional processes have a direct negative effect on functional recovery and on return to complex activities. To date, there is no good attention remediation treatment available. The primary objective of this review and pilot study is to provide an overview of the research evidence and to evaluate the feasibility of implementing a tDCS protocol to improve attention disorders in patients with mild complicated to severe subacute TBI, hospitalized in an inpatient rehabilitation facility. Our secondary objective is to extract preliminary data and observational information on participants’ response to treatment.MethodsParticipants were recruited from a consecutive series of patients admitted to the TBI unit of a subspecialized regional rehabilitation center. They received a 20-min tDCS stimulation 3 times a week for 3 weeks. A neuropsychological evaluation was performed before and after the intervention. We collected participants’ sociodemographic and clinical characteristics as well as information about satisfaction, tolerability, and adverse effects.ResultsOne hundred sixty-four patients were admitted between September 2018 and January 2020. One hundred fifty-eight were excluded, and 6 patients with presumed attentional deficits were enrolled. None completed the protocol as intended. No major side effects occurred.ConclusionNon-invasive brain neurostimulation is promising to enhance attention deficits in patients with TBI. Implementation of a tDCS protocol to fulfill this purpose in an intensive inpatient rehabilitation center has its limitations. We made recommendations to facilitate the implementation of similar projects in the future.Trial registrationISRCTN, ISRCTN55243064. Registered 14 October 2020—retrospectively registered.

Highlights

After a traumatic brain injury, disturbances in the attentional processes have a direct negative effect on functional recovery and on return to complex activities
Eligible patients were approached by a physician or nurse external to the research team, and written informed consent was obtained from all participants
A total of 164 patients were admitted to the traumatic brain injury (TBI) unit at the IURDPM for intensive rehabilitation between September 2018 and January 2020; all were identified for this research project

Summary

Introduction

After a traumatic brain injury, disturbances in the attentional processes have a direct negative effect on functional recovery and on return to complex activities. The primary objective of this review and pilot study is to provide an overview of the research evidence and to evaluate the feasibility of implementing a tDCS protocol to improve attention disorders in patients with mild complicated to severe subacute TBI, hospitalized in an inpatient rehabilitation facility. In the USA, annually, over 20,000 adults receive inpatient rehabilitation for moderate-to-severe traumatic brain injury (TBI) [1]. In the acute stage of TBI, impaired consciousness and post-traumatic amnesia are mostly seen, whereas attentional deficits, memory impairments, communication disorders, altered processing speed, and executive dysfunction are noted in the subacute period [5]

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Results

Discussion

Conclusion