Abstract
BackgroundAcquired Brain Injury (ABI) admissions have an incidence of 385 per 100,000 of the population in the UK, and as brain injury often involves the frontal networks, cognitive domains affected are likely to be executive control, working memory, and problem-solving deficits, resulting in difficulty with everyday activities. The above observations make working memory, and related constructs such as attention and executive functioning attractive targets for neurorehabilitation. We propose a combined home-based rehabilitation protocol involving the concurrent administration of a working memory training program (adaptive N-back task) with non-invasive transcranial direct current stimulation (tDCS) of the right dorsolateral prefrontal cortex to promote long-lasting modification of brain areas underlying working memory function.MethodPatients with a working memory deficit will be recruited and assigned to two age-matched groups receiving working memory training for 2 weeks: an active group, receiving tDCS (2 mA for 20 min), and a control group, receiving sham stimulation. After the end of the first 2 weeks, both groups will continue the working memory training for three more weeks. Outcome measures will be recorded at timepoints throughout the intervention, including baseline, after the 2 weeks of stimulation, at the end of the working memory training regimen and 1 month after the completion of the training.DiscussionThe aim of the study is to assess if non-invasive tDCS stimulation has an impact on performance and benefits of a working memory training regimen. Specifically, we will examine the impact of brain stimulation on training gains, if changes in gains would last, and whether changes in training performance transfer to other cognitive domains. Furthermore, we will explore whether training improvements impact on everyday life activities and how the home-based training regimen is received by participants, with the view to develop an effective home healthcare tool that could enhance working memory and daily functioning.Trial registrationThis study was registered with clinicaltrials.gov: NCT04010149 on July 8, 2019.
Highlights
Acquired Brain Injury (ABI) admissions have an incidence of 385 per 100,000 of the population in the UK, and as brain injury often involves the frontal networks, cognitive domains affected are likely to be executive control, working memory, and problem-solving deficits, resulting in difficulty with everyday activities
The aim of the study is to assess if non-invasive transcranial direct current stimulation (tDCS) stimulation has an impact on performance and benefits of a working memory training regimen
We will examine the impact of brain stimulation on training gains, if changes in gains would last, and whether changes in training performance transfer to other cognitive domains
Summary
The overarching aim of the study is to assess if a specific form of non-invasive brain stimulation, namely direct current, has an impact on performance during a working memory training regimen in patients with an acquired brain injury. The focus of this study are chronic brain injury patients These patients are no longer in a clinical setting but have returned home and are seen by the Community Brain Injury Service for community-based rehabilitation. This trial will provide valuable knowledge to health authorities and the research community on the potential of non-invasive brain stimulation and training regimens in addressing chronic cognitive impairment in clinical populations. By evaluating performance at 1 month after the completion of the training regimen, we will shed new light on the long-term effects of cognitive training, identifying potential modulatory effects of brain stimulation This finding will, in turn, inform future protocols, in order to maximise improvement of cognitive functions while minimizing the amount of training necessary.
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