Abstract

BackgroundSome individuals who sustain traumatic brain injuries (TBIs) continue to experience significant cognitive impairments chronically (months to years post injury). Many tests of executive function are insensitive to these executive function impairments, as such impairments may only appear during complex daily life conditions. Daily life often requires us to divide our attention and focus on abstract goals. In the current study, we compare the effects of two 1-month electronic cognitive rehabilitation programs for individuals with chronic TBI. The active program (Expedition: Strategic Advantage) focuses on improving goal-directed executive functions including working memory, planning, long-term memory, and inhibitory control by challenging participants to accomplish life-like cognitive simulations. The challenge level of the simulations increases in accordance with participant achievement. The control intervention (Expedition: Informational Advantage) is identical to the active program; however, the cognitive demand level is capped, preventing participants from advancing beyond a set level. We will evaluate these interventions with a military veteran TBI population.Methods/designOne hundred individuals will be enrolled in this double-blinded clinical trial (all participants and testers are blinded to condition). Each individual will be randomly assigned to one of two interventions. The primary anticipated outcomes are improvement of daily life cognitive function skills and daily life functions. These are measured by a daily life performance task, which tests cognitive skills, and a survey that evaluates daily life functions. Secondary outcomes are also predicted to include improvements in working memory, attention, planning, and inhibitory control as measured by a neuropsychological test battery. Lastly, neuroimaging measures will be used to evaluate changes in brain networks supporting cognition pre and post intervention.DiscussionWe will test whether electronically delivered cognitive rehabilitation aimed at improving daily life functional skills will provide cognitive and daily life functional improvements for individuals in the chronic phase of TBI recovery (greater than 3 months post injury). We aim to better understand the cognitive processes involved in recovery and the characteristics of individuals most likely to benefit. This study will also address the potential to observe generalizability or to transfer from a software-based cognitive training tool toward daily life improvement.Trial registrationClinicalTrials.gov, NCT03704116. Retrospectively registered on 12 Oct 2018.

Highlights

  • Some individuals who sustain traumatic brain injuries (TBIs) continue to experience significant cognitive impairments chronically

  • We will test whether electronically delivered cognitive rehabilitation aimed at improving daily life functional skills will provide cognitive and daily life functional improvements for individuals in the chronic phase of TBI recovery

  • We propose a study aimed at improving cognitive difficulties in individuals with chronic TBI through training on cognitive tasks set within the context of carrying out daily life functions

Read more

Summary

Discussion

This trial investigates training to improve cognition in individuals with mild and moderate chronic TBI. We are evaluating two treatment methods, ESA (active) and EIA (control). The efficacy of these treatments will be evaluated using experimental measures of daily life functioning and neuropsychological measures emphasizing cognitive abilities and neuroimaging measures, including fMRI, DTI, and rsfMRI. An estimated 59% of military personnel have sustained closedhead injuries. Many TBI interventions do not jointly address both cognitive and functional impairments. The proposed effort will evaluate the efficacy of VR-based intervention tools for meeting these needs. Telemedicine intervention tools are essential for addressing the underserved military chronic TBI population. Trial status At the time of the submission of this manuscript (January 29, 2019; Version 2 of protocol), enrollment was ongoing.

Background
Methods
Findings
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call