Abstract
Nearly half of all mild brain injury sufferers experience long-term cognitive impairment, so an important goal in rehabilitation is to address their multiple cognitive deficits to help them return to prior levels of functioning. Cognitive training, or the use of repeated mental exercises to enhance cognition, is one remediation method for brain injury. The primary purpose of this hypothesis-generating pilot study was to explore the statistical and clinical significance of cognitive changes and transfer of training to real-life functioning following 60 h of Brain Booster, a clinician-delivered cognitive training program, for six patients with mild traumatic brain injury (TBI) or non-traumatic acquired brain injury (ABI). The secondary purpose was to explore changes in functional connectivity and neural correlates of cognitive test gains following the training. We used a multiple case study design to document significant changes in cognitive test scores, overall IQ score, and symptom ratings; and we used magnetic resonance imaging (MRI) to explore trends in functional network connectivity and neural correlates of cognitive change. All cognitive test scores showed improvement with statistically significant changes on five of the seven measures (long-term memory, processing speed, reasoning, auditory processing, and overall IQ score). The mean change in IQ score was 20 points, from a mean of 108 to a mean of 128. Five themes emerged from the qualitative data analysis including improvements in cognition, mood, social identity, performance, and Instrumental Activities of Daily Living (IADLs). With MRI, we documented significant region-to-region changes in connectivity following cognitive training including those involving the cerebellum and cerebellar networks. We also found significant correlations between changes in IQ score and change in white matter integrity of bilateral corticospinal tracts (CST) and the left uncinate fasciculus. This study adds to the growing body of literature examining the effects of cognitive training for mild TBI and ABI, and to the collection of research on the benefits of cognitive training in general.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02918994.
Highlights
Cognitive deficits are common following brain injury, especially in working memory, attention, and processing speed – skills that are critical for information processing, decision making, and learning
She had no loss of consciousness or visible injuries and declined transport for medical attention at the time of the accident. She was diagnosed with whiplash at an urgent care clinic the following day after presenting with neck pain and headache. She was later diagnosed with diffuse traumatic brain injury (TBI) with loss of consciousness less than 30 min by a neuropsychiatrist
For the DTI structural connectivity Fractional Anisotropy (FA) analysis, we found three significant positive correlations out of the 17 total correlations between changes in IQ score and changes in white matter tract FA after controlling for multiple comparisons using the Benjamini Hochberg False Discovery Rate (FDR) method
Summary
Cognitive deficits are common following brain injury, especially in working memory, attention, and processing speed – skills that are critical for information processing, decision making, and learning. An important goal in rehabilitation is to address the multiple cognitive deficits seen in sufferers of mild brain injury to help them return to prior levels of functioning. The literature is replete with studies examining the efficacy of several cognitive training methods across diagnostic categories, for moderate to severe traumatic brain injury (TBI) (Ragnarsson et al, 1999; Hallock et al, 2016; Cicerone et al, 2019). Sharma et al (2017) examined the feasibility of a 12 weeks, selfadministered digital cognitive training program for patients with moderate to severe TBI, reporting on no efficacy results but finding a 30% attrition rate and only a 42.6% completion rate.
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