This study provides preliminary evidence that short-term intensive training in top-down modulation of information benefits gist-reasoning and generalizes to measures of executive function and real life function at chronic stages of post-TBI.
Little is known about strategic learning ability in preteens and adolescents with traumatic brain injury (TBI). Strategic learning is the ability to combine and synthesize details to form abstracted gist-based meanings, a higher-order cognitive skill associated with frontal lobe functions and higher classroom performance. Summarization tasks were used to measure strategic learning ability through the production of abstracted gist-based concepts, and specific probes measured memory for explicit details. Twenty middle school-aged preteens and teenagers who sustained a moderate to severe TBI 1 year postinjury and a control group of 20 typically developing 10-to 15-year-old subjects participated in this study. The results revealed that the youth with moderate to severe TBI were able to recall specific details at a comparable level to the control group. However, the youth with TBI demonstrated significantly lower strategic learning competence, as manifested by a reduced ability to combine details into gist-based ideas. The present findings advance the notion that skills that have not yet developed at the time of brain injury or are in a stage of development may be particularly vulnerable to the long-term and lasting sequelae of TBI in youth, although a longitudinal study is needed to verify this claim.
Adolescents with traumatic brain injury (TBI) typically demonstrate good recovery of previously acquired skills. However, higher-order and later emergent cognitive functions are often impaired and linked to poor outcomes in academic and social/behavioral domains. Few control trials exist that test cognitive treatment effectiveness at chronic recovery stages. The current pilot study compared the effects of two forms of cognitive training, gist reasoning (top-down) versus rote memory learning (bottom-up), on ability to abstract meanings, recall facts, and utilize core executive functions (i.e., working memory, inhibition) in 20 adolescents (ages 12–20) who were 6 months or longer post-TBI. Participants completed eight 45-min sessions over 1 month. After training, the gist reasoning group (n = 10) exhibited significant improvement in ability to abstract meanings and increased fact recall. This group also showed significant generalizations to untrained executive functions of working memory and inhibition. The memory training group (n = 10) failed to show significant gains in ability to abstract meaning or on other untrained specialized executive functions, although improved fact recall approached significance. These preliminary results suggest that relatively short-term training (6 h) utilizing a top-down reasoning approach is more effective than a bottom-up rote learning approach in achieving gains in higher-order cognitive abilities in adolescents at chronic stages of TBI. These findings need to be replicated in a larger study; nonetheless, the preliminary data suggest that traditional cognitive intervention schedules need to extend to later-stage training opportunities. Chronic-stage, higher-order cognitive trainings may serve to elevate levels of cognitive performance in adolescents with TBI.
Social problem solving was assessed in 28 youth ages 12-19 years (15 with moderate to severe traumatic brain injury (TBI), 13 uninjured) using a naturalistic, computerized virtual reality (VR) version of the Interpersonal Negotiations Strategy interview (Yeates, Schultz, & Selman, 1991). In each scenario, processing load condition was varied in terms of number of characters and amount of information. Adolescents viewed animated scenarios depicting social conflict in a virtual microworld environment from an avatar's viewpoint, and were questioned on four problem solving steps: defining the problem, generating solutions, selecting solutions, and evaluating the likely outcome. Scoring was based on a developmental scale in which responses were judged as impulsive, unilateral, reciprocal, or collaborative, in order of increasing score. Adolescents with TBI were significantly impaired on the summary VR-Social Problem Solving (VR-SPS) score in Condition A (2 speakers, no irrelevant information), p = 0.005; in Condition B (2 speakers + irrelevant information), p = 0.035; and Condition C (4 speakers + irrelevant information), p = 0.008. Effect sizes (Cohen's d) were large (A = 1.40, B = 0.96, C = 1.23). Significant group differences were strongest and most consistent for defining the problems and evaluating outcomes. The relation of task performance to cortical thickness of specific brain regions was also explored, with significant relations found with orbitofrontal regions, the frontal pole, the cuneus, and the temporal pole. Results are discussed in the context of specific cognitive and neural mechanisms underlying social problem solving deficits after childhood TBI.
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