A randomized clinical trial of plasticity-based cognitive training in mild traumatic brain injury

Abstract

Clinical practice guidelines support cognitive rehabilitation for people with a history of mild traumatic brain injury (mTBI) and cognitive impairment, but no class I randomized clinical trials have evaluated the efficacy of self-administered computerized cognitive training. The goal of this study was to evaluate the efficacy of a self-administered computerized plasticity-based cognitive training programmes in primarily military/veteran participants with a history of mTBI and cognitive impairment. A multisite randomized double-blind clinical trial of a behavioural intervention with an active control was conducted from September 2013 to February 2017 including assessments at baseline, post-training, and after a 3-month follow-up period. Participants self-administered cognitive training (experimental and active control) programmes at home, remotely supervised by a healthcare coach, with an intended training schedule of 5 days per week, 1 h per day, for 13 weeks. Participants (149 contacted, 83 intent-to-treat) were confirmed to have a history of mTBI (mean of 7.2 years post-injury) through medical history/clinician interview and persistent cognitive impairment through neuropsychological testing and/or quantitative participant reported measure. The experimental intervention was a brain plasticity-based computerized cognitive training programme targeting speed/accuracy of information processing, and the active control was composed of computer games. The primary cognitive function measure was a composite of nine standardized neuropsychological assessments, and the primary directly observed functional measure a timed instrumental activities of daily living assessment. Secondary outcome measures included participant-reported assessments of cognitive and mental health. The treatment group showed an improvement in the composite cognitive measure significantly larger than that of the active control group at both the post-training [+6.9 points, confidence interval (CI) +1.0 to +12.7, P = 0.025, d = 0.555] and the follow-up visit (+7.4 points, CI +0.6 to +14.3, P = 0.039, d = 0.591). Both large and small cognitive function improvements were seen twice as frequently in the treatment group than in the active control group. No significant between-group effects were seen on other measures, including the directly-observed functional and symptom measures. Statistically equivalent improvements in both groups were seen in depressive and cognitive symptoms.

Chronic Mild Traumatic Brain Injury: Aberrant Static and Dynamic Connectomic Features Identified Through Machine Learning Model Fusion

“…Secondly, their neurocognitive status largely reflected the “natural” course of illness recovery, not affected by systematic neuropsychiatric interventions. These characteristics render the present sample suitable to assess the chronic impact of mTBI given the, at least modest, effect of suspected malingering (Ross, Putnam, and Adams, 2006 ), and the documented impact of cognitive (Mahncke et al, 2021 ) and physical rehabilitation (Snyder et al, 2021 ) upon cognitive recovery.…”

Identification of Key Genes and Pathways in the Hippocampus after Traumatic Brain Injury: Bioinformatics Analysis and Experimental Validation

“…TBI is one of the most common traumatic injuries which can cause long-lasting cerebral damage and cognitive deficits [25]. Elucidating the potential molecular mechanisms and therapeutic targets for improving cognitive function helps to improve the clinical prognosis and alleviate the burden on patients suffering from TBI [26]. Transcriptomic profiling is a powerful tool that can identify the genes differ-entially expressed in specific physiological and pathological states and discover new diagnostic or therapeutic targets [27].…”

Consensus statement: An evidence‐based review of exercise, rehabilitation, rest, and return to activity protocols for the treatment of concussion and mild traumatic brain injury

“…Seven studies, including six RCTs and one small prospective comparative study, [82][83][84][85][86][87][88] were identified on cognitive rehabilitation. One study involved adolescents with acute concussion.…”