Retraining Neural Pathways Improves Cognitive Skills After A Mild Traumatic Brain Injury This study seeks to address the challenge of how to deliver targeted interventions that address individualized cognitive needs of mild traumatic brain injury (mTBI) patients. mTBIs are prevalent, with over 2.5 million concussions occurring in the U.S. each year with only 1 in 6 of these concussions being diagnosed. mTBIs represent 80% of TBIs. The bulk of mTBIs result from motor vehicle accidents, falls, and situations involving sudden acceleration and/or deceleration of the head, such as sports injuries. A mTBI can result in substantial cognitive impairments, with an inability to return to work or school, and low levels of satisfaction with one's quality of life. Currently, there are no proven solutions to remediate cognitive deficits prevalent in those with a mTBI. Visual timing deficits are persistent in individuals with a mild TBI (mTBI), and are thought to be due to processing deficits in the dorsal pathways, and attention and executive control networks. The premise of the current proposal is rehabilitative treatments for those with a mTBI fall short because these timing issues are not being addressed. To address these limitations, we developed a movement-discrimination intervention (PATH training) that is designed to stimulate dorsal motion pathways. PATH is hypothesized to improve the precision in timing of visual events, and in turn improve cognitive functions that rely upon visual timing, such as working memory span, a function that is commonly impaired in mTBI patients. This study will provide clinical testing of therapeutic training for the treatment of cognitive disorders caused by a mTBI. We will extend previous results from a pilot study of four mTBI subjects to a much larger sample of mTBI subjects. We will determine the feasibility of an intervention that remediates visual timing deficits to improve visual and cognitive deficits in mTBI more than a Sham or a conventional working memory training task. The proposed study tests the ability of PATH neurotraining to improve visual working memory, and processing speed (primary outcomes) and auditory working memory (WM), selective attention, cognitive flexibility, sustained attention, reading speed, and reading proficiency (secondary outcomes) in mTBI subjects rapidly and effectively. We predict that PATH training is more effective than either conventional WM training or Sham training. These predictions will be evaluated by both percentile scores on neuropsychological tests of cognitive function, scores on reading speed, reading proficiency, MoCA screening test, and questionnaires, and Magnetoencephalography (MEG) brain recordings for a subset of subjects in treatment groups, providing a biomarker, as is required for commercialization. MEG brain recordings will be used to determine whether PATH neurotraining improves the function of the visual motion, attention, and working memory networks more than found after N-Back WM training. MEG recordings will also be used to determine whether PATH neurotraining strengthens coupled: 1) theta/gamma activity, and 2) alpha/ gamma activity. There is a need to provide a proven solution for a mTBI by developing, and marketing a rapid and effective treatment shown in clinical trials to improve cognitive skills.
Public Health Relevance Statement: This study will contribute to the fundamental knowledge of how to remediate visual and cognitive deficits resulting from a mTBI to enhance the health, lengthen the life and reduce the disabilities that result from a mTBI. The goal of this study is to determine the feasibility of a timing intervention (PATH neurotraining) to significantly improve working memory, processing speed (primary outcomes) and auditory working memory, selective attention, cognitive flexibility, sustained attention, reading speed, and reading proficiency (secondary outcomes) in mTBI patients more than after either Sham or conventional working memory training The present work is a critical step towards establishing feasibility of PATH training and determining early stage data demonstrating efficacy and understanding individual differences regarding which participants with mTBI may be the best targets for these types of timing interventions.
Project Terms: Acceleration; ages; Age; Athletic Injuries; Sports Injuries; Attention; Back; Dorsum; Brain; Brain Nervous System; Encephalon; Brain Concussion; Cerebral Concussion; Commotio Cerebri; concussion; concussive; Clinical Trials; Cognition Disorders; cognitive disease; cognitive disorder; cognitive syndrome; Deceleration; Diagnosis; Discrimination; Cognitive Discrimination; Exhibits; Goals; Head; Health; Magnetoencephalography; MEG imaging; magnetoencephalographic imaging; Marketing; Memory; Short-Term Memory; Immediate Memory; Shortterm Memory; working memory; Motion; Movement; body movement; Neural Pathways; Neurons; Nerve Cells; Nerve Unit; Neural Cell; Neurocyte; neuronal; Neuropsychological Tests; Neuropsychologic Tests; Patients; Pilot Projects; pilot study; Quality of life; QOL; Questionnaires; Reaction Time; Response RT; Response Time; psychomotor reaction time; Reading; Rehabilitation therapy; Medical Rehabilitation; Rehabilitation; rehab therapy; rehabilitative; rehabilitative therapy; Research; Rest; Running; Schools; Standardization; Testing; Unconscious State; Unconscious; Unconsciousness; consciousness loss; Veterans; Visual Cortex; visual cortical; Work; falls; Prefrontal Cortex; dosage; improved; Lateral; Dorsal; Area; Phase; Training; disability; selective attention; Visual; Individual; satisfaction; Education for Intervention; Instruction Intervention; Training Intervention; instructional intervention; Educational Intervention; Impaired cognition; Cognitive Disturbance; Cognitive Impairment; Cognitive decline; Cognitive function abnormal; Disturbance in cognition; cognitive dysfunction; cognitive loss; Nature; Knowledge; Life; cognitive function; Auditory; Event; Stream; Post-Concussion Syndrome; Post-Concussion Symptoms; Post-Concussive Symptoms; Post-Concussive Syndrome; processing speed; age group; Performance; Speed; neurotransmission; Nerve Impulse Transmission; Nerve Transmission; Neuronal Transmission; axon signaling; axon-glial signaling; axonal signaling; glia signaling; glial signaling; nerve signaling; neural signaling; neuronal signaling; Cognitive deficits; cognitive defects; novel; Participant; vehicular accident; Motor carrier accident; motor vehicle accident; Sampling; response; Intervention; Intervention Strategies; interventional strategy; executive function; executive control; therapeutic testing; therapeutic evaluation; automobile accident; car accident; Address; Data; research clinical testing; Clinical Evaluation; Clinical Testing; clinical test; Cognitive; Process; Behavioral; Pathway interactions; pathway; designing; design; remediation; Outcome; Patients with traumatic brain injury; traumatic brain injury patients; TBI Patients; Population; Individual Differences; Visual Motion; Coupled; Impairment; Cognitive remediation; trial comparing; improve function; improved functional outcomes; functional improvement; commercialization; primary outcome; secondary outcome; effective treatment; effective therapy; bio-markers; biologic marker; biomarker; Biological Markers; flexible; flexibility; screenings; screening; reading achievement; reading competence; reading proficiency; reading ability; personalization of treatment; personalized therapy; personalized treatment; personalized medicine; cognitive assessment; cognitive testing; cognitive ability; attentional control; neural correlate; cognitive skill; phase 2 trial; phase II trial; sustained attention; MTBI; mild TBI; mild brain trauma; mild traumatic brain injury; treatment group; phase II designs; phase 2 designs
