Remotely Supervised tDCS Combined with Cognitive Training to Improve Complex Attention in Active-Duty Service Members and Veterans with Mild TBI
Abstract
Objectives: Mild traumatic brain injury (mTBI) is a common medical condition that occurs when an injury to the head results in a loss of consciousness, feeling dazed or confused, or being unable to remember events occurring immediately after the injury. Difficulty with complex attention, a process that involves attention, concentration, and working memory, is one of the most commonly reported cognitive problems following mTBI. Existing treatments for mTBI-related cognitive difficulties require significant investments of time and effort, may be difficult to find, and have relatively small benefits that may not improve real life functioning. As a result, new, readily accessible interventions that improve complex attention are needed to improve outcomes and quality of life following mTBI and decrease time to recovery. Our research team will be evaluating a new approach to cognitive rehabilitation of mTBI using a brain stimulation technique called Remotely Supervised Transcranial Direct Current Stimulation combined with Cognitive Training (RS-tDCS+) that has shown promise for improving complex attention in both healthy and clinical populations. RS-tDCS+ is a home-based, low-risk, non-invasive technique that is designed to boost cognitive training by enhancing learning and the brain’s ability to reorganize connections. This study will evaluate RS- tDCS+ for improving complex attention in active-duty Service Members (ADSM) and Veterans with a history of mTBI. Different tests of complex attention and symptom questionnaires will be used to determine the effects of real versus sham (placebo) RS-tDCS+. Second, we will investigate electrical and connectivity changes in the brain associated with RS-tDCS+ using electroencephalogram (EEG) and magnetic resonance imaging (MRI). Third, we will investigate the lasting effects of any observed changes by evaluating participants at 1 and 6 weeks post-treatment. Lastly, we will explore the impact of individual differences (e.g., PTSD, depression, sleep quality, time since injury, baseline impairment, age, sex, ADSM versus Veteran) on treatment outcome. Focus Areas: The proposed study aligns closely with FY21 TBIPHRP Clinical Trial Award Treatment Focus Area 3a by investigating the efficacy of RS-tDCS+ in the chronic phase of recovery from mTBI (?3 months post- injury) to 1) increase accessibility to care, 2) improve cognitive functioning, post-concussion symptom outcomes, and quality of life, and 3) investigate the durability of the intervention in ADSM and Veterans. Risks: The safety and tolerability of RS-tDCS is well established. While some mild side effects (e.g., itching, burning, headache, fatigue) may be experienced, these resolve after stopping treatment. Benefit to Service Members, Veterans, and Family Members: The proposed study will accelerate the implementation of RS-tDCS+ by providing critically missing support for the efficacy and feasibility of improving complex attention deficits following mTBI using a randomized, controlled clinical trial that mimics clinical treatment. While this study may or may not benefit participants personally, others may benefit in the future as the results of this study may help the investigators further develop tools for improved treatment of mTBI. A community advisory board comprised of DOD and VA medical providers and former active-duty and Veteran TBI patients will be formed to ensure the project meets the needs of ADSM and Veterans. RS-tDCS+ addresses two major obstacles of current TBI treatments: accessibility and adherence. Most current treatments for cognitive challenges after mTBI require repeated in-person visits with a clinician. ADSM and Veterans typically have a variety of obstacles preventing either access/availability of care or ability to participate (e.g., proximity to the clinic, insufficient clinician staffing, long waiting lists, high operational tempo). While traditional clinical application of tDCS tr
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252311071
Entities
People
- Lars Hungerford
Organizations
- General Dynamics
- United States Army