Improving Cognitive and Functional Deficits After TBI Using Virtual Technology
Abstract
Traumatic brain injury (TBI) is the leading cause of death and disability in Americans under age 45, with approximately 2% of citizens having a TBI-related disability. As many as 15% of returning Veterans meet criteria for mild TBI, representing greater than 90% of military TBI. Interventions that address the cognitive symptoms associated with TBI can have a large impact on quality of life. Improvements in brain function can be made months to years after the occurrence of the TBI or TBIs in accordance with the mission of the Clinical and Rehabilitative Medicine Research Program (CRMRP). Training through cognitive interventions may be required to restore function at later stages when brain healing slows. Many of our current Veterans and military are under-served by a lack of access to cognitive interventions that address their daily life needs. Addressing the challenge of chronic TBI symptoms is made difficult, as most cognitive interventions require numerous site visits to a physical location, typically a Veterans Affairs (VA) hospital or other clinical facility. This delivery method presents challenges, as many Veterans do not wish to self-identify as having psychological or performance difficulties and visit a therapist. Having to enroll in a research study to evaluate problems with cognition and emotional functions is often not appealing. This has led to high levels of difficulty carrying out research to address the challenge of chronic TBI. It is also a significant challenge for reaching many individuals most in need of intervention training. Another challenge of the multiple visit-based intervention delivery format is that many individuals with chronic TBI symptoms have difficulties scheduling their daily affairs and planning transportation. This makes it especially challenging for individuals in need to regularly attend their clinical visits, leading to high dropout rates in clinical intervention studies and treatments. Lastly, many cognitive interventions are aimed at training attention or memory, rather than cognition as it applies to real-life problems. A better approach for chronic TBI interventions is to train cognition in a way that addresses real-life challenges, while maintaining strong experimental control and reflecting clear cognitive functions. The proposed project seeks to build our capacity to reach, engage, and sustain cognitive improvement in America s fighting men and women in a way that addresses the challenges they face in daily life. We will accomplish this through the use of virtual reality (VR) technologies that may better simulate the difficulties that military personnel and Veterans face in performing daily life activities. Individuals enrolled in the study will be issued a laptop loaded with the VR intervention software as well as software to connect with a clinical interventionist, who will virtually meet with the participant twice per week and provide coaching sessions and information on strategies that can be applied toward VR cognitive performance improvement and toward engaging these same skills in the context of daily life. The combination of technologically based rehabilitation and virtual human sessions has the advantage of providing both skill-acquisition through repeated practice with the advantages of human input and guidance. The VR format is highly familiar to many Veterans of recent wars. The remote deployment of the system will alleviate repeated clinical site visits and transportation challenges. The focus on a game-based rehabilitation training regime will emphasize cognitive improvement packaged in a user-friendly manner. Reducing attention deficits and improving planning are important targets toward helping people to perform effectively in job situations, manage personal affairs, and maintain social connections. The potential to remediate deficits in memory, attention, and planning can be a key step toward improving the lives of Veterans who frequentl
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 31, 2017
- Source ID
- W81XWH1610053
Entities
People
- Daniel C Krawczyk
Organizations
- United States Army
- University of Texas at Dallas