Home-Based, Online Mindfulness and Cognitive Training for Soldiers and Veterans with TBI
Abstract
The Scientific Objective: In this proposal, online individuated brain training program (cognitive training + mindfulness/stress-reduction training) with caregiver support portal and lifestyle monitor will be evaluated as a quality of life (QOL)-enhancing strategy by comparing it to an active control condition (casual video games + online traumatic brain injury [TBI] information session) for Veterans with TBI. Our main project goals are (a) to determine the effectiveness of this advanced brain training approach; (b) to initiate strategies that encourage and document other key lifestyle changes known to contribute to brain health; (c) to further optimize delivery strategies to ensure near-universal access; (d) to assure that training has restored brain health and brought the patient to a better, safer brain-health level; and (e) to determine long-term patient fates. To achieve these goals, we will randomize 80 Veterans with TBI to 12 weeks of in-home brain training vs. a control intervention. Patient outcomes will be measured primarily using neuropsychological assessments in processing speed (composite score of Pattern Comparison, Digit Symbol Coding, and Letter Comparison). As secondary measures, we will use neuropsychological assessments in attention (composite score of Attentional Blink, and Stroop), working memory (composite score of Picture Sequence Memory Test, and the Rey Auditory Verbal Learning Test), and executive function (composite score of Trail Making B and Task Switch). Functional and structural magnetic resonance imaging (MRI) will be used to measure structural and functional neurological changes attributable to these interventions. The Functional Activities Questionnaire shall be used to document everyday function activity levels. Self-reported sleep quality, physical activity, levels of social communication, brain healthy diet, and mood shall be documented using daily program-embedded questionnaires delivered throughout the training to further measure QOL impacts and to help determine the magnitude and endurance of increased resilience after training completion. Rationale: The fundamental science of brain plasticity -- the study of mechanisms by which the brain undergoes functional, structural, and chemical change -- has rapidly advanced over the past two decades. We now know that the brain is continuously plastic, subject to training-based refinement, re-strengthening, and reconnection, at any age. There is strong evidence that cognitive training (CT) targeting functional neurological system recoveries can effectively restore more normal functionality, repairing and rejuvenating neurological processes after stroke or TBI. In earlier studies, scientists working collaboratively with our Posit Science team have engaged normally aging and higher-risk (e.g., Mild Cognitive Impairment, MCI) participants in training, using limited subsets of modules that shall be a part of these customized cognitive training programs. Results showed significant gains in assessments of memory and cognitive control indicating substantial near- and far-transfer. Furthermore, imaging studies demonstrated that activation in brain area (left hippocampus), which is most commonly affected in MCI and early Alzheimer s disease (AD), increased after cognitive training as compared to the decreased activation in the control group. These observations show that despite presumed injury to the hippocampus in MCI that typically leads to AD, the hippocampus in MCI retains sufficient neuroplasticity to benefit from cognitive remediation. Further, these studies suggest that we can reactivate disconnected Default Mode Network (DMN)-level machinery, where AD symptomatology emerges early in disease progression -- in individuals with high risk of AD onset. Along with CT, the proposed brain training program provides Mindfulness/Stress-reduction Training (MT). MT has been employed to improve cognitive control and to train individuals w
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 31, 2017
- Source ID
- W81XWH1610685
Entities
People
- Hyun Kyu Lee
Organizations
- Posit Science Corporation
- United States Army