Personalized, Augmented Cognitive Training (PACT) for Service Members and Veterans with a History of TBI
Abstract
Background: Mild traumatic brain injury (TBI) is a common medical condition that occurs when a head injury causes someone to lose consciousness, feel dazed or confused, or be unable to remember events occurring immediately after the injury. While most individuals with mild TBI recover within weeks or months, some individuals with mild TBI report chronic symptoms such as difficulty with cognitive skills like attention, learning, or memory, along with other symptoms such as irritability or headache. Previous studies, including those conducted by our scientific team, have shown that cognitive rehabilitation can help patients with persistent symptoms after mild TBI return to full duty, work, school, and other important life activities. Specifically, cognitive rehabilitation can provide lasting improvements in thinking abilities, functional capacity, post-concussive symptoms, and quality of life after mild TBI. However, effective interventions are still out of reach for many Service members and Veterans with TBI. For patients who have returned to duty, employment, or education, scheduling up to 60 hours of treatment (a typical treatment schedule in many settings) may not be feasible. Additionally, some patients may live in areas where it is burdensome to make numerous visits to a medical center. In response to these needs, our team has created a new treatment, Personalized Augmented Cognitive Training (PACT). PACT compresses treatment into 6 hours of once-weekly personalized, one-on-one training by selecting treatment modules based on patient needs and priorities — substantially reducing the total amount of time required to complete treatment. PACT can be offered either in-person (in clinic) or via home-based video telemedicine (i.e., Skype), depending upon patients’ preferences. Additionally, PACT includes training and encouragement for Service members and Veterans to make self-directed use of mobile apps that train cognitive skills and strategies. Objectives: The primary goal of this study is to evaluate whether PACT is effective at improving cognition, symptoms, and functional outcomes among military Service members and Veterans with a history of mild TBI. We also seek to learn more about factors that can enhance or interfere with treatment, such as number of previous TBIs, presence of post-traumatic stress, and choice of in-person vs. video telemedicine delivery of care. Military/Veteran Impact: Over 300,000 U.S. military personnel have sustained a mild TBI since 2000. Persistent post-concussive symptoms can result in reduced quality of life, reduced operational readiness, and difficulty with community reintegration. Cognitive rehabilitation has been shown to be effective; however, access to care is often disrupted by intensive treatment schedules, difficulties with transportation, and a lack of personalization based on patient’s individual challenges and preferences. This study will evaluate a new approach to improve Service members’ and Veterans’ access to effective cognitive intervention for mild TBI. If study results demonstrate that the PACT intervention is successful in reducing symptoms, improving cognition, or enhancing functional recovery, this safe and non-invasive intervention could implemented very rapidly within a wide range of Department of Defense (DoD) and Veterans Affairs (VA) settings, enhancing recovery, improving quality of life, and bolstering occupational performance. Our research team draws upon the expertise and leadership of numerous clinical scientists and providers within both DoD and VA environments. Additionally, this study will be supported by the Defense and Veterans Brain Injury Center (DVBIC), a DoD organization devoted to improving care for Service members and Veterans with TBI. This ensures that this study will be relevant to the military and Veteran communities. If the study is successful, members of the study team will represent the initial cadre of provider
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Nov 19, 2019
- Source ID
- W81XWH1910656
Entities
People
- Elizabeth W Twamley
Organizations
- United States Army
- Veterans Medical Research Foundation of San Diego