PC-Based Cognitive Rehabilitation for Traumatic Brain Injury (TBI)

PC-Based Cognitive Rehabilitation for TBI

The investigators evaluated whether it was possible to improve the measurement of memory, attention, and executive function in patients who have suffered traumatic brain injury through the use of computer-based testing.

Note: the original design of the study was altered due to failure to recruit sufficient numbers of patients who were willing to undergo prolonged cognitive training.

Study Overview

• Status: Completed
• Conditions: Traumatic Brain Injury
• Intervention / Treatment: Behavioral: Digit span testing; Behavioral: Spatial span testing; Behavioral: Finger tapping; Behavioral: Simple reaction time; Behavioral: Choice reaction time; Behavioral: Verbal fluency; Behavioral: Verbal list learning; Behavioral: Trail making test; Behavioral: Design fluency; Behavioral: Questionnaire completion

Detailed Description

Here we describe a series of computer-based tests that were used to evaluate memory, attention, and executive function in large groups of control subjects and in patients with chronic mild and moderate/severe TBI. This extensive battery of neuropsychological tests (NPTs) and subjective rating scale measures were obtained at study entry from the TBI cohort. NPT and rating scale data were compared to those obtained from control subjects to characterize the cognitive deficits following mild, moderate and severe TBI. .

Normative data were obtained by regressing the influences of age, education, and computer use on scores to create normed z-scores on different NPTs,. We hypothesized that patient with TBI would show deficits on tests of memory, attention, and executive function relative to their predicted z-scores (based on the aforementioned regression functions) and that deficits would be more pronounced in patients with severe TBI than in patients with mild TBI.

• Study Type: Observational
• Enrollment (Actual): 265

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years to 74 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Controls subjects of various ages (approximately 230), and TBI patients (approximately 30).

Description

Inclusion Criteria:

Control subjects were required to meet the following inclusion criteria:

• (a) fluency in the English language
• (b) no current or prior history of bipolar disorder, mania, or schizophrenia
• (c) no current substance abuse
• (d) no concurrent history of neurologic disease known to affect cognitive functioning
• (e) on a stable dosage of any required medication
• (f) auditory functioning sufficient to understanding normal conversational speech and visual acuity normal or corrected to 20/40 or better

Exclusion criteria:

• History of TBI

Exclusion Criteria for TBI patients:

• TBI patients had to meet the same inclusion criteria as the controls with the exception that they were required to have a history of TBI. They also had to be in the chronic phase, i.e., 1-4 yrs post-injury.

• Exclusion criteria:

  • current substance abuse
  • current psychiatric diagnosis other than PTSD

Study Plan

How is the study designed?

Design Details

• Observational Models: Ecologic or Community
• Time Perspectives: Cross-Sectional

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Control subjects; Control subjects = 237. These subjects underwent extensive testing with computerized neuropsychological tests including digit span testing, spatial span testing, simple reaction time testing, choice reaction time testing, finger tapping, verbal fluency, design fluency, verbal list learning, questionnaire completion, and the trail making test.	Behavioral: Digit span testing; Testing of short-term verbal memory with digit span; Behavioral: Spatial span testing; Testing of short-term visuospatial memory with spatial span.; Behavioral: Finger tapping; Testing motor speed with a finger tapping test.; Behavioral: Simple reaction time; Testing the time to respond to the appearance of a visual stimulus.; Behavioral: Choice reaction time; Testing the time needed to discriminate and respond to different visual stimuli.; Behavioral: Verbal fluency; Evaluating how many words are produced in 90s.; Behavioral: Verbal list learning; Evaluating short-term memory, learning, and memory interference in the recall of 12-word lists, presented three times. Evaluating long-term memory and recognition after a 20 min interval.; Behavioral: Trail making test; Evaluating visuomotor speed and executive function in Trail Making Tests, A and B. In the first, subjects connect successive numbers with the mouse. In the second, they connect numbers and letters in alternation.; Behavioral: Design fluency; Subjects create the maximal number of 4-line patterns in 90 s.; Behavioral: Questionnaire completion; Question completion time is measured on each question of the Post-Traumatic Stress Disorder check list (PCL) and on the cognitive failures questionnaire.
TBI patients; TBI patients N = 28. These patients underwent extensive testing with computerized neuropsychological tests including digit span testing, spatial span testing, simple reaction time testing, choice reaction time testing, finger tapping, verbal fluency, design fluency, verbal list learning, questionnaire completion, and the trail making test.	Behavioral: Digit span testing; Testing of short-term verbal memory with digit span; Behavioral: Spatial span testing; Testing of short-term visuospatial memory with spatial span.; Behavioral: Finger tapping; Testing motor speed with a finger tapping test.; Behavioral: Simple reaction time; Testing the time to respond to the appearance of a visual stimulus.; Behavioral: Choice reaction time; Testing the time needed to discriminate and respond to different visual stimuli.; Behavioral: Verbal fluency; Evaluating how many words are produced in 90s.; Behavioral: Verbal list learning; Evaluating short-term memory, learning, and memory interference in the recall of 12-word lists, presented three times. Evaluating long-term memory and recognition after a 20 min interval.; Behavioral: Trail making test; Evaluating visuomotor speed and executive function in Trail Making Tests, A and B. In the first, subjects connect successive numbers with the mouse. In the second, they connect numbers and letters in alternation.; Behavioral: Design fluency; Subjects create the maximal number of 4-line patterns in 90 s.; Behavioral: Questionnaire completion; Question completion time is measured on each question of the Post-Traumatic Stress Disorder check list (PCL) and on the cognitive failures questionnaire.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Performance in TBI Patients and Controls	Subjects were assessed on a set of cognitive tests. Here we describe the results on the simple reaction time test in which subjects respond as rapidly as possible to the computer-controlled occurrence of a visual stimulus by pressing a mouse button. Two control groups were used. One large control group underwent a single test to provide data from subjects with a broad range of age and education. The other, smaller, control group underwent three tests at weekly intervals to evaluate the test-retest reliability of the measure.	Subjects were tested in a single 2-hr session.

Collaborators and Investigators

• Sponsor: US Department of Veterans Affairs

Publications and helpful links

General Publications

• Atkins Whitmer D, Woods DL. Analysis of the cost effectiveness of a suicide barrier on the Golden Gate Bridge. Crisis. 2013;34(2):98-106. doi: 10.1027/0227-5910/a000179.
• Disbrow EA, Russo KA, Higginson CI, Yund EW, Ventura MI, Zhang L, Malhado-Chang N, Woods DL, Sigvardt KA. Efficacy of tailored computer-based neurorehabilitation for improvement of movement initiation in Parkinson's disease. Brain Res. 2012 May 3;1452:151-64. doi: 10.1016/j.brainres.2012.02.073. Epub 2012 Mar 9.
• Whitaker KJ, Kang X, Herron TJ, Woods DL, Robertson LC, Alvarez BD. White matter microstructure throughout the brain correlates with visual imagery in grapheme-color synesthesia. Neuroimage. 2014 Apr 15;90:52-9. doi: 10.1016/j.neuroimage.2013.12.054. Epub 2014 Jan 7.
• Woods DL, Herron TJ, Yund EW, Hink RF, Kishiyama MM, Reed B. Computerized analysis of error patterns in digit span recall. J Clin Exp Neuropsychol. 2011 Aug;33(7):721-34. doi: 10.1080/13803395.2010.550602.
• Hubel KA, Reed B, Yund EW, Herron TJ, Woods DL. Computerized measures of finger tapping: effects of hand dominance, age, and sex. Percept Mot Skills. 2013 Jun;116(3):929-52. doi: 10.2466/25.29.PMS.116.3.929-952.
• Hubel KA, Yund EW, Herron TJ, Woods DL. Computerized measures of finger tapping: reliability, malingering and traumatic brain injury. J Clin Exp Neuropsychol. 2013;35(7):745-58. doi: 10.1080/13803395.2013.824070. Epub 2013 Aug 15.
• Woods DL, Kishiyamaa MM, Lund EW, Herron TJ, Edwards B, Poliva O, Hink RF, Reed B. Improving digit span assessment of short-term verbal memory. J Clin Exp Neuropsychol. 2011 Jan;33(1):101-11. doi: 10.1080/13803395.2010.493149.

Helpful Links

• laboratory website

Study record dates

Study Major Dates

• Study Start: July 1, 2009
• Primary Completion (Actual): March 1, 2013
• Study Completion (Actual): March 1, 2013

Study Registration Dates

• First Submitted: June 23, 2009
• First Submitted That Met QC Criteria: June 24, 2009
• First Posted (Estimate): June 25, 2009

Study Record Updates

• Last Update Posted (Estimate): July 31, 2015
• Last Update Submitted That Met QC Criteria: July 28, 2015
• Last Verified: July 1, 2015

More Information

Terms related to this study

• Keywords: memory; neuroplasticity; cognitive training; recovery of function; cognitive impairment; attention
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Wounds and Injuries; Craniocerebral Trauma; Trauma, Nervous System; Brain Injuries; Brain Injuries, Traumatic
• Other Study ID Numbers: B6119-R