Changes in brain-behavior relationships following a 3-month pilot cognitive intervention program for adults with traumatic brain injury

S Porter, I J Torres, W Panenka, Z Rajwani, D Fawcett, A Hyder, N Virji-Babul, S Porter, I J Torres, W Panenka, Z Rajwani, D Fawcett, A Hyder, N Virji-Babul

Abstract

Facilitating functional recovery following brain injury is a key goal of neurorehabilitation. Direct, objective measures of changes in the brain are critical to understanding how and when meaningful changes occur, however, assessing neuroplasticity using brain based results remains a significant challenge. Little is known about the underlying changes in functional brain networks that correlate with cognitive outcomes in traumatic brain injury (TBI). The purpose of this pilot study was to assess the feasibility of an intensive three month cognitive intervention program in individuals with chronic TBI and to evaluate the effects of this intervention on brain-behavioral relationships. We used tools from graph theory to evaluate changes in global and local brain network features prior to and following cognitive intervention. Network metrics were calculated from resting state electroencephalographic (EEG) recordings from 10 adult participants with mild to severe brain injury and 11 age and gender matched healthy controls. Local graph metrics showed hyper-connectivity in the right inferior frontal gyrus and hypo-connectivity in the left inferior frontal gyrus in the TBI group at baseline in comparison with the control group. Following the intervention, there was a statistically significant increase in the composite cognitive score in the TBI participants and a statistically significant decrease in functional connectivity in the right inferior frontal gyrus. In addition, there was evidence of changes in the brain-behavior relationships following intervention. The results from this pilot study provide preliminary evidence for functional network reorganization that parallels cognitive improvements after cognitive rehabilitation in individuals with chronic TBI.

Keywords: Evidence-based medicine; Neurology; Rehabilitation.

Figures

Fig. 1
Fig. 1
Baseline functional connectivity measures showing differences between TBI − Baseline and controls in local connectivity measures. (A. F10 Hub Value; B. F7 Degree; C. F7 Betweenness; D. F7Hub Value).
Fig. 2
Fig. 2
Post-intervention connectivity measures for TBI − Baseline, TBI − 3 Months Post Intervention compared to Controls, showing significant changes after 3 months in F10 Degree (A.), F10 Betweenness (B.) and F10 F10Hub Value (C.).
Fig. 3
Fig. 3
Scatter plot showing relationship between Global Density and Global composite score in controls, TBI participants at baseline and TBI participants at 3 months post intervention.
Fig. 4
Fig. 4
(A). Scatter plot showing the relationship between RAVALT and Density in controls, TBI participants at baseline and TBI participants at 3 months post intervention. (B). Scatter plot showing the relationship between RAVALT and F10 Degree in controls, TBI participants at baseline and TBI participants at 3 months post intervention.

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