1. TeleCognitive Training In Adults With Traumatic Brain Injury
Asha Vas, Molly Keebler, Kay Moolenijzer, Sandi Chapman
Center for BrainHealth, University of Texas at Dallas
BACKGROUND
TBI is a chronic health condition. Long-term monitoring, including assessment and training, are critical to sustain and optimize function and prevent later emerging deficits or decline in cognitive capacities (Corrigan & Hammond, 2013).
Several factors such as geography, disability, resources, and travel costs hinder the current model of coming back to rehabilitation centers. Therefore, tele-rehab may offer a viable solution to achieve later-stage follow-up with clinicians (Brennan et al., 2010).
AIMS and HYPOTHESES
Overall goal: To examine feasibility of online delivery of a proven reasoning training labeled Strategic Memory Advanced Reasoning Training (SMART) in adults with TBI
Aim 1: To examine effects of SMART on higher-order reasoning in adults with TBI
Hypothesis 1: Adults with TBI will show significant gains in higher-order reasoning (trained domain) at post-SMART as compared to pre-SMART.
Aim 2: To explore generalizable benefits of SMART to untrained cognitive domains
Hypothesis 2: The effects of SMART will generalize to untrained abilities including mental flexibility, innovation, and memory
Aim 3: To determine benefits of SMART on daily-life functionality
Hypothesis 3: The effects of SMART will be evident on improved participation in daily life tasks and psychological resilience.
METHODS
Design- Pre-post feasibility study
Participants: N=10, (7 men, 3 women) including seven civilians, and three veterans
Training: Ten-twelve sessions (1 hr. each) over weeks on Skype audio-video interactive platform.
Measures:
EF-Abstraction, WM, inhibition, switching, memory
Questionnaires- participation in daily life activities, depressive symptoms, and resilience
Pre- and post-training assessments-in person.
Analysis: ANOVA to compare pre- versus post-SMART cognitive and psychological functioning
Demographic and Clinical Characteristics
Mean (SD)
Range
Age
42.9 (11.37)
22-65
Edu
17.4 (1.9)
14-20
GOSe
6.2 (1.14)
4-8
SES
49.5(6.93)
IQpre
115.7 (7.66)
IQcurrent
114 (11.55)
96-134
Note- GOSe- Glasgow Outcome Scale Extended, SES- Socio economic status, IQ- Intelligence Quotient.
DISCUSSION and SIGNIFICANCE for REHABILITATION
The current proposal extends emerging approaches to leverage a telehealth platform of two-way audio- video interaction to maximize access to cognitive rehabilitation in adults with TBI.
Telehealth top-down training programs such as SMART are feasible and beneficial in training higher-order reasoning abilities, even in chronic stages of recovery. Furthermore, improved reasoning abilities could generalize to associated executive functions, psychological health, resilience, and daily function.
Online delivery of cognitive training could have significant economic & health policy implications.
More research is needed to examine and validate TeleCognitive training as standard TBI care.
RESULTS
Significant gains: Memory (p<.01), depressive symptoms (p<.01), resilience (p<.05), and participation in daily life activities (p<.05).
Positive trends: executive functions
REFERENCES
1. Brennan, D., Tindall, L., Theodoros, D., Brown, J., Campbell, M., Christiana, D., et al. (2010). A blueprint for telerehabilitation guidelines. International Journal of Telerehabilitation, 2(2), 31.
2. Corrigan, J. D., & Hammond, F. M. (2013). Traumatic brain injury as a chronic health condition. Archives of Physical Medicine and Rehabilitation, 94(6),
Supported by the Friends of Brain Health Research Award and the Dee Wyly BrainHealth Research fund.