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

Here we propose two randomized clinical trials to determine if at-home PC-based adaptive
training can improve cognitive function in chronic TBI patients. Both trials will use
protocols designed to drive beneficial neuroplastic changes using paradigms similar to those
that have shown promising results in smaller scale studies. The first experiment will
investigate the effects of training of short-term verbal and spatial memory. 36 patients
with chronic mild, moderate and severe TBI will be evaluated with an extensive battery of
neuropsychological tests (NPTs) and subjective rating scale measures at study entry. NPT and
rating scale data will be compared to those obtained from 100 matched control subjects to
characterize the cognitive deficits following mild, moderate and severe TBI. Patients will
then be randomly assigned to immediate training (IT) or delayed training (DT) groups in a
longitudinal crossover design. IT patients will begin training for 20 min/day on each of
three different memory tasks for a period of three months. Training data will be
automatically uploaded to monitor daily compliance and learning rate. NPT and rating scale
assessments will be obtained midway through the study. Comparisons of changes in trained
(IT) and untrained (DT) groups will be used to evaluate training efficacy. Then, during the
second phase of the study, the DT group will undergo identical training. Repeat testing at
the end of the study will quantify the effects of training on the DT group, and evaluate
retention of training benefit in the IT group.

The second experiment will evaluate the effects of training on attention and executive
function using a similar randomized trial with a separate group of 36 chronic TBI patents.
A comparison of the magnitude of training-related improvements in the two experiments will
be used to evaluate specific- and non-specific factors that contribute to training benefit
and identify the patient characteristics that are most critical for successful cognitive
rehabilitation.

Inclusion Criteria:

- Patients with a history of traumatic brain injury.

- Patients should reside in the Northern California region.

Exclusion Criteria:

- History of bipolar disorder, mania, or schizophrenia.

- No current substance abuse.

- 1-4 yrs post-injury.

- On stable dosage of any required medication.