Neural Bases of Cognitive Rehabilitation for Brain Injury

Brain injury often results in a disruption of attentional regulation processes, which reduces
the efficiency and effectiveness of cognitive functions including learning, memory,
problem-solving and goal management, leading to significant functional disability. Despite
the importance of these problems, few effective interventions are available. Current projects
involve developing novel theory-driven neural biomarkers and behavioral measurement tools and
training interventions that target attentional control processes. The collection of results
will help delineate neural mechanisms that support improved attention regulation that may
serve as neurobiological targets for the development of novel interventions that enhance the
benefits of rehabilitation.

In a controlled intervention study design, individuals with traumatic brain injury (TBI) and
chronic executive control dysfunction will participate in comparison interventions, with pre-
and post-intervention measurements of performance on neurocognitive 'challenge' tests
assessing targeted and non-targeted domains, functional performance in low structure
'real-world' settings, and functional MRI measurements assessing goal-directed information
processing. The interventions are: Goal-oriented attentional self-regulation (GOALS)
training, Brain Health Education (EDU), Pathfinder Attention Regulation Training (PATH), and
Tonic and Phasic Alertness Training (TAPAT).

GOALS is designed to train attention regulation skills with meta-cognitive strategies for
goal management, with application to participant-selected projects.

Brain Health Education is designed to increase knowledge and understanding of key factors
that affect brain functioning.

Pathfinder training is designed to intensively train goal-directed self-regulation skills
using a combination of digital game scenarios and application to personal life.

TAPAT is designed to improve alertness at two levels: tonic attention of sustained attention
and phasic alertness, or the capacity to rapidly and effectively interrupt an ongoing
response pattern.

Participants undergo fMRI, neuropsychological and functional assessments at baseline,, after
the interventions, and at follow-up.

Inclusion Criteria:

Patients with a history of TBI (reported plausible mechanism of head injury, loss of
consciousness with some period of post-traumatic alteration in cognition) who are > 6
months post-injury will be screened for evidence of mild-moderate residual dysfunction in
executive control functions based on corroborated reports of real-world difficulties
(Mayo-Portland Adaptability Inventory).

Exclusion Criteria:

- Severely apathetic/abulic

- aphasic

- or other reasons for patients being unable or unwilling to participate with the
training tasks

- severe cognitive dysfunction

- history of neurodevelopmental abnormalities

- ongoing illicit drug or alcohol abuse (AUDIT>8)

- severe depression as measured by Beck Depression Inventory (>29)

- severe PTSD precluding participation in research activities (such as group training or
MRI scanning)

- There will be no restriction in regard to gender, race and socioeconomic status.