Rehabilitation of Visual Attention Following mTBI

Mild traumatic brain injury (mTBI) is one of the most commonly sustained combat-related
injuries. Complaints of poor attention often follow mTBI and can become chronic in some
individuals. Chronic attention complaints have traditionally been treated with cognitive
rehabilitation by speech pathologists. Recent research has shown that computerized programs
may add additional value either independently or in conjunction with traditional therapies.
Researchers at UC Riverside have already completed research showing that vision training,
using the ULTIMEYES program that they created, led to improved vision both on standard
assessments, such as reading eye-charts, and in real world skills, such as reading and
playing baseball. This program is designed to broadly improve basic aspects of vision, such
as visual acuity and contrast sensitivity, as well as high-level vision, such as attention.
Furthermore, an associated memory training task (Recall The Game) shows improvements in
memory tasks and transfer to skills such as fluid intelligence.

The objective of this proposal is to evaluate the effectiveness of rehabilitation for visual
attention deficits in U.S. military service members across three programs:

1. Visual Attention and Memory Program (UCR Games)

2. Cognitive and Psychological Based Rehabilitation (Speech Pathologist-Directed Therapy)

3. General Cognitive Rehabilitation Games (Lumosity [2])

The investigators hope to gain a better understanding of the unique and cumulative influence
of different cognitive rehabilitation programs on improving attention complaints in mTBI.
This proposal contains both retrospective and prospective components.

The retrospective component consists of examining archival data from Lumosity, previously
collected as part of routine clinical care. The data contain pre- and post-assessments of
post-concussive symptoms, symptom frequency, and cognitive testing. The investigators expect
that data analysis will reveal evidence of improvement in severity of post-concussive
symptoms, in frequency of troublesome cognitive problems, and in performance on
neuropsychological tests when pre- and post-assessments are compared.

The prospective component will consist of 120 service members with mTBI who have ongoing
attention complaints and are more than three months post-injury. Each service member will be
randomly assigned to one of four arms, differentiated only by the specific computer-based
rehabilitation program used. All individuals will also be treated per current standard of
care guidelines by a speech pathologist.

Each of the four arms will be comprised of 30 participants. A cognitive testing battery will
be administered to each participant before and after implementation of each intervention. The
cognitive testing battery form will vary based on time of administration in order to control
for practice effects. Performance on the cognitive testing battery and self-report measures
will be compared between and within the three arms.

This research will help the military to identify the best cognitive rehabilitation treatment
program to address ongoing attention complaints following mTBI.

Inclusion Criteria:

- Closed TBI

- Have sufficient information available that we can confidently classify severity as
mild based on DOD/VA criteria

- Time tested post-injury > 3 months

- Ongoing attention complaints

Exclusion Criteria:

- Moderate/Severe TBI

- Penetrating TBI

- Attention Deficit Hyperactivity Disorder

- Learning Disorder

- Diagnosed medical condition that is expected to impact cognitive performance (i.e.
Multiple Sclerosis, Stroke)