Cognitive rehabilitation after traumatic brain injury
Wednesday, September 16, 2015
Traumatic brain injury (TBI) is a serious public health problem in the United States. Each year, TBIs contribute to a substantial number of deaths and cases of permanent disability. In 2010, 2.5 million TBIs occurred either as an isolated injury or along with other injuries.
TBIs can cause a wide range of functional short- or long-term changes. The impact of head injuries on cognitive and neuropsychological can be especially extensive and wide ranging. Common disabilities include problems with thinking, memory and reasoning, sensory processing (sight, hearing, touch, taste and smell), communication (expression and understanding), and behavior or mental health (depression, anxiety, personality changes, aggression, acting out, and social inappropriateness).
Researchers, headed by Dr. Nancy Chiaravalloti, director of neuroscience, neuropsychology and TBI research at Kessler Foundation, recently published results of a randomized clinical trial of a cognitive intervention to improve learning and memory in individuals with TBI — the TBI-MEM trial.
In a previous trial with the modified Story Memory Technique (mSMT), a 10-session behavioral intervention teaching context and imagery to facilitate learning, significant improvement in learning and memory abilities was demonstrated in persons with multiple sclerosis (MS), which provided the first Class I evidence for the efficacy of cognitive rehabilitation in this particular population.
In the present double-blind, placebo-controlled, randomized clinical trial, changes in cerebral activation on functional magnetic resonance imaging following mSMT treatment in persons with TBI were examined. Eighteen participants with moderate to severe TBI were assigned to either the treatment (n=9) or placebo group (n=9). All underwent neuropsychological assessment, cognitive ability assessment and functional magnetic resonance imaging (fMRI) during a learning task before and after treatment.
The treatment group was administered mSMT; the placebo group underwent memory exercises without visualization or context training. fMRI findings showed a pattern of changes in cerebral activation in the mSMT treatment group, which is consistent with the findings in the mSMT study with MS patients.
According to Chiaravalloti, the changes demonstrated in the trial likely reflect increased brain efficiency and decreased task difficulty after training with mSMT. Because memory deficits are a major cause of disability after TBI, identifying effective cognitive interventions is critical to improving quality of life in this population.
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