Evaluating the effectiveness of reasoning training in military and civilian chronic traumatic brain injury patients: study protocol

Abstract

BackgroundIndividuals who sustain traumatic brain injuries (TBIs) often continue to experience significant impairment of cognitive functions mediated by the prefrontal cortex well into chronic stages of recovery. Traditional brain training programs that focus on improving specific skills fall short of addressing integrative functions that draw upon multiple higher-order processes critical for social and vocational integration. In the current study, we compare the effects of two short-term, intensive, group-based cognitive rehabilitation programs for individuals with chronic TBI. One program emphasizes learning about brain functions and influences on cognition, while the other program adopts a top-down approach to improve abstract reasoning abilities that are largely reliant on the prefrontal cortex. These treatment programs are evaluated in civilian and military veteran TBI populations.Methods/designOne hundred individuals are being enrolled in this double-blinded clinical trial (all measures and data analyses will be conducted by blinded raters and analysts). Each individual is randomly assigned to one of two treatment conditions, with each condition run in groups of five to seven individuals. The primary anticipated outcomes are improvement in abstract reasoning and everyday life functioning, measured through behavioral tasks and questionnaires, and attention modulation, as measured by functional neuroimaging. Secondary expected outcomes include improvements in the cognitive processes of working memory, attention, and inhibitory control.DiscussionResults of this trial will determine whether cognitive rehabilitation aimed at teaching TBI-relevant information about the brain and cognition versus training in TBI-affected thinking abilities (e.g., memory, attention, and executive functioning) can improve outcomes in chronic military and civilian TBI patient populations. It should shed light on the nature of improvements and the characteristics of patients most likely to benefit. This trial will also provide information about the sustainability of treatment-related improvements 3 months post-training.Trial registrationClinicalTrials.gov Identifier: NCT01552473

Strategy‐based reasoning training modulates cortical thickness and resting‐state functional connectivity in adults with chronic traumatic brain injury

“…The data included in these analyses are a part of an ongoing study (Krawczyk et al., 2013). We analyzed 60 individuals at the chronic stage of TBI who ranged from lower moderate disability to lower good recovery (age 20–65; >6 months postinjury; 5–7 on the Extended Glasgow Outcome Scale (GOS‐E; Wilson, Pettigrew, & Teasdale, 1998), who completed MRI scans that passed the quality assurance (QA) procedures described below.…”

Reasoning training in veteran and civilian traumatic brain injury with persistent mild impairment

“…The current study is a subset of a larger ongoing Department of Defense (DoD) study (Krawczyk et al, 2013). Sixty community dwelling individuals (32 men and 28 women) between the ages of 19 and 65 years with a history of TBI in chronic stages of recovery (.…”

“…Three-month follow-up testing took place 3-4 months after the training sessions were completed. Additional methodological details about the larger study are provided in Krawczyk et al (2013).…”

The Role of Opioid Use in Distinguishing between Suicidal Ideation and Attempts

“…For the purposes of this study, we examined lifetime history of use categorically. The scale has been utilized across a range of samples, including military personnel (e.g., Krawczyk et al, 2013), and has exhibited strong psychometric properties (Humeniuk et al, 2008).…”