Attention impairment is ubiquitous in TBI survivors. This is a devastating impairment because attention is the backbone of cognitive systems. Attention is requisite for other cognitive processes that are vital to everyday functioning such as memory, problem solving, language skills, and the cognitive control of behavior. Studies of attention training have shown improved attention on laboratory measures, but limited translation to real-world tasks2. Notably, these previously-tested rehabilitation approaches have not included training in the very cogni- tive processes needed for translation of training to everyday tasks which include internal verbalization and self- monitoring, also called metacognitive strategies 3, 4. One training method for metacognitive strategies has shown promise 5, 6, but is lacking in basic attention training. Rehabilitation specialists have recently argued for a rehabilitation approach wherein both basic foundational attention and metacognitive strategies should be synergistically combined 7. Consequently, we will test an innovative combination of direct-attention training and metacognitive training for which the other compensates disadvantages of each. Because of the promise of each type of training separately, and the potential additive effects of the combination, it is critical to test this combined attention and metacognitive training in Veteran survivors of chronic moderate-to-severe TBI (m/sTBI). We will address the following two specific aims: We propose to conduct a pilot study to examine CRT effects in a group of Veterans with chronic m/sTBI, focused on remediating attention-control impairments using both direct-attention and metacognitive-strategy training approaches in a AB/BA crossover design with 1- month follow-up to address the following two specific aims: 1) Test treatment response to combined direct- attention and metacognitive-strategy training in Veterans with chronic m/sTBI; and 2) identify mechanisms and biomarkers of rehabilitation-related neuroplasticity. Under the first aim we will test for effects of combined di- rect-attention and metacognitive-strategy trainig on measures of complex functional activities and neurocogni- tive tests of attention-control functions. Under the second aim, we will test effects of our CRT approach on be- havioral and brain activity while participants perform a well-validated attentional task that probes the functio of three dissociable attentional systems. The approach is innovative because it combines a theoretically motivat- ed and novel approach to address a significant source of disability in Veteran survivors of TBI. The proposed research is significant because findings will form the foundation for a larger-scale trial to enable us to deter- mine the durability of gains and the functional impact of treatment on Veteran's real world activities and to more positively shape healthcare for our Veterans who are suffering from TBI.
Traumatic brain injury (TBI) is reaching epidemic proportions among Veterans returning from the OEF/OIF/OND conflicts. Thus, Veterans and the VA are faced with a highly prevalent disorder that impairs cognitive, emotional and occupational functioning. This research will test the effects of a novel approach to rehabilitation of cognitive impairment in Veterans with moderate-to-severe TBI. We will also examine brain activity associated with response to rehabilitation to understand brain changes associated with this cognitive rehabilitation approach. This important area of investigation will increase our understanding of how to best treat cognitive impairment in Veteran survivors of TBI and, therefore, improve healthcare for our Veterans.
