Due to an increase in recreation-related injuries and the prevalence of stroke risk factors in this population, young adults are a frequently affected and growing cohort to suffer acquired brain injury (ABI). ABI leads to persistent cognitive-linguistic deficits, resulting in decreased community participation, productivity and quality of life. At the time of injury, many young adults are already enrolled in college, but often struggle to successfully return to school even when cognitive-linguistic skills are only mildly impaired. Comprehensive, contextualized cognitive rehabilitation (CR) has resulted in improved cognition, community integration and independence for individuals with ABI. Furthermore, preliminary work has shown that young adults with ABI (n = 4) who participated in a novel intensive cognitive-communication rehabilitation (ICCR) program, consisting of classroom-style lectures, metacognitive strategy instruction, individual rehabilitation and technology training demonstrated significant gains on at least one standardized measure of cognitive-linguistic function over time, while controls did not (n = 2). Experimental participants who completed multiple semesters of ICCR (n = 3) also improved in their classroom performance, participation and quality of life with two participants enrolling in college. Research suggests that sufficient repetition, intensity, salience and specificity of training in a complex, enriched environment likely leads to a) cognitive-linguistic gains and b) brain reorganization. Yet, the specific cognitive-linguistic skills important for college success that improve over time as a function of academically- focused comprehensive, contextualized CR programs incorporating these principles remains unknown. Furthermore, no studies have investigated the neuroplasticity underpinning domain-level changes in cognitive- linguistic function after such programs. To address aim 1, growth curves will be applied to assess longitudinal changes in a range of cognitive-linguistic domains constructed using items across standardized cognitive- linguistic assessment batteries. To address aim 2, functional near infrared spectroscopy (fNIRS), an ecologically valid neuroimaging method that circumvents some of the challenges associated with magnetic resonance imaging, will be used to measure treatment-related neural changes during cognitive-linguistic tasks over time. Twelve young adults with ABI will participate in ICCR and undergo behavioral and fNIRS assessments before and after multiple 12-week semesters. Twelve healthy controls will undergo fNIRS assessment at a single timepoint for comparison with the experimental participants. Achieving these aims will demonstrate the efficacy of this novel, comprehensive, contextualized CR program at improving specific cognitive-linguistic skills important for college success and the corresponding neuroplasticity in young adults with ABI, a group poised for rehabilitation success and brain reorganization.
In college, students need to attend to course material, recall newly learned information, answer questions, manage their time and perform a number of other cognitive-linguistic skills frequently impaired after acquired brain injury (ABI). Young adults with ABI would typically be enrolled in college, but their cognitive-linguistic deficits often preclude their admission, resulting in reduced community integration, productivity and quality of life. Investigating the specific cognitive-linguistic skills that improve over time as a function of intensive cognitive- communication rehabilitation and the neural networks underpinning these gains will support young adults with ABI to reach their academic goals and ultimately, improve their community participation and overall well-being.
