Sparse evidence exists to guide training of higher order cognition in adolescents with chronic traumatic brain injury (TBI), although it costs society billions of dollars each year in long-term loss of productivity. A TBI during childhood impacts cognitive development, especially during adolescence when higher order cognitive skills develop further. TBI-related problems include persistent executive control impairments, which are implicated in poor school performance and social maladjustment. With a high incidence of TBI in adolescence and dynamic maturation of prefrontal cortex prior to and during this period, this project targets cognitive training of adolescents with chronic stage TBI. Purpose: This exploratory research examines the effects of intensive gist-based training over one month on strategic learning in adolescents with chronic TBI. Supportive evidence reveals positive effects of training on gist-based strategies in adolescents with attention deficit hyperactivity disorder and young adults with TBI. A secondary goal is to evaluate generalizability of training to non-trained skills. Previous work has linked gist-performance to separate measures of executive function including inhibition, working memory, nonverbal reasoning, and reading competence. A third goal measures the maintenance of gist improvements at one month post training. Methods: 30 adolescents between the ages of 12 to 18 years at study will be recruited from a TBI cohort and from local hospital records. Criteria include 12 to 60 months post-complicated mild, -moderate or -severe TBI, gist-processing deficits as measured by the Test of Strategic Learning (TOSL) and other eligibility criteria. Baseline assessments will be followed by stratified blocked randomization into immediate (n=15) or one-month delayed (n=15) training groups. Both groups will undergo ten - 45 minute sessions of one-on-one training in a school setting over one month. Skills addressed in the 10 training sessions include inhibition of unimportant details while selecting key points, organizing and paraphrasing important points, integrating key points into gist-based concepts, integrating gist information with previous knowledge, and summarizing using abstract ideas. Effects of training will be measured by the primary outcome measure (TOSL) immediately after and one month post training. Generalization effects of training will be evaluated by separate measures of inhibition, working memory, nonverbal reasoning, and reading comprehension immediately after training. Significance: To date, few training studies have focused on remediating impairments in higher order cognitive function in adolescents with chronic TBI, despite evidence that the brain is highly modifiable in response to intensive training. This project translates the findings of commonly impaired gist-based processing in pediatric TBI to a novel cognitive training program to determine if the impairment can be reduced and whether the effects generalize to untrained cognitive domains.
Traumatic brain injury (TBI) is the number one cause of acquired long term disability with the highest rates occurring during adolescence. Despite evidence that higher order cognitive abilities may worsen or fail to adequately develop years after the brain injury, limited efforts have focused on ways to mitigate or prevent later emerging deficits in chronic TBI with potential to improve lifelong productivity and economic savings. This research seeks to discover whether one month of intensive training can enhance reasoning and learning potential in adolescents with chronic TBI, if effects are maintained one-month post training, and whether training generalizes to non-trained executive function measures.
