Cognitive impairment is common after brain damage, and is a major source of long-term disability. Cognitive rehabilitation, even when delivered long after injury, may improve functional, but much of the evidence for this comes from methodologically compromised studies. We propose to form a regional network to conduct clinical trials of cognitive rehabilitation interventions. Initial studies will focus on interventions derived from promising laboratory research based on theoretical models of cognitive function and dysfunction. The proposed network will conduct controlled clinical trials at a central Research Clinic and, for those that appear to have value, will promote more naturalistic effective trials in clinical settings throughout the region. Studies that begin by focusing on impairment and functional limitation-level outcomes, will be followed by those that emphasize societal participation and quality of life. To accomplish these regional goals, we proposal to establish: an Administrative ore to oversee the overall operation of the Network; a Clinical Trials Core to centralize subject recruitment and screening across 3 large rehabilitation hospitals, to operate a central Research Clinic with staff trained to conduct the clinical trials; a Neuroimaging Core, to conduct research on the methodological problems that limit the application of fMRI to cognitive rehabilitation research, and to support the use of fMRI in current and future research projects; and an Information Technology Core, that will oversee the main information dissemination and collaborator recruitment activities of the Network. Three initial projects are proposed. Two focus on impairment-based treatments for TBI-related attention deficits and stroke-related hemispatial neglect and will make use of both the Clinical Trials and Neuroimaging Cores. The third focuses on a functional limitation based treatment for aphasia and relies on the Clinical Trials Core. The experience of the applicants as well as the specific communication structures put in place, ensure that the proposed activities and research will function as the nucleus of an enlarging focus of research activity throughout the region and beyond.
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