Combining attention and metacognitive training to improve goal directed behavior in Veterans with TBI

背景：颅脑损伤可能是疾病过程的开始，它会产生持续的变化 受伤数年后，导致虚弱的慢性脑损伤症状。一些研究发现， 到30%的患有mTBI的人都有持续的症状。持久的认知 MTBI后的缺陷对完全功能恢复和重新进入社会角色构成了障碍。 执行功能障碍、注意力不集中和记忆障碍是最严重的 创伤性脑损伤幸存者面临的永久性残疾。据估计，44%患有mTBI的退伍军人还 有重叠症状的创伤后应激障碍。50%的战斗中有注意力问题 对于日常运作至关重要的其他认知过程来说，退伍军人是必不可少的 例如记忆、解决问题、语言技能和对行为的认知控制。 需要有效的干预措施来解决慢性mTBI造成的认知缺陷。 在目前临床实践中使用的注意力和执行功能治疗中，有一种 缺乏那些有确凿证据支持有效性的人。当前认知 对患有mTBI的退伍军人的干预不包括具体的注意力训练，缺乏严格的 培训或仅在自我报告的症状上有所改善。为了提高翻译水平， 建议在注意力训练的同时进行策略训练。目标管理 培训(GMT)就是这样的一种策略培训，已被发现可以改善执行功能 退伍军人的mTBI技能。然而，GMT缺乏具体的注意力训练，这是一个限制 在这种情况下，注意力是目标管理中正常执行功能的一个组成部分。 在注意训练缺乏严谨性的情况下，注意与目标的关系 管理，以及注意力训练和目标管理训练相结合的承诺， 我们将创新性地将元认知干预(GMT)与训练方法相结合 注意力训练，还包括注意力恢复的个人功能目标。 方法：这是一项随机对照先导研究，以确定GMT Plus的有效性 50例退伍军人颅脑损伤患者的注意训练研究设计为平行研究， 在治疗前/治疗后和6个月时随机给予试验性给药或对照 在治疗之后。将使用多元线性回归模型来确定是否存在 治疗效果与创伤后应激障碍、抑郁、 焦虑、疼痛、睡眠、滥用药物等。

Background: TBI can be the beginning of a disease process that produces change that continue years after injury resulting in debilitating chronic TBI symptomatology. Some studies find that up to 30% of people that have sustained mTBI have persistent symptoms. Enduring cognitive deficits after mTBI present barriers to full functional recovery and re-entry into societal roles. Executive dysfunction, poor attention-concentration, and memory difficulties are the most persistent disabilities faced by mTBI survivors. An estimate 44% of Veterans with mTBI also have PTSD with overlapping symptoms. Attention problems are reported by 50% of combat Veterans which are requisite for other cognitive processes that are vital to everyday functioning such as memory, problem solving, language skills, and the cognitive control of behavior. Effective interventions are needed to address the cognitive deficits resulting from chronic mTBI. Of the attention and executive function treatments currently used in clinical practice, there is a dearth of those with substantial evidence to support effectiveness. Current cognitive interventions for Veterans with mTBI did not include specific attention training, lacked rigorous training or found improvement only on self-reported symptoms. In order to improve translation, strategy training has been recommended to accompany attention training. Goal Management Training (GMT) is such a strategy training and has been found to be improve executive function skills in Veterans with mTBI. However, GMT lacks specific attention training, which is a limitation in that attention is a component of the normal executive function used in goal management. Given the need in mTBI lack of rigor in attention training, the relationship of attention to goal management, and the promise of combined attention training and goal management training, we will innovatively combine the metacognitive intervention, GMT, with a drill method of attention training that also includes individual functional goals for attention recovery. Method: This is a randomized control pilot study to determine effectiveness of GMT plus Attention Training in 50 Veterans with mTBI. The research design is a parallel study with randomization to treatment or control with test administration at pre/post and six months following treatment. A multiple linear regression model will be used to determine if there is a significant association between treatment effect and comorbidities such as PTSD, depression, anxiety, pain, sleep, substance abuse, etc.