Retraining Neural Pathways to Improve Cognitive Skills after a Mild Traumatic Brain Injury (mTBI)

神经通路再训练改善轻度颅脑损伤后的认知技能 这项研究旨在解决如何提供有针对性的干预措施以应对个性化的挑战 轻度创伤性脑损伤患者的认知需求。MTBI很普遍，超过250万 美国每年都会发生脑震荡，其中只有六分之一被诊断出脑震荡。MTBIS 占TBI的80%。大多数MTBI是由机动车事故、跌倒和涉及 头部突然加速和/或减速，如运动损伤。一次mTBI可以导致大量的 认知障碍，无法重返工作或学校，对自己的工作满意度低 生活质量。目前，还没有得到证实的解决方案来补救那些普遍存在的认知缺陷 MTBI。轻度颅脑损伤(MTBI)患者的视觉计时缺陷是持久的，被认为是由于 背侧通路、注意力和执行控制网络中的加工缺陷。其前提是 目前的建议是对mTBI患者进行康复治疗，因为这些时机问题 没有被寻址。为了解决这些局限性，我们开发了一种运动歧视干预 (路径训练)旨在刺激背部运动路径的训练。PATH被假设为改善 视觉事件计时的精确度，进而改善依赖视觉计时的认知功能，例如 工作记忆广度，这是mTBI患者常见的一种功能受损。这项研究将为临床提供 治疗脑外伤所致认知障碍的治疗训练测试。我们将延长 先前对四个mTBI受试者的先导性研究的结果是对mTBI受试者的一个大得多的样本。我们会 确定补救视觉计时缺陷以改善视觉和认知的干预措施的可行性 MTBI的缺陷不仅仅是假的或常规的工作记忆训练任务。建议的研究测试 路径神经训练改善视觉工作记忆和处理速度的能力(主要结果) 听觉工作记忆(WM)、选择性注意、认知灵活性、持续注意、阅读速度、 和阅读能力(次要结果)在mTBI受试者中迅速而有效地。我们预测了这条道路 训练比传统的WM训练或Sham训练都更有效。这些预测将是 通过认知功能神经心理测试的百分位数分数、阅读分数来评估 速度、阅读能力、MoCA筛查测试、问卷和脑磁图(MEG) 治疗组中受试者子集的脑记录，提供生物标记物，如 商业化。脑磁图记录将被用来确定路径神经训练是否改善 视觉运动、注意力和工作记忆网络的功能比N-back WM更多 训练。脑磁图记录也将被用来确定路径神经训练是否增强耦合：1) Theta/Gamma活动，以及2)α/Gamma活动。需要为mTBI提供经过验证的解决方案 通过开发和销售一种在临床试验中显示的快速有效的治疗方法来提高认知技能。

Retraining Neural Pathways Improves Cognitive Skills After A Mild Traumatic Brain Injury This study seeks to address the challenge of how to deliver targeted interventions that address individualized cognitive needs of mild traumatic brain injury (mTBI) patients. mTBIs are prevalent, with over 2.5 million concussions occurring in the U.S. each year with only 1 in 6 of these concussions being diagnosed. mTBIs represent 80% of TBIs. The bulk of mTBIs result from motor vehicle accidents, falls, and situations involving sudden acceleration and/or deceleration of the head, such as sports injuries. A mTBI can result in substantial cognitive impairments, with an inability to return to work or school, and low levels of satisfaction with one’s quality of life. Currently, there are no proven solutions to remediate cognitive deficits prevalent in those with a mTBI. Visual timing deficits are persistent in individuals with a mild TBI (mTBI), and are thought to be due to processing deficits in the dorsal pathways, and attention and executive control networks. The premise of the current proposal is rehabilitative treatments for those with a mTBI fall short because these timing issues are not being addressed. To address these limitations, we developed a movement-discrimination intervention (PATH training) that is designed to stimulate dorsal motion pathways. PATH is hypothesized to improve the precision in timing of visual events, and in turn improve cognitive functions that rely upon visual timing, such as working memory span, a function that is commonly impaired in mTBI patients. This study will provide clinical testing of therapeutic training for the treatment of cognitive disorders caused by a mTBI. We will extend previous results from a pilot study of four mTBI subjects to a much larger sample of mTBI subjects. We will determine the feasibility of an intervention that remediates visual timing deficits to improve visual and cognitive deficits in mTBI more than a Sham or a conventional working memory training task. The proposed study tests the ability of PATH neurotraining to improve visual working memory, and processing speed (primary outcomes) and auditory working memory (WM), selective attention, cognitive flexibility, sustained attention, reading speed, and reading proficiency (secondary outcomes) in mTBI subjects rapidly and effectively. We predict that PATH training is more effective than either conventional WM training or Sham training. These predictions will be evaluated by both percentile scores on neuropsychological tests of cognitive function, scores on reading speed, reading proficiency, MoCA screening test, and questionnaires, and Magnetoencephalography (MEG) brain recordings for a subset of subjects in treatment groups, providing a biomarker, as is required for commercialization. MEG brain recordings will be used to determine whether PATH neurotraining improves the function of the visual motion, attention, and working memory networks more than found after N-Back WM training. MEG recordings will also be used to determine whether PATH neurotraining strengthens coupled: 1) theta/gamma activity, and 2) alpha/ gamma activity. There is a need to provide a proven solution for a mTBI by developing, and marketing a rapid and effective treatment shown in clinical trials to improve cognitive skills.