Training of Gist-Based Strategic Reasoning in Adolescents with Chronic Traumatic

描述（由申请人提供）：存在稀疏的证据来指导慢性创伤性脑损伤（TBI）青少年的高阶认知训练，尽管它每年花费社会数十亿美元的长期生产力损失。儿童时期的TBI会影响认知发展，特别是在青少年时期，高阶认知技能会进一步发展。TBI相关的问题包括持续的执行控制障碍，这与学校表现不佳和社会适应不良有关。由于青少年TBI的发病率很高，在此期间和之前，前额叶皮层的动态成熟，该项目的目标是对患有慢性TBI的青少年进行认知训练。目的：这项探索性研究探讨了为期一个月的强化gist-based培训策略学习在青少年与慢性TBI的影响。支持性证据显示，在注意缺陷多动障碍青少年和TBI年轻人中，基于gist-based策略的培训具有积极作用。第二个目标是评估培训对非培训技能的普遍性。先前的工作已经将gist-performance与执行功能的单独测量联系起来，包括抑制，工作记忆，非语言推理和阅读能力。第三个目标是在培训后一个月内保持gist的改进。方法：从TBI队列和当地医院记录中招募30名年龄在12至18岁之间的青少年。标准包括12至60个月后复杂的轻度，中度或重度TBI，gist-processing缺陷，如通过测试的战略学习（TOSL）和其他资格标准。基线评估后，将分层区组随机分为立即（n=15）或延迟1个月（n=15）训练组。两组将在学校接受为期一个月的10 - 45分钟的一对一培训。在10个培训课程中涉及的技能包括在选择关键点时抑制不重要的细节，组织和解释重要的点，将关键点整合到基于gist的概念中，将gist信息与以前的知识整合，以及使用抽象的想法进行总结。培训效果将在培训后立即和培训后一个月通过主要结局指标（TOSL）进行测量。训练后立即通过单独的抑制、工作记忆、非语言推理和阅读理解测量来评估训练的泛化效果。重要性：到目前为止，很少有训练研究集中在治疗慢性TBI青少年的高阶认知功能障碍，尽管有证据表明大脑对强化训练的反应是高度可变的。该项目将儿科TBI中常见的受损gist-based处理的结果转化为一种新的认知训练计划，以确定是否可以减少损伤以及这种影响是否适用于未经训练的认知领域。 公共卫生相关性：创伤性脑损伤（TBI）是获得性长期残疾的头号原因，发生在青春期的发病率最高。尽管有证据表明高阶认知能力可能在脑损伤后数年恶化或未能充分发展，但有限的努力集中在减轻或预防慢性TBI后期出现的缺陷的方法上，这些方法有可能提高终身生产力和经济储蓄。本研究旨在发现一个月的强化训练是否可以增强慢性TBI青少年的推理和学习潜力，如果效果在训练后一个月保持不变，以及训练是否可以推广到未经训练的执行功能措施。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: 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.