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

慢性创伤青少年基于要点的策略推理训练

• 批准号: 7990249
• 负责人: SANDRA Bond CHAPMAN
• 金额: $ 13.88万
• 依托单位: UNIVERSITY OF TEXAS DALLAS
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2011-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7990249
• 关键词: Address; Adolescence; Adolescent; Age; Attention; Attention deficit hyperactivity disorder; Brain; Brain Injuries; Child; Childhood; Chronic; Cognition; Cognitive; Cognitive deficits; Competence; Complex; Comprehension; Development; Economics; Eligibility Determination; Goals; Hospital Records; Impairment; Incidence; Injury; Knowledge; Learning; Link; Maintenance; Measures; Memory; Methods; Motor; Neuronal Plasticity; Outcome Measure; Performance; Population; Prefrontal Cortex; Process; Productivity; Randomized; Reading; Recovery; Recruitment Activity; Research; Residual state; Rest; Savings; Schools; Self Care; Short-Term Memory; Societies; Staging; Students; Testing; Text; Training; Training Programs; Translating; Traumatic Brain Injury; Work; Writing; abstracting; base; brain research; clinical application; cognitive function; cognitive training; cohort; cost; disability; executive function; improved; novel; prevent; primary outcome; productivity loss; public health relevance; response; skills; skills training; social; standardize measure; young adult

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.

描述(由申请人提供)：指导患有慢性创伤性脑损伤(TBI)的青少年的高级认知训练的证据很少，尽管它每年给社会造成数十亿美元的长期生产力损失。童年时期的脑外伤影响认知发展，特别是在青春期，更高层次的认知技能进一步发展。与TBI相关的问题包括持续的执行控制障碍，这与糟糕的学校表现和社会适应不良有关。鉴于脑外伤在青春期的高发病率，以及在此期间前额叶皮质的动态成熟，本项目的目标是慢性期脑外伤青少年的认知训练。目的：这项探索性研究考察了为期一个月的强化主旨训练对慢性脑外伤青少年策略学习的影响。支持性证据显示，在患有注意缺陷多动障碍的青少年和患有脑外伤的年轻人中，培训对基于主旨的策略有积极影响。第二个目标是评估培训对未培训技能的概括性。之前的研究已经将主旨表现与包括抑制、工作记忆、非语言推理和阅读能力在内的执行功能的单独测量联系起来。第三个目标衡量的是培训后一个月的主要改进情况。方法：30名年龄在12至18岁的青少年将从脑损伤队列和当地医院记录中招募。标准包括复杂的轻度、中度或重度颅脑损伤后12至60个月，战略学习测试(TOSL)测量的主要加工缺陷和其他资格标准。在基线评估之后，将分层整组随机分为立即训练组(n=15)或延迟一个月训练组(n=15)。两组都将在一个月的学校环境中接受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主旨的概念中，将主旨信息与先前的知识相结合，以及使用抽象的想法进行总结。培训效果将在培训后即刻和一个月后通过主要结果衡量(TOSL)进行衡量。训练后立即通过抑制、工作记忆、非语言推理和阅读理解四个方面的测量来评估训练的概括效果。意义：到目前为止，很少有训练研究专注于纠正慢性脑外伤青少年的高级认知功能障碍，尽管有证据表明，大脑对高强度训练的反应是高度可改变的。该项目将儿童脑外伤患者常见的基于GIST的加工受损的发现转化为一种新的认知训练计划，以确定是否可以减少这种损害，以及其影响是否推广到未经训练的认知域。 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，青春期发病率最高。尽管有证据表明，在脑损伤后数年，较高级别的认知能力可能会恶化或无法充分发展，但有限的努力集中在缓解或防止慢性脑损伤后来出现的缺陷的方法上，有可能提高终身生产力和经济储蓄。本研究旨在探索一个月的强化训练是否可以提高慢性脑外伤青少年的推理和学习能力，如果训练后一个月的效果保持不变，以及训练是否推广到未受过训练的执行功能测量。