Developing Process-Specific Verbal Memory Interventions for Veterans with TBI

描述（由申请人提供）： 背景和目的：创伤性脑损伤（TBI）被描述为OIF-OEF-OND战斗经验的“标志性损伤”。由于记忆编码、巩固或检索的问题而导致的慢性记忆缺陷通常在中重度TBI（M-STBI）后可见，并且可能对社区重返、再培训和康复造成障碍。研究表明，使用认知治疗，如记忆策略训练，无错学习技术，检索练习和其他方法在记忆康复中有一定的疗效。然而，一些患者并没有从这些干预措施中受益，而另一些患者则没有得到很大改善。之前没有一项小组研究试图将退伍军人的特定信息处理缺陷与针对其特定问题的记忆康复治疗（患者治疗匹配）相匹配，尽管这种方法应该会产生最好的结果。我们建议开发和测试三种记忆疗法，每种疗法都旨在促进记忆处理特定阶段的改善。退伍军人将根据他们的主要损伤部位进行分类，并将参加（a）与其缺陷相匹配的治疗，以及（B）不匹配的治疗。是 预测退伍军人参与者将从匹配的治疗中获得更大的益处。如果成功的话，这项研究可以指导决策制定最有效的方法来减轻M-STBI退伍军人的致残性记忆缺陷。程序：拟议的研究分三个阶段进行。在第一阶段，三种记忆疗法（记忆策略训练、无错学习和检索练习）将通过制定治疗手册正式化。治疗师将接受培训，以提供高保真的治疗，并将衡量他们对治疗方案的依从性。在第2阶段，将使用神经心理学（NP）和神经影像学（MRI）探头对M-STBI导致的慢性记忆缺陷退伍军人进行评估。NP探针将使我们能够根据参与者在编码、巩固或提取方面的记忆缺陷的主要部位将其分为三组。MRI序列使得能够发现该分类的结构（形态测量和扩散成像）和功能（静息状态功能连接）生物标志物，用于评估治疗改善的神经基础的后续试验。在第3阶段，退伍军人参与者将接受两种疗法的治疗，一种与他们的缺陷相匹配，另一种不匹配。将通过评估NP指标和实际功能指标以及生活质量的变化来衡量治疗效果。关键问题：我们的主要目标是在M-STBI后患有慢性记忆障碍的退伍军人异质人群中开发和测试三种特定于过程的记忆干预措施的疗效。我们的目的是了解是否改善疗效的结果，从适当的病人治疗匹配。我们还希望完善一个分类系统，可靠地识别编码，巩固和检索缺陷或参与者，并确定这种分类方案的特定结构和功能的大脑生物标志物。对于我们的长期目标，我们的目标是最大限度地提高记忆改善疗法的疗效，以减轻获得性脑损伤后的记忆障碍，并使用NP和脑成像生物标志物更好地了解康复干预引起的变化机制。这些知识将促进发现治疗衰弱性记忆功能障碍和最大限度地恢复受伤后的功能的最佳做法。

DESCRIPTION (provided by applicant): Background and Purpose: Traumatic brain injury (TBI) has been described as a "signature injury" of the OIF-OEF-OND combat experience. Chronic memory deficits due to problems in memory encoding, consolidation, or retrieval, are often seen after moderate-severe TBI (M- STBI) and may pose barriers to community re-entry, retraining, and rehabilitation. Studies have demonstrated some efficacy in memory rehabilitation using cognitive treatments such as memory strategy training, errorless learning techniques, retrieval practice, and other methods. However, some patients do not benefit from such interventions, while others minimally improve. No prior group study has attempted to match the Veteran's specific information-processing deficit with a memory rehabilitation therapy targeted to their specific problem (patient-treatment matching), though such an approach should produce the best results. We propose to develop and test three memory therapies, each designed to foster improvement in a particular stage of memory processing. Veterans will then be classified by their primary locus of impairment and will participate in (a) a treatment matched to their deficit, and (b) a mismatched treatment. It is predicted that Veteran participants will show greater benefit from the matched treatment. If successful, this research could guide decision-making regarding the most efficacious approaches to alleviating disabling memory deficits in Veterans with M-STBI. Procedures: The proposed research takes place in three phases. In Phase 1, three memory therapies (memory strategy training, errorless learning, and retrieval practice) will be formalized through the development of a treatment manual. Therapists will be trained to provide these treatments with high fidelity, and their adherence to treatment regimens will be measured. In Phase 2, Veterans with chronic memory deficits from M-STBI will be evaluated with neuropsychological (NP) and neuroimaging (MRI) probes. The NP probes will allow us to classify participants into three groups, according to the primary locus of their memory deficit in encoding, consolidation, or retrieval. MRI sequences enable discovery of structural (morphometric and diffusion imaging) and functional (resting state functional connectivity) biomarkers of this classification, for use i a later trial evaluating the neural basis of treatment improvement. In Phase 3, Veteran participants will undergo treatment with two therapies, one matched to their deficit, the other mismatched. Treatment effect will be measured by assessing change on NP measures and on real-life functional measures and quality of life. Key Questions: Our primary goal is to develop and test the efficacy of three process-specific memory interventions in a heterogeneous population of Veterans with chronic memory impairment after M-STBI. We aim to learn whether improved efficacy results from appropriate patient-treatment matching. We also hope to refine a classification system that reliably identifies encoding, consolidation, and retrieval deficits in or participants, and to identify specific structural and functional brain biomarkers of this classification scheme. For our long term goal, we aim to maximize the efficacy of memory improvement therapies for alleviating memory impairment after acquired brain injury, and to use both NP and brain imaging biomarkers in better understanding mechanisms of change resulting from rehabilitative intervention. This knowledge will enhance discovery of best practices for treating debilitating memory dysfunction and maximizing functional recovery after injury.