Multi-level assessment and rehabilitation of combat mild traumatic brain injury

与战斗相关的轻度创伤性脑损伤(MTBI)和合并疾病在退伍军人中很常见 报道的比率从14%到22%不等。MTBI的慢性后遗症可能会使人非常虚弱，因为 认知控制过程中的缺陷，包括注意力、执行功能和记忆。在之前 研究表明，参加认知训练计划的慢性获得性脑损伤患者的目标是- 定向注意自我调节(Goals)，目标是应用程序的执行控制功能 基于正念的注意力调节和目标管理，在以下方面改善认知表现： 复杂的注意力/执行功能和记忆，复杂的功能任务表现，以及日常功能。 此外，训练后的功能磁共振成像(FMRI)结果显示，神经调制显著增强 正在处理。最近完成的32名退伍军人随机对照目标研究的初步数据 慢性脑外伤在注意力和执行力方面也显示出短期和长期(长达2年)的改善 功能、复杂的现实生活任务和情绪调节。 这项研究的主要目标是调查目标的潜在短期和长期影响。 认知训练计划，并使用先进的磁共振成像来研究脑结构和功能的变化 慢性脑外伤退伍军人注意、记忆、执行功能和情绪的调节回路。 我们假设1)目标训练将改善注意力和执行功能方面的神经认知功能 慢性颅脑损伤退伍军人的领域、复杂功能任务表现与情绪调节 神经认知功能的改善将与宏观结构、微观结构和功能相关 高场(3T)和超高场(7T)结构磁共振成像中相应脑网络的变化， 在训练前后进行扩散张量成像(DTI)和静息状态功能磁共振成像；3)两者的变化 行为功能和成像测量将在培训后6个月保持不变，并与 改进活动和参与度。 目的1：确定目标训练对神经认知能力的短期和长期影响 注意和执行控制网络在mTBI中的神经可塑性。 目的2：确定目标训练对复杂功能任务的短期和长期效果 在mTBI中，表现和日常功能，以及与记忆功能相关的通路的可塑性。 目的3：确定目标训练对情绪调节措施的短期和长期效果。 以及与情绪加工有关的额缘神经网络在mTBI中的可塑性 在一项随机、对照的干预性研究设计中，36名有慢性(6个月)脑外伤病史的退伍军人 残存的认知困难将随机参加为期5周的认知训练(目标)或 照常治疗(TAU)的比较。在基线、第5周(目标后)和6个月时，参与者将 接受多层次评估，包括：1)高场(3T)和超高场神经成像 (7)结构磁共振成像、扩散张量成像(DTI)和静息功能磁共振成像；2)神经心理学 评估侧重于复杂的注意和执行功能；3)复杂的“现实生活”功能任务 表现；4)日常功能和情绪调节/健康的自我报告测量。 该项目完成后，将决定培训核心注意自我调节控制功能是否发挥作用 通过与个人相关的活动将有效地改善退伍军人的生活质量和日常功能 使用mTBI。这项研究设计将提供对现实生活功能的潜在益处的测试，并确定 这些益处在多大程度上与假设目标认知/行为的实际变化有关 以及与这些功能相对应的大脑网络。

Combat-related mild traumatic brain injury (mTBI) and co-morbid conditions are prevalent in returning Veterans with the reported rates ranging from 14- 22%. Chronic sequela of mTBI can be highly debilitating due to deficits in the cognitive control processes, including attention, executive functions, and memory. In prior studies, individuals with chronic acquired brain injury who participated in a cognitive training program, Goal- Oriented Attentional Self-Regulation (GOALS), which targets executive control functions of applied mindfulness-based attention regulation and goal management, improved cognitive performance in areas of: complex attention/executive function and memory, complex functional task performance, and daily functioning. Furthermore, functional MRI (fMRI) results after training indicated significantly enhanced modulation of neural processing. Preliminary data from recently completed randomized-control GOALS study in 32 Veterans with chronic TBI also show both short and longer term (up to 2 years) improvements in attention and executive function, complex real-life tasks, and emotional regulation. The primary objectives of this study are to investigate the potential short and longer term effects of GOALS cognitive training program, and to use advanced MRI to investigate changes in brain structure and function in the circuits that regulate attention, memory, executive function and emotion in Veterans with chronic mTBI. We postulate that 1) GOALS training will improve neurocognitive function in attention and executive function domains, complex functional task performance, and emotional regulation in Veterans with chronic mTBI; 2) improved neurocognitive function will be correlated with macrostructural, microstructural and functional changes in the corresponding brain networks on high field (3T) and ultra-high field (7T) structural MR imaging, diffusion tensor imaging (DTI) and resting state fMRI performed pre- and post-training; 3) Changes in both behavioral function and imaging measures will be maintained at 6 months post-training and be associated with improvements in activities and participation. AIM 1: To determine the short and long term effects of GOALS training on neuro-cognitive performance and neural plasticity of attention and executive control networks in mTBI. AIM 2: To determine the short and long term effects of GOALS training on complex functional task performance and daily functioning, and on plasticity in pathways related to memory function, in mTBI. AIM 3: To determine the short and long term effects of GOALS training on measures of emotional regulation, and on plasticity of frontolimbic networks related to emotion processing, in mTBI In a randomized, controlled interventional study design, 36 Veterans with a history of chronic (> 6 month) mTBI and residual cognitive difficulties will be randomized to participate in 5 weeks of cognitive training (GOALS) or a treatment as usual (TAU) comparison. At baseline, week 5 (post GOALS), and at 6 months, participants will undergo a multi-level assessment battery consisting of: 1) neuroimaging with high field (3T) and ultra-high field (7T) structural MR imaging, diffusion tensor imaging (DTI) and resting state fMRI; 2) neuropsychological assessment focusing on complex attention and executive function; 3) complex `real life' functional task performance; and 4) self-report measures of daily functioning and emotional regulation/heath. When completed, this project will determine whether training core attentional self-regulatory control functions via personally-relevant activities will be effective in improving quality of life and daily functioning for Veterans with mTBI. The study design will provide a test of potential benefits on real-life functioning, and also determine to what extent these benefits are related to actual changes in hypothetically targeted cognitive/behavioral functions and brain networks corresponding to these functions.