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

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.