Training in Goal-directed Attention Regulation for Individuals With Brain Injury

Not Applicable

Completed

Conditions: Brain Injury

Interventions: Behavioral: training in goal-directed attention regulation
Behavioral: computer-assisted training in goal-directed attention regulation
Behavioral: brain health education

Registration Number: NCT01035606

Lead Sponsor: VA Office of Research and Development

Brief Summary: Brain injuries affect the lives of numerous Veterans. This study examines how the brain is affected by injury and how rehabilitation training for attention dysfunction may change brain functioning.

Detailed Description: Traumatic brain injuries (TBI) are a leading cause of long-term disability among combat Veterans. The most common and persistent sequelae after TBI are cognitive-behavioral deficits in 'executive control' and 'attention' functions. Such abnormalities may directly contribute to poor long-term outcomes as well as impede rehabilitation of dysfunction in other cognitive and motor domains. Effective treatments would potentially make a major impact in improving functional outcomes, but consistently effective treatments are not available. The overall goal of this research is to improve the investigators' understanding of plasticity in brain function after TBI and to develop improved cognitive neurorehabilitation treatments. The intervention involves individual and group-based training in cognitive skills.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 49

Inclusion Criteria

history of traumatic brain injury
greater than 1 week from injury
residual dysfunction related to attention and executive control

Exclusion Criteria

aphasia
active illicit drug use
severe depression
contraindications to MRI scanning

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Goal-oriented Attention Regulation Training	training in goal-directed attention regulation	training in goal-directed attention regulation
Technology-assisted Goal-directed Self-Regulation Training	computer-assisted training in goal-directed attention regulation	computer-assisted training in goal-directed attention regulation
Education	brain health education	brain health education

Primary Outcome Measures

Name	Time	Method
Self-report	5 Weeks (After completion of active trainings in Arm 1 and Arm 3)	Responses to goal processing questionnaire relating to areas of personal goal-based functioning. This scale measured participants self-perceived changes to their cognitive and emotional functioning. Participants indicated the degree to which they perceived changes to 11 questions after receiving trainings in Arm 1 and Arm 3 on a 10-point scale (1=domain became worse, 5 = no change, 10 = domain improved). Participants did not complete this measure after Arm 2.

Secondary Outcome Measures

Name	Time	Method
Change From Baseline to Post-training for Task Errors on a Functional Performance Measure	5 weeks (After completion of Arm 1 and Arm 2)	Participants completed a functional assessment task, the modified Multiple Errands Task (MET). The MET is an unstructured functional task that permits assessment of participants' abilities to follow outlined rules and complete multiple 'real-world' tasks in a limited time period. Participants were provided written instructions and a map of the hospital where the assessment took place, and were instructed to complete 12 subtasks in 40 minutes while following 9 specified rules. Participants completed this at task at baseline and following Training (Arms 1 \& 2, but not 3). Outcome measure was computed as post-training - baseline (negative value reflects less errors made post-training).
Change to Attention and Executive Functioning Composite Scores	5 weeks (After completion of Arm 1 and Arm 2)	Participants completed the following neuropsychological measures of attention and executive functions before and after Arms 1 and 2, but not Arm 3. Letter Number Sequencing from WIAT-III; Auditory Consonant Trigram: 9,18, 36 seconds; Digit Vigilance Test (Time and Errors); DKEFS subtests: Design Fluency, Verbal Fluency Switching, Inhibition (Time and Errors); and Inhibition/Switching (Time and Errors); and Trails B. Performance on these measures were scored based upon age, and when available, educational and repeated administration norms. Resultant scores were transformed into z-scores and aggregated to form a composite measure. Higher z-scores reflect better functioning. The unit of analysis for this outcome was the change score from baseline to post-training. Positive change scores reflect improved performance over time\[post-training - baseline\], whereas negative change scores reflect worsening performance over time.