Transcript NNS poster 2015 (1)

Effects of Cognitive Rehabilitation In Improving Attention Deficits And
Diffusion Tensor Imaging Findings Following Mild Traumatic Brain Injury
N Hamzah1, Veeramuthu V1, Narayanan NV1, Ramli N1, Tan JH1, Sidhu AS1, Mustafa N2, Delano-Wood L3, Cinna K1,
Mazlan M1
1University Malaya, Kuala Lumpur, Malaysia, 2University Malaya Medical Centre, Malaysia, 3UCSD, San Diego, USA
Methods
Introduction
Results
Mild traumatic brain injury (mTBI) is defined as traumatic
Design: an intervention study of 6 months duration
Fifteen patients with mTBI (mean age 27.12, SD 6.30) in the
injury that induces physiological disruption of the brain
Cognitive Intervention protocol:
treatment group underwent DTI scan at an average 12.1 hours
function (1).). At least one third of patients fail to return to full
1.
functional status at 3 and 6 months and may continue to have
post trauma and neuropsychological Assessment Battery
functional and neurocognitive deficits 1 year post injury and
(S-NAB) within 1 week of trauma. Clinical assessment
beyond (2,3) Cognitive rehabilitation is a treatment for mTBI
and symptoms review within 2 weeks post trauma with
patients. Currently there is limited data to explain on how
neuroimaging techniques can verify neural reorganization/
(SD 4.84) with S-NAB at an average of 8.25 hours (SD 7.08) upon
full GCS recovery. Results were compared to 15 mTBI controls
(who received standard treatment with a mean age of 28.15, SD
5.84). Currently intervention group n=5 ongoing therapy.
education session
2.
neuroplasticity including the mechanism that underlie such
Treatment
phase:
involves
applying
cognitive
rehabilitation for duration of 3 months using computer-
outcomes for post mTBI (4)I, in relation to the effects of
based CogniPlus cognitive training program (CPS) for
cognitive intervention in altering brain architecture and
associated outcomes. There is also limited evidence on the
Assessment phase: involves DTI imaging at <10 hours
attention deficits and metacognitive training.
3.
application of early cognitive rehabilitation in improving
Follow-up phase: reassessment of S-NAB at 3 months
followed by therapy progress review. Intensity and type
symptoms after mTBI or, such intervention as a deliberate
of therapy changes depending on progress. A repeat of
external factor that may allow for neuroplastic responses.
S-NAB and DTI scan are done at end of therapy (at 6
months).
Aim
This study Is to evaluate the effectiveness of cognitive
Outcome measures:
•
rehabilitation therapy in the alteration of neuropsychological
performance and diffusion tensor imaging (DTI) parameters in
Comparison of DTI parameters at <10 hours trauma
duration and at 6 months post injury.
•
Comparison of S-NAB done within 2 weeks post mTBI.
mTBI patients.
Table 1: Demographic distribution of control group patients
included in this study (n=15)
GCS, Glasgow Coma Scale; LOC, Loss of Consciousness; PTA, Post
Traumatic Amnesia; GOSE, Glasgow Outcome Score Extended
Participants
Inclusion criteria:
Conclusion
• Between 18-60 years old of age
• Male gender
Individualized cognitive rehabilitation therapy intervention within
• mTBI as a result of motor vehicle accidents only
the first 6 months of injury may improve cognitive outcome with
• No previous history of head trauma
favorable changes structurally assessed by DTI parameters in mTBI
• Negative CT brain scan
patients. However, cognitive rehabilitation intervention is still
• Able to comply with cognitive rehabilitation therapy
ongoing.
program (written consent)
• No chronic illness or CNS pathology or psychiatric
Acknowledgement
condition premorbidly
This work is funded by University of Malaya Research Grant
Exclusion criteria
(UMRG 447 HTM 12).
• Normal neurocognitive assessment result at baseline
• On pharmaceutical treatment affecting central nervous
system
Flowchart 1: Flowchart of recruitment of patients and
group division
• Major polytrauma including long bone fractures, intraabdominal injuries and chest injuries
References
1.
American Congress of Rehabilitation Medicine (ACRM).
2.
McMahon P, Hricik A, Yue JK, Puccio AM, Inoue T, Lingsma HF, et al. Symptomatology and functional outcome in mild traumatic brain injury: results from the prospective TRACK-TBI study. Journal of neurotrauma.
2014; 31(1):26-33.
3.
Mazlina Mazlan, Norfaridah Ahmad Roslan. Post-Concussion Syndrome and Quality of Life after mTBI in Malaysian Patients, 2015. Unpublished manuscript, University of Malaya, MY
4.
Tracy J.I, Osipowicz K.Z. A conceptual framework for interpreting neuroimaging studies of brain neuroplasticity and cognitive recovery. NeuroRehabilitation. 2011; 29(4): 331-338.