Behavioral and Neural Effects of Intensive Cognitive-Communication Rehabilitation in Young College-Bound Adults with Acquired Brain Injury

青年大学生脑卒中成人严重认知 - 交流康复的行为和神经效应

NATALIE GILMORE Show email (2019-08-01 to 2021-07-31) $90,536

Project ID: F31DC017892 (NIDCD)

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Abstract

Due to an increase in recreation-related injuries and the prevalence of stroke risk factors in this population, young adults are a frequently affected and growing cohort to suffer acquired brain injury (ABI). ABI leads to persistent cognitive-linguistic deficits, resulting in decreased community participation, productivity and quality of life. At the time of injury, many young adults are already enrolled in college, but often struggle to successfully return to school even when cognitive-linguistic skills are only mildly impaired. Comprehensive, contextualized cognitive rehabilitation (CR) has resulted in improved cognition, community integration and independence for individuals with ABI. Furthermore, preliminary work has shown that young adults with ABI (n = 4) who participated in a novel intensive cognitive-communication rehabilitation (ICCR) program, consisting of classroom-style lectures, metacognitive strategy instruction, individual rehabilitation and technology training demonstrated significant gains on at least one standardized measure of cognitive-linguistic function over time, while controls did not (n = 2). Experimental participants who completed multiple semesters of ICCR (n = 3) also improved in their classroom performance, participation and quality of life with two participants enrolling in college. Research suggests that sufficient repetition, intensity, salience and specificity of training in a complex, enriched environment likely leads to a) cognitive-linguistic gains and b) brain reorganization. Yet, the specific cognitive-linguistic skills important for college success that improve over time as a function of academically- focused comprehensive, contextualized CR programs incorporating these principles remains unknown. Furthermore, no studies have investigated the neuroplasticity underpinning domain-level changes in cognitive- linguistic function after such programs. To address aim 1, growth curves will be applied to assess longitudinal changes in a range of cognitive-linguistic domains constructed using items across standardized cognitive- linguistic assessment batteries. To address aim 2, functional near infrared spectroscopy (fNIRS), an ecologically valid neuroimaging method that circumvents some of the challenges associated with magnetic resonance imaging, will be used to measure treatment-related neural changes during cognitive-linguistic tasks over time. Twelve young adults with ABI will participate in ICCR and undergo behavioral and fNIRS assessments before and after multiple 12-week semesters. Twelve healthy controls will undergo fNIRS assessment at a single timepoint for comparison with the experimental participants. Achieving these aims will demonstrate the efficacy of this novel, comprehensive, contextualized CR program at improving specific cognitive-linguistic skills important for college success and the corresponding neuroplasticity in young adults with ABI, a group poised for rehabilitation success and brain reorganization.

由于该群体中与娱乐相关的伤害和中风危险因素的流行增加，年轻成人经常受到影响并且正在成长为患有后天性脑损伤（ABI）的队列。 ABI导致持续的认知语言障碍，导致社区参与，生产力和生活质量下降。在受伤的时候，许多年轻人已经入读大学，但即使认知语言技能只是轻度受损，他们也往往难以成功返回学校。综合的情境化认知康复（CR）已经改善了ABI患者的认知，社区整合和独立性。此外，初步工作表明，ABI（n = 4）参加新型强化认知沟通康复（ICCR）计划的年轻人，包括课堂式讲座，元认知策略教学，个人康复和技术培训，显示出显着收益关于认知语言功能的至少一种标准化测量随着时间的推移，而对照没有（n = 2）。完成ICCR多个学期（n = 3）的实验参与者，在两名参加大学学习的学员中，课堂表现，参与度和生活质量也有所提高。研究表明，在复杂，丰富的环境中，足够的重复，强度，显着性和特异性训练可能导致a）认知语言学上的收益和b）大脑重组。然而，具有大学成功的特定认知语言技能随着时间的推移而不断改进，这些技能作为以学术为中心的综合性语境化CR课程的一个功能，其中包含这些原则仍然未知。此外，没有研究调查支持这些程序后认知语言功能的领域水平变化的神经可塑性。为了解决目标1，将应用增长曲线来评估使用标准化认知语言评估电池项目构建的一系列认知语言领域的纵向变化。为了解决目标2，功能性近红外光谱（fNIRS）是一种生态学上有效的神经成像方法，可以避免与磁共振成像相关的一些挑战，将用于测量认知语言任务中随时间推移的治疗相关神经变化。 12名ABI青年将参加ICCR，并在多个12周学期之前和之后接受行为和fNIRS评估。 12名健康对照将在单个时间点进行fNIRS评估，以与实验参与者进行比较。实现这些目标将证明这种新颖，全面，情境化的CR计划在改善对大学成功具有重要意义的特定认知语言技能以及ABI年轻成年人相应的神经可塑性方面的功效，ABI是一个准备康复成功和大脑重组的群体。