Effects of Cognitive Rehabilitation In Improving Attention Deficits

Effects of Cognitive Rehabilitation In Improving Attention Deficits And Diffusion Tensor Imaging Findings Following Mild Traumatic Brain Injury N Hamzah 1, Veeramuthu V 1, Narayanan NV 1, Ramli N 1, Tan JH 1, Sidhu AS 1, Mustafa N 2, Delano-Wood L 3, Cinna K 1, Mazlan M 1 1 University Malaya, Kuala Lumpur, Malaysia, 2 University Malaya Medical Centre, Malaysia, 3 UCSD, San Diego, USA Methods Introduction Results Mild traumatic brain injury (m. TBI) is defined as traumatic Design: an intervention study of 6 months duration Fifteen patients with m. TBI (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 and beyond (2, 3) Cognitive rehabilitation is a treatment for m. TBI symptoms review within 2 weeks post trauma with patients. Currently there is limited data to explain on how neuroimaging techniques can verify neural reorganization/ 2. 5. 84). Currently intervention group n=5 ongoing therapy. Treatment phase: involves applying cognitive 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 m. TBI or, such intervention as a deliberate of therapy changes depending on progress. A repeat of S- external factor that may allow for neuroplastic responses. NAB and DTI scan are done at end of therapy (at 6 months). Outcome measures: • rehabilitation therapy in the alteration of neuropsychological performance and diffusion tensor imaging (DTI) parameters in (who received standard treatment with a mean age of 28. 15, SD based Cogni. Plus cognitive training program (CPS) for cognitive intervention in altering brain architecture and This study Is to evaluate the effectiveness of cognitive full GCS recovery. Results were compared to 15 m. TBI controls rehabilitation for duration of 3 months using computer- outcomes for post m. TBI (4)I, in relation to the effects of Aim (SD 4. 84) with S-NAB at an average of 8. 25 hours (SD 7. 08) upon education session neuroplasticity including the mechanism that underlie such associated outcomes. There is also limited evidence on the Assessment phase: involves DTI imaging at <10 hours Comparison of DTI parameters at <10 hours trauma duration and at 6 months post injury. • Comparison of S-NAB done within 2 weeks post m. TBI 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 • m. TBI 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 m. TBI • 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. 2. American Congress of Rehabilitation Medicine (ACRM). Mc. Mahon 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. Mazlina Mazlan, Norfaridah Ahmad Roslan. Post-Concussion Syndrome and Quality of Life after m. TBI 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. Neuro. Rehabilitation. 2011; 29(4): 331 -338.