Metacognitive Training to Enhance Strategy Use In Blast Related TBI

元认知训练可增强爆炸相关 TBI 中策略的使用

• 批准号: 8926243
• 负责人: Julia Kay Waid-Ebbs
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-10-01 至 2018-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8926243
• 关键词: Activities of Daily Living; Address; Adult; Affect; Award; Beck depression inventory; Behavior; Blast Cell; Brain Concussion; Brain Injuries; Case Series; Cellular Phone; Clinical Trials; Cognition; Cognitive; Color; Communities; Community Participation; Comorbidity; Control Groups; Data; Decision Making; Diagnosis; Educational workshop; Effectiveness; Emotional; Environment; Equipment and supply inventories; Executive Dysfunction; Florida; Freedom; Frequencies; Future; Goals; Health; Home environment; Impairment; Individual; Informal Social Control; Injury; Intention; Intervention; Investigation; K-Series Research Career Programs; Laboratories; Lead; Learning; Life; Linear Regressions; London; Measures; Mental Depression; Mentors; Methods; Monitor; Outcome; Participant; Patients; Performance; Pilot Projects; Pittsburgh Sleep Quality Index; Post-Traumatic Stress Disorders; Probability; Problem Solving; Process; Randomized; Recovery; Recruitment Activity; Regression Analysis; Research; Research Personnel; Role; Sample Size; Sampling; Schedule; Scientist; Services; Severities; Signal Transduction; Site; Sleep; Sleep Disorders; Soldier; Speech; Sports; Symptoms; Technology; Testing; Time; Training; Training Programs; Translating; Translations; Traumatic Brain Injury; Veterans; War; Woman; Work; base; brain health; cognitive ability; cognitive capacity; cognitive process; cognitive skill; combat; community reintegration; computerized; design; disability; effective therapy; executive function; group intervention; improved; innovation; innovative technologies; interest; learning strategy; member; men; mild traumatic brain injury; neuromechanism; operation; preference; public health relevance; skills; skills training; social skills; success; treatment effect; treatment group; treatment response; wound

DESCRIPTION: Background: Traumatic brain injury has been referred to as the "signature" injury of the Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn (OIF/OEF/OND) wars. Over 25,000 soldiers were diagnosed with mild traumatic brain injury (mTBI) in 2012 alone. Not only do soldiers have blast-related mTBI, estimates of comorbid Post Traumatic Stress Disorder (PTSD), range from 11% to 50%. Since neural mechanisms affected by mTBI and PTSD often are overlapping, it is suggested that mTBI and PTSD may have an additive effect on symptoms. Indeed, an estimated 44-50% of soldiers with mTBI/PTSD remain symptomatic after one-year, compared to an estimated 10% in sports related concussion. Both mTBI and PTSD are associated with deficits in executive functioning. Additional factors that accompany mTBI in combat Veterans are depression and sleep deficits. Consequently, the combination of all these factors, impact executive functions and result in combat Veterans who are struggling to live productive lives. An effective treatment of executive function is needed for Veterans diagnosed with mTBI. Goal Management Training (GMT) is a metacognitive intervention that has been validated in TBI. However, limitations in GMT studies raise questions regarding effectiveness of GMT in mTBI. Based on preliminary data, GMT improved significantly on a problem solving measure in Veterans with blast-related mTBI, but lacked transfer to everyday activities. Therefore, we developed a Smartphone application to enhance the transfer of GMT skills to everyday tasks. The purpose: of this randomized study is to determine the effect of an innovative treatment for executive functions, enhanced with Smartphone technology, in Veterans with multiple blast related mTBI. In addition to determining the overall benefit of GMT, the study will investigate the influence of comorbid factors, such as post-traumatic stress disorder, depression, sleep disorders and cognitive capacity. Method: Veterans diagnosed with repeat blast-related mTBI and executive function deficit will be recruited from two sites (Tampa and North Florida/South Georgia) by Speech Services. Veterans will be randomized to GMT (38 participants) or to a control treatment called Brain Health Workshop (BHW) (16 participants).The Tower of London, a measure of planning and problem solving will be used to determine response to treatment. Primary analysis will use two sample t-test to compare group A (intervention) and group B (control) on improvements in time to completion on the TOL. In addition, as an exploratory analysis, we will perform a regression analysis that includes treatment group, PTSD severity and their interaction as independent variables, to adjust for PTSD severity measured by Clinician Administered PTSD Scale and to investigate whether there is interaction between treatment group and PTSD severity. Additional, exploratory tertiary analysis using paired t-tests will determine whether treatment effect generalizes to executive function performance in everyday activities (BRIEF-A) or engagement in community participation (CRIS). To test the second specific aim, a general linear regression will be used to determine whether factors such as PTSD, sleep, depression or cognitive capacity is associated with response to treatment. Results: If the results support the hypothesis that GMT will improve executive functions than this cognitive intervention can be adapted to a tele-health method of delivery and tested in a larger clinical trial. Moreover, the influence of the four factors on response to treatment, can guide future studies to determine which patients are likely to benefit from GMT.

描述： 背景：创伤性脑损伤被称为行动伊拉克自由/行动的“签名”伤害，持久自由/行动新黎明（OIF/OEF/OND）战争。仅2012年，超过25,000名士兵就被诊断出患有轻度脑损伤（MTBI）。士兵不仅具有与爆炸相关的MTBI，对创伤后应激障碍（PTSD）的估计值从11％到50％不等。由于受MTBI和PTSD影响的神经机制通常是重叠的，因此建议MTBI和PTSD可能对症状产生添加作用。实际上，一年后，估计有44-50％的MTBI/PTSD士兵仍然有症状，而与运动相关的脑震荡估计为10％。 MTBI和PTSD都与执行功能的缺陷有关。战斗退伍军人中MTBI伴随的其他因素是抑郁症和睡眠不足。因此，所有这些因素的结合，影响执行职能并导致战斗的退伍军人努力过上生产力的生活。需要对执行功能进行有效的处理 退伍军人被诊断为MTBI。目标管理培训（GMT）是TBI验证的元认知干预措施。但是，GMT研究的局限性提出了有关GMT在MTBI中有效性的问题。基于初步数据，GMT在与Blast相关的MTBI的退伍军人中的解决方案措施方面显着改善，但缺乏转移到日常活动。因此，我们开发了一个智能手机应用程序，以增强GMT技能向日常任务的转移。目的：这项随机研究是为了确定具有多个爆炸相关的MTBI的退伍军人，通过智能手机技术增强了对执行功能的创新处理的影响。除了确定GMT的总体益处外，该研究还将研究合并症因素的影响，例如创伤后应激障碍，抑郁症，睡眠障碍和认知能力。方法：通过演讲服务，将从两个地点（坦帕和北佛罗里达/南部佐治亚州）招募被诊断为重复爆炸的MTBI和执行功能赤字的退伍军人。退伍军人将被随机分配给GMT（38名参与者）或称为脑健康研讨会（BHW）（16名参与者）的对照治疗。初级分析将使用两个样本t检验来比较A组（干预）和B组（对照）在TOL完成的时间上的改进。此外，作为探索性分析，我们将执行一个回归分析，其中包括治疗组，PTSD严重程度及其作为独立变量的相互作用，以调整由临床医生管理的PTSD量表测量的PTSD严重程度，并研究治疗组和PTSD严重程度之间是否存在相互作用。使用配对t检验的其他探索性三级分析将确定治疗效果是在日常活动（简介A）或参与社区参与（CRIS）中的执行功能表现（CRIS）。为了测试第二个特定目标，将使用一般线性回归来确定诸如PTSD，睡眠，抑郁或认知能力等因素是否与对治疗的反应有关。结果：如果结果支持GMT将改善执行功能的假设，而不是这种认知干预措施，则可以适应一种远程保健方法，并在更大的临床试验中进行了测试。此外，这四个因素对治疗反应的影响可以指导未来的研究以确定哪些患者可能受益于GMT。