Combining attention and metacognitive training to improve goal directed behavior in Veterans with TBI

结合注意力和元认知训练来改善患有 TBI 的退伍军人的目标导向行为

• 批准号: 10390281
• 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: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10390281
• 关键词: Address; Anxiety; Attention; Attention Concentration; Attentional deficit; Behavior; Behavior Control; Brain Concussion; Chronic; Cognition; Cognitive; Cognitive deficits; Combined Modality Therapy; Community Participation; Control Groups; Data; Disease; Effect Modifiers (Epidemiology); Effectiveness; Emotional; Executive Dysfunction; Failure; Future; Goals; Impairment; Individual; Individual Differences; Injury; Intervention; Laboratories; Language; Lead; Linear Regressions; London; Measures; Memory; Mental Depression; Methods; Modeling; Neuronal Plasticity; Neuropsychological Tests; Outcome; Pain; Patient Self-Report; Performance; Persons; Pilot Projects; Post-Traumatic Stress Disorders; Problem Solving; Process; Randomized; Reaction Time; Recording of previous events; Recovery; Recovery of Function; Reporting; Research Design; Role; Shapes; Sleep; Substance abuse problem; Survivors; Symptoms; System; Task Performances; Testing; Time; Training; Translating; Translations; Veterans; Work; clinical practice; cognitive control; cognitive process; cognitive training; cohort; combat; combat veteran; community reintegration; comorbidity; computerized; design; disability; effective intervention; effectiveness evaluation; executive function; experience; feasibility testing; functional improvement; implementation facilitation; improved; innovation; insight; mild traumatic brain injury; performance based measurement; performance tests; persistent symptom; psychosocial; skills; success; symptomatology; translational approach; treatment effect

Background: TBI can be the beginning of a disease process that produces change that continue years after injury resulting in debilitating chronic TBI symptomatology. Some studies find that up to 30% of people that have sustained mTBI have persistent symptoms. Enduring cognitive deficits after mTBI present barriers to full functional recovery and re-entry into societal roles. Executive dysfunction, poor attention-concentration, and memory difficulties are the most persistent disabilities faced by mTBI survivors. An estimate 44% of Veterans with mTBI also have PTSD with overlapping symptoms. Attention problems are reported by 50% of combat Veterans which are requisite for other cognitive processes that are vital to everyday functioning such as memory, problem solving, language skills, and the cognitive control of behavior. Effective interventions are needed to address the cognitive deficits resulting from chronic mTBI. Of the attention and executive function treatments currently used in clinical practice, there is a dearth of those with substantial evidence to support effectiveness. Current cognitive interventions for Veterans with mTBI did not include specific attention training, lacked rigorous training or found improvement only on self-reported symptoms. In order to improve translation, strategy training has been recommended to accompany attention training. Goal Management Training (GMT) is such a strategy training and has been found to be improve executive function skills in Veterans with mTBI. However, GMT lacks specific attention training, which is a limitation in that attention is a component of the normal executive function used in goal management. Given the need in mTBI lack of rigor in attention training, the relationship of attention to goal management, and the promise of combined attention training and goal management training, we will innovatively combine the metacognitive intervention, GMT, with a drill method of attention training that also includes individual functional goals for attention recovery. Method: This is a randomized control pilot study to determine effectiveness of GMT plus Attention Training in 50 Veterans with mTBI. The research design is a parallel study with randomization to treatment or control with test administration at pre/post and six months following treatment. A multiple linear regression model will be used to determine if there is a significant association between treatment effect and comorbidities such as PTSD, depression, anxiety, pain, sleep, substance abuse, etc.

背景：TBI可以成为疾病过程的开始，该过程会导致持续变化 受伤后几年导致慢性TBI症状学衰弱。一些研究发现 30％的持续MTBI的人具有持久的症状。持久的认知 MTBI之后的缺陷列出了充分功能恢复并重新进入社会角色的障碍。 执行功能障碍，注意力集中和记忆困难是最大的 MTBI幸存者面临的持续残疾。估计有44％的MTBI退伍军人 具有重叠症状的PTSD。注意问题由50％的战斗报告 对于其他对日常运作至关重要的认知过程必需的退伍军人 例如记忆，解决问题，语言技能和行为的认知控制。 需要有效的干预措施来解决慢性MTBI导致的认知缺陷。 在临床实践中目前使用的关注和执行功能治疗中，有一个 缺乏证据支持有效性的人的缺乏。当前的认知 MTBI退伍军人的干预措施不包括特定的注意培训，缺乏严格 仅针对自我报告的症状进行培训或发现改善。为了改善翻译， 建议进行策略培训以伴随着注意力培训。目标管理 培训（GMT）是这样的策略培训，已被发现可以改善执行职能 MTBI的退伍军人技能。但是，GMT缺乏特定的注意力培训，这是一个限制 在这个注意力中，是目标管理中使用的正常执行功能的组成部分。 鉴于MTBI缺乏注意力训练缺乏严格性，注意力与目标之间的关系 管理以及将注意力培训和目标管理培训结合在一起的希望， 我们将创新地将元认知干预措施GMT与钻探方法相结合 注意训练还包括个人功能目标，以恢复注意力。 方法：这是一项随机对照试验研究，旨在确定GMT Plus的有效性 50名退伍军人的注意力训练。研究设计是一项平行研究 在预/邮政和六个月后通过测试给药随机治疗或对照 治疗后。多个线性回归模型将用于确定是否存在 治疗效果与合并症（例如PTSD，抑郁， 焦虑，疼痛，睡眠，滥用药物等。