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 可能是疾病过程的开始，该过程会产生持续的变化 受伤后数年，导致慢性 TBI 症状使人衰弱。一些研究发现 30% 的 mTBI 患者有持续症状。持久的认知 mTBI 后的缺陷对功能的完全恢复和重新进入社会角色构成障碍。 执行功能障碍、注意力不集中和记忆困难是最严重的 mTBI 幸存者面临持续的残疾。据估计，44% 的退伍军人也患有 mTBI 患有具有重叠症状的创伤后应激障碍 (PTSD)。 50% 的战斗报告称存在注意力问题 退伍军人对于日常功能至关重要的其他认知过程是必需的 例如记忆力、问题解决能力、语言能力和行为的认知控制。 需要采取有效的干预措施来解决慢性 mTBI 引起的认知缺陷。 在目前临床实践中使用的注意力和执行功能治疗中，有一种 缺乏有充分证据支持有效性的证据。当前认知 对患有 mTBI 的退伍军人的干预措施不包括具体的注意力训练，缺乏严格的 培训或仅在自我报告的症状上发现改善。为了提高翻译水平， 建议策略训练与注意力训练同时进行。目标管理 培训（GMT）就是这样一种策略培训，已被发现可以提高执行功能 患有 mTBI 的退伍军人的技能。然而，GMT 缺乏特定的注意力训练，这是一个限制 注意力是目标管理中正常执行功能的一个组成部分。 鉴于 mTBI 缺乏严格的注意力训练，注意力与目标的关系 管理，以及结合注意力培训和目标管理培训的承诺， 我们将创新地将元认知干预GMT与演练方法结合起来 注意力训练还包括注意力恢复的个人功能目标。 方法：这是一项随机对照试点研究，旨在确定 GMT plus 的有效性 对 50 名患有 mTBI 的退伍军人进行注意力训练。研究设计是一项平行研究 在前/后和六个月内随机分配至治疗组或对照组并进行测试 治疗后。将使用多元线性回归模型来确定是否存在 治疗效果与合并症（如创伤后应激障碍（PTSD）、抑郁症、 焦虑、疼痛、睡眠、药物滥用等。