Developing Process-Specific Verbal Memory Interventions for Veterans with TBI

为患有 TBI 的退伍军人制定特定过程的言语记忆干预措施

• 批准号: 8986675
• 负责人: RUSSELL M BAUER
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-01-01 至 2016-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8986675
• 关键词: Adherence; Area; Base of the Brain; Behavioral; Belief; Biological Markers; Blast Cell; Brain; Brain Injuries; Brain imaging; Chronic; Classification; Classification Scheme; Clinical; Clinical Trials; Cognitive; Data; Decision Making; Development; Diagnosis; Diffusion; Diffusion Magnetic Resonance Imaging; Ensure; Exhibits; Fostering; Functional Imaging; Goals; Health; Heterogeneity; Image; Impairment; Individual; Injury; Intervention; Investigation; Knowledge; Learning; Life; Link; Magnetic Resonance Imaging; Manuals; Measures; Mechanics; Memory; Memory Disorders; Memory impairment; Methods; Nature; Neuronal Plasticity; Participant; Patients; Performance; Phase; Population; Population Heterogeneity; Procedures; Process; Protocols documentation; Public Health; Quality of life; Recovery; Recovery of Function; Rehabilitation therapy; Research; Rest; Retrieval; Severities; Solid; Staging; Standard Preparations; Structure; Survivors; System; Taxonomy; Techniques; Temporal Lobe; Testing; Therapeutic; Time; Training; Traumatic Brain Injury; Treatment Protocols; Treatment outcome; Veterans; alternative treatment; base; clinical decision-making; clinical practice; cognitive function; combat; community reentry; design; disease heterogeneity; effective therapy; efficacy testing; experience; functional outcomes; imaging biomarker; improved; information processing; memory acquisition; memory consolidation; memory encoding; memory process; morphometry; neuroimaging; neuropsychological; programs; relating to nervous system; research clinical testing; response; targeted treatment; treatment effect; white matter

DESCRIPTION (provided by applicant): Background and Purpose: Traumatic brain injury (TBI) has been described as a "signature injury" of the OIF-OEF-OND combat experience. Chronic memory deficits due to problems in memory encoding, consolidation, or retrieval, are often seen after moderate-severe TBI (M- STBI) and may pose barriers to community re-entry, retraining, and rehabilitation. Studies have demonstrated some efficacy in memory rehabilitation using cognitive treatments such as memory strategy training, errorless learning techniques, retrieval practice, and other methods. However, some patients do not benefit from such interventions, while others minimally improve. No prior group study has attempted to match the Veteran's specific information-processing deficit with a memory rehabilitation therapy targeted to their specific problem (patient-treatment matching), though such an approach should produce the best results. We propose to develop and test three memory therapies, each designed to foster improvement in a particular stage of memory processing. Veterans will then be classified by their primary locus of impairment and will participate in (a) a treatment matched to their deficit, and (b) a mismatched treatment. It is predicted that Veteran participants will show greater benefit from the matched treatment. If successful, this research could guide decision-making regarding the most efficacious approaches to alleviating disabling memory deficits in Veterans with M-STBI. Procedures: The proposed research takes place in three phases. In Phase 1, three memory therapies (memory strategy training, errorless learning, and retrieval practice) will be formalized through the development of a treatment manual. Therapists will be trained to provide these treatments with high fidelity, and their adherence to treatment regimens will be measured. In Phase 2, Veterans with chronic memory deficits from M-STBI will be evaluated with neuropsychological (NP) and neuroimaging (MRI) probes. The NP probes will allow us to classify participants into three groups, according to the primary locus of their memory deficit in encoding, consolidation, or retrieval. MRI sequences enable discovery of structural (morphometric and diffusion imaging) and functional (resting state functional connectivity) biomarkers of this classification, for use i a later trial evaluating the neural basis of treatment improvement. In Phase 3, Veteran participants will undergo treatment with two therapies, one matched to their deficit, the other mismatched. Treatment effect will be measured by assessing change on NP measures and on real-life functional measures and quality of life. Key Questions: Our primary goal is to develop and test the efficacy of three process-specific memory interventions in a heterogeneous population of Veterans with chronic memory impairment after M-STBI. We aim to learn whether improved efficacy results from appropriate patient-treatment matching. We also hope to refine a classification system that reliably identifies encoding, consolidation, and retrieval deficits in or participants, and to identify specific structural and functional brain biomarkers of this classification scheme. For our long term goal, we aim to maximize the efficacy of memory improvement therapies for alleviating memory impairment after acquired brain injury, and to use both NP and brain imaging biomarkers in better understanding mechanisms of change resulting from rehabilitative intervention. This knowledge will enhance discovery of best practices for treating debilitating memory dysfunction and maximizing functional recovery after injury.

描述（由申请人提供）： 背景和目的：创伤性脑损伤（TBI）已被描述为OIF-OEF-OND战斗体验的“签名损伤”。由于记忆编码，整合或检索的慢性记忆缺陷，经常在中度重度TBI（M-Stbi）之后看到，并可能对社区重新进入，重新训练和康复构成障碍。研究表明，使用认知治疗（例如记忆策略训练，无误的学习技术，检索实践和其他方法）在记忆康复方面有一些功效。但是，有些患者没有从这种干预措施中受益，而另一些患者则最少改善。没有先前的小组研究试图将退伍军人的特定信息处理赤字与针对其特定问题的记忆康复疗法（患者治疗匹配）相匹配，尽管这种方法应该会产生最佳结果。我们建议开发和测试三种记忆疗法，每种记忆疗法旨在在特定的内存处理阶段促进改进。然后，退伍军人将通过其主要损害基因座进行分类，并将参与（a）与他们的赤字相匹配的治疗，以及（b）不匹配的治疗方法。这是 预测资深参与者将在匹配的治疗中显示出更大的好处。如果成功，这项研究可以指导有关减轻M-STBI退伍军人残疾记忆缺陷的最有效方法的决策。程序：拟议的研究分为三个阶段。在第1阶段，将通过制定治疗手册来形式化三种记忆疗法（记忆策略培训，无错误的学习和检索实践）。将对治疗师进行培训，以提供高保真度，并将测量其对治疗方案的依从性。在第2阶段，将使用神经心理学（NP）和神经影像学（MRI）探针评估具有慢性记忆缺陷的退伍军人。根据他们的编码，合并或检索的主要记忆缺陷，NP探针将使我们能够将参与者分为三组。 MRI序列可以发现该分类的结构（形态计量学和扩散成像）和功能（静止状态功能连通性）生物标志物，以便在后来的试验中评估治疗改善的神经基础。在第3阶段，资深参与者将接受两种疗法治疗，一种与他们的赤字相匹配，另一个与他们的赤字相匹配。治疗效果将通过评估NP措施以及现实生活中的功能措施和生活质量的变化来衡量。关键问题：我们的主要目标是开发和测试三种特定过程记忆干预措施在M-STBI后具有慢性记忆障碍的退伍军人人口中的三种特定过程记忆干预措施的功效。我们旨在了解适当的患者治疗匹配是否会导致提高功效。我们还希望完善一个分类系统，该系统可靠地识别或参与者中的编码，合并和检索缺陷，并确定此分类方案的特定结构和功能性脑生物标志物。对于我们的长期目标，我们旨在最大程度地提高记忆改善疗法在获得脑损伤后减轻记忆障碍的功效，并同时使用NP和脑成像生物标志物，以更好地理解康复干预导致变化的机制。这些知识将增强发现最佳实践，以治疗衰弱的记忆功能障碍并在受伤后最大化功能恢复。