Depression and difficulty concentrating are some of the potential long-term symptoms of a traumatic brain injury (TBI), but a specially designed cognitive training program may help improve these and other symptoms—even 10 years after the injury. That’s the finding from a new study from the University of Texas at Dallas’s Center for BrainHealth, published in the journal Neuropsychological Rehabilitation.
The researchers developed and tested an eight-week, 18-hour cognitive training program called SMART (for “Strategic Memory Advanced Reasoning Training”) in a group of TBI patients, many of whom had sustained the initial injury more than 10 years earlier.
The SMART Approach to Rehab
For the study, 31 TBI patients between the ages of 19 and 65 participated in the SMART program; 13 were veterans. All had experienced TBI more than six months earlier, with two-thirds experiencing the injury more than 10 years earlier. They all had chronic cognitive or psychological symptoms, including difficulty carrying out daily tasks, grasping complex concepts, or problem-solving, which affected their ability to work full-time or find employment.
During the program, the patients learned strategies for improving their attention, reasoning, and innovative thinking skills. For example, the researchers explained, patients with TBI have trouble multitasking, which can tax the injured brain. In order to improve concentration, investigators taught the patients to identify and block out distractions in order to better focus on a single task. In turn, honing these attention skills helped the patients read complex articles and tease out the core ideas and messages. The participants were also asked to apply these strategies in their daily lives, for instance by reading the newspaper and identifying the most important parts of a news story.
The researchers compared the effects of the SMART program to those of a brain health workshop, in which 29 people with TBI learned basic facts about brain health and brain injury, but did not learn any specific strategies for dealing with the symptoms of TBI.
SMART Improves Memory, Thinking, and Mood
After eight weeks, people in the SMART program had improved their ability to grasp abstract concepts, as measured by a reading test, by 20 percent and improved their scores on memory tests by more than 30 percent, the researchers reported. The patients also reported a 60 percent decline in symptoms of depression and stress, and a 40 percent reduction in symptoms of post-traumatic stress disorder (PTSD).
These cognitive and psychological improvements could also “have a positive impact on one’s confidence, cognitive control, sense of well-being, and self-worth,” the researchers wrote.
Brain Imaging Shows Signs of Improvement
As part of the study, the researchers also administered magnetic resonance imaging (MRI) scans to all of the participants, looking at blood flow in areas of the brain linked with stress and depressive symptoms, such as the frontal lobe, the anterior cingulate, and the precuneus. In people with TBI, blood flow to these regions is decreased, which is considered a marker of injury severity and is linked to worse performance on cognitive tests and symptoms of PTSD, the researchers explained.
Patients who participated in the SMART program had a more than 25 percent increase in blood flow to these brain regions, suggesting a healthier and less-stressed brain, which could also explain the improvements on psychological health, the researchers said.
Effects Last for Several Months
The benefits of the SMART training program persisted when the researchers administered another set of cognitive tests and MRI scans three to four months after the program ended, noted lead investigator Sandra Bond Chapman, PhD, founder and chief director of the Center for BrainHealth, in a news release.
Need for Further Study
The results are promising but preliminary, and will need to be verified in rigorous future studies, said Dr. Chapman and her colleagues. If future research confirms the results, SMART could be added to the growing arsenal of cognitive training programs that have shown promise for treating the long-term effects of TBI, the researchers said, with the ultimate goal of helping people with TBI lessen their symptoms, rejoin the workforce, and lead happier, healthier, and more productive lives.
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