neuromodulation and neurorehabilitation for mtbi

Conditions: Mild Traumatic Brain Injury; Post Traumatic Stress Disorder

Summary: this study will determine (i) the magnitude of immediate and sustained effects of a current clinical standard interactive computer attention processing training (apt) when combined with intermittent theta burst stimulation (itbs), a type of repetitive transcranial magnetic stimulation and (ii) determine how apt + itbs changes the neurocognitive system of attention in individuals with persistent attention deficits related to mtbi +/- ptsd.


Eligibility criteria:
inclusion criteria: * at least 18 years of age and no older than 80 years of age * 3 months post exposure to mtbi event * have a history of mtbi with ptsd or mtbi without ptsd as defined by formalized measures to classify mtbi based on the symptom attribution and classification algorithm (saca) and the ptsd module l of the scid * endorse at least moderate severity on at least one of the four cognitive complaints in the neurobehavioral symptom inventory exclusion criteria: * participating in another research study * non-fluent in english (speaking and reading) * history of epilepsy pre-injury * receiving antiepileptic treatment for documented active seizures in the past 6 months * taking medications that lower seizure threshold including antipsychotics, trazodone and tramadol * history of surgery on blood vessels in brain and/or valves of the heart * history of brain hemorrhage, neurovascular conditions and neurodegenerative disorders * history or current diagnosis of psychotic spectrum disorders (i.e. bipolar, schizophrenia) * significant heart disease as determined by physician review of medical chart * pregnant at time of enrollment or any time during study participation * mri or tms/itbs contraindications such as claustrophobia, metal in eyes/face or brain * cardiac pacemakers/defibrillators, cochlear implants, nerve stimulators, intracranial metal clips * diagnosis of moderate or severe tbi (loss of consciousness \> 30 minutes, alteration of consciousness \> 24 hours, post traumatic amnesia or neuropsychological testing results * prescribed dosage of mental health medications have been altered within the month preceding study screening. any participant whose mental health medication(s) has/have changed, within 30 days of study screening. the following are considered a medication change: the addition of or discontinuation of medication, a change in the dose or dosage (daily amount) of medication. * taking prescribed cns stimulants and choosing to not stop these medications during study participation * taking prescribed cns stimulants and choosing to not stop these medications during study participation * testing positive for opiates and do not have a prescription for opiates. if on prescription opiates and taking more than the equivalent of 200 mg of morphine per day. * questionably valid test performance as indicated by a score of ≤ 85% on the immediate recognition, delayed recognition or consistency scales of the medical symptom validity test (msvt) and clinical determination of questionable performance validity by a neuropsychologist on the research team * actively suicidal as evidenced by plan to harm or recent attempt communicated on the structured clinical interview for dsm-v (scid-5). * increased intracranial pressure (icp) as evidenced through a funduscopic evaluation or on the baseline mri scan. * moderate or severe cannabis use disorder defined by ≥ 4 symptoms on the scid-5 * severe alcohol use disorder defined by ≥ 6 symptoms on the scid-5 * baseline systolic bp greater or equal to 170

Keywords: mtbi ptsd intermittent theta burst stimulation cognitive training neuroimaging