Title: TRACK-COG-TBI: Computer-based TRACKing and Training COGnition after traumatic brain injury (TBI)
Funder: Department of Health and Social Care

Abstract: We will develop a computer-based system to track cognitive function after traumatic brain injury (TBI) and deliver targeted home cognitive rehabilitation. We will initially deploy it in a critical care setting and then track recovery in patients discharged home. Cognitive rehabilitation will be delivered through the same IT platform into patient s homes who show persistent cognitive problems. The objective is to produce a cost-effective and practical method to manage cognitive impairment after TBI.. In a critical care setting there are frequently profound abnormalities of awareness, attention, emotion and memory. After discharge cognitive problems often persist without necessarily being appreciated. This can be disastrous as it leads to job loss and family breakdown. Patients and their families often feel abandoned after discharge and our patient engagement work has identified improving care in this period as a priority. We need improved ways of tracking and re-training cognitive function after TBI. Advances in information technology and changing attitudes to its use make it timely to address this problem. An integrated system linking critical care and home assessments will lead to clinical improvement by rapidly identifying individuals who need early intervention. Importantly, we need to repeatedly test cognition so that patient s recovery trajectory can be measured. This is not currently achievable, as assessments require face-to-face testing from trained staff. We have developed a computer-based system allowing detailed and repeated tests of cognitive function. The system tests cognitive domains commonly affected by TBI, including speed, memory, attention and executive function. In addition, it provides a cost-effective and scalable way to deliver cognitive rehabilitation at home. We have shown the general utility of the approach by testing more than 100,000 healthy individuals over the Internet. We are now developing this approach for clinical purposes with guidance from TBI patients and their families (see Additional Information). This work shows that: (a) patient s like the system (Fig4); (b) they are happy to do repeated testing sessions (Fig1); (c) they show clear improvements on both trained and non-trained cognitive tests after repeated testing (Figs3&5); and (d) they feel that doing the tests repeatedly is helpful (Fig4). The system will be deployed in two of London s Major Trauma Centres (St Mary s and St George s). Therefore, we will demonstrate that the software will be scalable across NHS centres. Adoption of this software by the NHS will depend on having a clear health economic argument. Our system will be low-cost and we believe it will lead to large economic savings in health and social care costs. For example, a 5% increase in UK patient s returning to work would save around &pound;100 million/year. To strengthen this case we will collaborate with the Health Economics Research Centre team at the University of Oxford. We will collect detailed data on health-related quality of life, health and social care costs, productivity losses and informal care costs, which will inform the financial case. Our team has an established track record in translational TBI research (Sharp), internet-based cognitive assessment/training (Hampshire), and health economics (Leal). We are asking for support to optimise our approach for TBI patients and then demonstrate proof-of-principle that it can be used to track large numbers of patients. We will test whether the benefits perceived by our patients generalise to real-world activities and whether we can efficiently deliver internet-based cognitive rehabilitation into a patient s home. The work will demonstrate how the new system can be adopted within NHS Major Trauma Units. Furthermore, the assessment of the impact of TBI on health and non-health costs and patients quality of life will support commercialisation and adoption by the NHS.

Lay abstract: Problems with thinking after brain trauma (cognitive impairments) are called the hidden disability as they often go unrecognized. Difficulty remembering, planning and concentrating are important causes of long-term disability. The effects of these problems are often devastating. Patients and their families often feel abandoned after their discharge. By the time it is clear that people are not recovering, many months have often passed and important interventions have been delayed. What is needed is a way to track patient s recovery and intervene quickly where necessary. We have developed a computer-based system to repeatedly test cognitive function. The system tests thinking problems commonly affected by brain injury. It also provides a way to provide targeted cognitive re-training for patient s who are not recovering. Re-training thinking skills after trauma is likely to need hundreds of hours of work. It is not possible to deliver this using conventional services as it would overwhelm the available resources. However, this can be achieved using our computer-based system where patient s work at home on their rehabilitation. We have already applied our general approach to test thinking skills in more than 100,000 healthy individuals via the Internet. We have begun to develop this approach with help from patient s who have thinking problems after brain injury (see Additional Information). This shows that: (a) they like the system (Fig4); (b) they are happy do regular daily sessions (Fig1); (c) they improve over the course of training (Figs3&5); and (d) they feel that the system is helping them (Fig4). This has provided us with the motivation to develop the system further. Our goal is to provide a system that all patients can access after brain injury, which will accurately test their cognitive function and allow access to effective re-training if necessary.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: INJURIES AND ACCIDENTS