Therapeutic Resources for Attention Improvement With Neuroimaging for TBI
Condition: Traumatic Brain Injury
MeSH terms: Brain Injuries; Brain Injuries, Traumatic
Study type: Observational

Summary: 
      One of the most common symptoms suffered by traumatic brain injury (TBI) patients is
      disruption in attention. Lack of attention impacts daily life including academic or
      professional tasks, and interpersonal relationships. The focus of Therapeutic Resources for
      Attention Improvement with Neuroimaging for Traumatic Brain Injury (TRAIN-TBI) is to
      investigate the changes in neurological function with special interest in attention after TBI
      for children ages 8 to 16. This study will be done through advanced neuroimaging procedures,
      neurocognitive testing, and an online training tool created by The Brain Plasticity
      Institute. The investigators hypothesize that the training will improve attention in TBI
      subjects and that the advanced imaging will show corresponding neural connectivity changes,
      as compared to matched healthy controls.
    

Detailed description: 
      Specific Aim 1: To use advanced functional neuroimaging methods to better understand the
      nature of attention disruption in patients who have sustained a TBI. We will use imaging data
      acquired at 3 Tesla (3T) for quantification of regional changes in brain volume over time.
      The microstructural integrity of white matter tracts will be assessed with diffusion tensor
      imaging (DTI). Resting state functional MRI (rs-fMRI) from 3T will provide an understanding
      of the neural networks associated with the brain's baseline activity which may be correlated
      to cognitive health. We will also try to better understand attention processing in relation
      to time by employing magnetoencephalography (MEG). By overlaying MEG information on top of
      structural T1 and T2-weighted MRI sequences, we can get a better overall picture, in both
      spatial and temporal resolutions, of the brain cognitive tasks. MEG examination will include
      standard cognitive tasks that rely on intact attention and executive functioning, but are not
      directly trained by the attention training modules. This allows for assessment of the
      improvement in functional attention and the ability of training to generalize across related
      cognitive tasks. All imaging will be corroborated with neuropsychological and neurocognitive
      testing to assess whether or not abnormalities seen in the imaging are indicative of
      functionality.

      Specific Aim 2: To measure the extent of improvement of patients' attention post cognitive
      training, and to better understand the processes and timelines that underlie the recovery of
      attention dysfunction. Comparing the pre- and post-training neurocognitive test results will
      measure the difference, if any, in attention capacity. These improvements will be correlated
      to respective advanced imaging. 3T MRI and MEG information from both before and after the
      cognitive training will be compared to look for any anatomical, functional, and connectivity
      changes.

      Specific Aim 3: To determine which demographic factors (age, race, etc.) and clinical factors
      (medical history, severity of injury, etc.) contribute to attention impairment, if any. By
      collecting detailed clinical intake assessments from patients (and/or parents, if applicable)
      and medical records, as recommended the NIH Common Data Elements for TBI, we will be able to
      identify any epidemiological variables that significantly contribute to both 1) sustaining
      attention deficits post-TBI and 2) the propensity for recovery after successful completion of
      the cognitive training protocol.
    

Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Subjects with TBI will be recruited from the Bay Area Concussion and Head Injury Program at
        UCSF or referred to us by colleagues. Healthy controls will be recruited via flyers and
        referred to us.
      
Keywords: Traumatic Brain Injury; Post-Concussive Symptoms; Brain Imaging; Cognition