title: Working memory updating training and the rehabilitation of goal management after brain injury
Creators: name: Pappa, Aikaterini
Publisher: name: University of Glasgow
Year: 2022

description: This thesis follows an interdisciplinary research approach employing methods from the fields of clinical neuropsychology and cognitive neuroscience to investigate the plastic changes following cognitive training. Disentangling the mechanism behind the training-induced cognitive and neural plastic changes can have a direct impact on the cognitive rehabilitation of individuals with long term cognitive impairments. Chapter one provides a brief overview of the executive function difficulties associated with acquired brain injury (ABI) and a description of the clinically evaluated goal management strategy-based training (Levine, Manly and Robertson, 2012). Process-based training paradigms and their implication for generalisation of learning are subsequently discussed together with the theoretical framework of adult plasticity proposed by Lövdén et al., (2010). The chapter discusses working memory processes, their relationship with executive functions and provides a description of the WM neural network involving fronto-parietal and striatal areas. At the end of this chapter, the development of a multidisciplinary intervention integrating goal management strategies and working memory process-based training in adults with ABI is described. Chapters two, three and four primarily focus on research in healthy adult populations and investigate the cognitive and neural changes following working memory updating (WMU) training. Chapter two is a meta-analysis of the training and transfer effects conducted together with a systematic review of the functional activity changes following WMU training. Existing work focuses mainly on healthy adults together with a small number of studies involving neurological populations. Chapters three and four investigate the grey matter volumetric changes and the task-based functional connectivity changes following adaptive working memory updating training in healthy young adults. These analyses are complementary to a previous fMRI analysis conducted by Flegal, Ragland and Ranganath (2019). Chapters five, six and seven focus on the transition from research with healthy adults to individuals with ABI and describes the development of an integrated goal management strategy and WMU process-based training protocol targeting executive dysfunction ABI. Chapter five is a critical review discussing key issues in the field of cognitive training with emphasis on WM protocols and highlights the importance of employing interdisciplinary methods from the field of cognitive neuroscience and clinical neuropsychology. Chapter six involves the detailed description of the integrated processes and strategies (iPRESS) training protocol combining the goal management training (GMT) (Levine, Manly and Robertson, 2012) with the adaptive WMU training protocol employed in Flegal, Ragland and Ranganath (2019). This chapter further describes the amendments put in place to allow for remote delivery of the iPRESS protocol due to COVID-19 constraints and disruptions. Chapter seven investigates the feasibility of running the remote version of iPRESS and to test the fMRI task protocol adapted for an individual with ABI. Chapter eight discusses the implications of the research conducted in this thesis involving a better understanding of the training-induced plastic changes as well as the development of interdisciplinary cognitive interventions. Finally, the chapter posits research questions to be addressed in the future.