Cognitive therapy to enhance MRI measures of neural repair and improve clinical outcomes following traumatic brain injury

Neural repair and plasticity likely play a role in the variable degree of recovery seen after concussion or mild traumatic brain injury TBI, and magnetic resonance imaging (MRI) provides a means to detect both structural and functional changes in neural circuitry.

Diffusion Tensor Imaging (DTI) is highly sensitive to axonal shearing; however, this modality has not been used to systematically evaluate the acute phase of mild TBI (<1 week after injury). Cognitive rehabilitation therapy (CRT) may help in treatment of mild TBI, but further research is required to establish efficacy of this type of intervention. In this project, we intend to fill the fundamental gap in understanding the association between changes in brain structure and function, and clinical outcomes following a mild TBI, while testing the efficacy of a CRT intervention. The therapy involves mindfulness and relaxation techniques using music that the subject selects on a portable mp3 player. This intervention is designed to be accessible to those individuals most at risk of concussion, including young adults, athletes, and military personnel.

The goal of this project is to test the hypothesis that 6 weeks of cognitive rehabilitation therapy will improve clinical outcome measures of memory, attention, executive function, and reaction time, while decreasing post concussive symptoms, through a mechanism of neural repair and plasticity detected by longitudinal structural and functional neuroimaging.

 

Aim 1: To test the ability of sequential MRI in the first week after head injury to provide a quantitative measurement of organic brain dysfunction that correlates with concussion outcomes.
Hypothesis. Patients who demonstrate evolving changes on DTI neuroimaging in the acute injury phase (<1 week) will have high rate of post-concussive syndrome. Specifically, the development of decreases in fractional anisotropy and increases in diffusivity over a 1 week interval after injury in regions of interest most vulnerable to concussion (the gray-white matter junction regions of frontal, parietal, and temporal lobes, the corpus callosum, the internal capsule, and the dorsal brainstem), will correlate with and decreased clinical outcomes and higher prevalence of post-concussive symptoms at 1 week and 3 month follow up.

Aim 2: To establish the efficacy of a music-based CRT for improving recovery from mild TBI, and examine the correlation between recovery and neuroplastic changes detected on structural and fMRI.
Hypothesis. Patients randomized to 6 week CRT intervention initiated within the first 2 weeks after head injury will have decreased prevalence of post-concussive symptoms at 3 and 12 months after trauma, compared to controls. Neuroplastic changes may be beneficial or deleterious, and we will determine whether evolving DTI measures in regions of interest, or fMRI measures of limbic emotional circuits during emotional tasks and activation of the prefrontal and anterior cingulate cortices during cognitive tasks play a role in recovery from mild TBI.

Last modified January 03 2012 06:16 PM