Category: Brain Injury; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
To determine the safety and feasibility of using transcranial direct current stimulation (tDCS) paired with a computerized attention training program (Attention Process Training-III) for individuals with persistent cognitive impairments one year or more following a traumatic brain injury (TBI).
Single blind, randomized controlled, pilot study.
Outpatient services within a rehabilitation hospital.
Participants (or Animals, Specimens, Cadavers) :
4 adults ≥ 1-year post-TBI with persistent cognitive impairments. Cognitive impairment was determined by a score on the Symbol Digit Modalities Test (SDMT) written administration that was at least 1.5 standard deviations below the age and education adjusted mean. Two participants receiving active tDCS + APT-III and two participants receiving placebo tDCS + APT-III are included in this preliminary investigation of results. Active tDCS participants ranged in age from 54-63, and placebo tDCS participants ranged in age from 27-57. Each participant was referred by a collaborating physiatrist or volunteered after learning of the study in a community resource center for individuals who have experienced a traumatic brain injury.
15 sessions of active or placebo tDCS paired with Attention Process Training-III (APT-III).
Main Outcome Measure(s) :
SDMT, Conners' Continuous Performance Test (CPT), Paced Auditory Serial Addition Test (PASAT), Performance Assessment of Self-Care Skills (PASS), Test of Everyday Attention (TEA), Patient Reported Outcome Measure Information System – Global Health (PROMIS) and tDCS Adverse Effect Questionnaire.
Baseline and endpoint scores for cognitive assessments are compared for each of the participants. The active tDCS participants made greater improvements on outcome measures from baseline to end of treatment. Notable improvements for the participants in the active group include their performances on the SDMT Oral administration (z-score increase of -3.44 to -2.88 and -3.38 to -2.92) compared to the placebo. Active tDCS participants also showed an increased number of attempted trials on the PASAT when compared to the placebo. Safety monitoring for all participants following each tDCS session indicated no adverse reactions, with only occasional mild, transient symptoms reported.
tDCS as a neuromodulatory treatment paired with evidence-based attention training was safe and feasible. Improvements in attention measures and perceptions of overall health were consistently demonstrated in both active and placebo conditions; however, greater improvement was seen on some measures of cognition for participants receiving attention training paired with active tDCS.
Jacob Lowe– Psychometrist, Marianjoy Rehabilitation Hospital, Wheaton, Illinois
Clare Goodman– Speech Pathologist, Marianjoy Rehabilitation Hospital at Northwestern Medicine, Wheaton, Illinois
Eric Larson– Director, Psychology and Brain Injury, Marianjoy Rehabilitation Hospital, part of Northwestern Medicine, Wheaton, Illinois
Ann Guernon– Clinical Research Manager/Clinical Research Coordinator, Hines VA/Marianjoy Rehabilitation Hospital, Sugar Grove, Illinois