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Brain bases of recovery following cognitive rehabilitation for traumatic brain injury: a preliminary study

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Abstract

Many patients with traumatic brain injury (TBI) have persistent cognitive deficits, including decreased attention and working memory. This preliminary study examined fMRI data from a clinical trial implementing a 4-week virtual reality driving intervention to assess how sustained training can improve deficits related to traumatic brain injury. Previously-reported behavioral findings showed improvements in working memory and processing speed in those who received the intervention; this report explores the brain bases of these effects by comparing neural activity related to working memory (n-back task) and resting state connectivity before and after the intervention. In the baseline visit (n = 24), working memory activity was prominent in bilateral DLPFC and prefrontal cortex, anterior insula, medial superior frontal gyrus, left thalamus, bilateral supramarginal / angular gyrus, precuneus, and left posterior middle temporal gyrus. Following intervention, participants showed less global activation on the n-back task, with regions of activity only in the bilateral middle frontal cortex, posterior middle frontal gyrus, and supramarginal gyrus. Activity related to working memory load was reduced for the group that went through the intervention (n = 7) compared to the waitlist control group (n = 4). These results suggest that successful cognitive rehabilitation of working memory in TBI may be associated with increased efficiency of brain networks, evidenced by reduced activation of brain activity during cognitive processing. These results highlight the importance of examining brain activity related to cognitive rehabilitation of attention and working memory after brain injury.

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Acknowledgements

The authors would like to thank A. Safford, B. Brandler, B. Guise, S. Nelson Schmitt, M. Constanzo, D. Pham and B. Robertson for their contributions in study design, data collection and manuscript preparation. The views expressed in this manuscript reflect the views of the authors and do not necessarily reflect the official policy of the Department of the Navy, Department of Defense, or the United States Government. Support for this work has been provided by the Defense and Veterans Brain Injury Center, Uniformed Services University of the Health Sciences, the U.S. Army Medical Research and Materiel Command, and the Center for Neuroscience and Regenerative Medicine Award #306136-8.01-60855.

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Authors and Affiliations

  1. Naval Medical Center San Diego, 34730 Bob Wilson Drive, San Diego, CA, 92134, USA

    Sarah I. Gimbel, Mark L. Ettenhofer & Evelyn Cordero

  2. Henry M. Jackson Foundation, 6720A Rockledge Drive, Bethesda, MD, 20817, USA

    Sarah I. Gimbel & Evelyn Cordero

  3. Defense and Veterans Brain Injury Center, 7700 Arlington Blvd Suite 5101, Falls Church, VA, 22041, USA

    Sarah I. Gimbel & Mark L. Ettenhofer

  4. Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA

    Mark L. Ettenhofer, Evelyn Cordero & Michael Roy

  5. Center for Neuroscience and Regenerative Medicine, 12725 Twinbrook Parkway, Rockville, MD, 20852, USA

    Mark L. Ettenhofer, Michael Roy & Leighton Chan

  6. National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA

    Leighton Chan

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  1. Sarah I. Gimbel
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Correspondence to Mark L. Ettenhofer.

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Gimbel, S.I., Ettenhofer, M.L., Cordero, E. et al. Brain bases of recovery following cognitive rehabilitation for traumatic brain injury: a preliminary study. Brain Imaging and Behavior 15, 410–420 (2021). https://doi.org/10.1007/s11682-020-00269-8

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