Verbal Working Memory and Attention Remediation for Adults With Traumatic Brain Injury.

This project will examine if computerized cognitive remediation will improve working memory and attention in 25 adults with moderate to severe brain injury and compared their cognitive performance to the control group of 25 adults with moderate to severe brain injury. The control group will train on computerized tasks of social awareness. Participants in both groups will be assessed prior to training and immediately post-training and one month-post training.

The study design will be randomized assignment with a control group.Participants in both groups will undergo three cognitive assessments at baseline, at the end of 40 cognitive training modules, and 1-month post-completion of the first follow-up assessment.

Participants will randomized into the BrainHQ Cognitive Training modules which are 45 minutes training sessions. There will be 40 training sessions. Since the intervention is presented both visually and verbally through the computer, noise cancelling head phones will also be provided to the participants. Participants will complete the training protocols in the lab under the study team's supervision to ensure the participants are engaged and are completing the tasks.

Participants will randomized into the BrainHQ People Skills Modules which are 45 minutes training sessions. There will be 40 training sessions. Since the intervention is presented both visually and verbally through the computer, noise cancelling head phones will also be provided to the participants. Participants will complete the training protocols in the lab under the study team's supervision to ensure the participants are engaged and are completing the tasks.

The BrainHQ is a computerized training program developed from Posit Science designed to improve multiple cognitive domains. The subtests exercises include 3 modules for the experimental group: 1) Sound Sweeps: which is identify whether sound pitches are going up or down; 2) Memory Grids: matching pairs of words; and 3) Syllable Stack: recognition of sequences of confusable syllables. Since the intervention is presented both visually and verbally through the computer, noise cancelling head phones will also be provided to the participants.

The BrainHQ is a computerized training program developed from Posit Science designed to improve multiple cognitive domains. The BrainHQ will provide 3 training modules for the control group: 1) Recognition: a picture of a face is presented briefly and then the subject picks the recognized face from 3 pictures. 2) Face to Face: matching the emotional expression of 3 pictures to the emotional expression of the picture previously presented; 3) Face Facts: recalling 3 facts about a person that was previously presented. Participants will spend 45 minutes at each training session. Since the intervention is presented both visually and verbally through the computer, noise cancelling head phones will also be provided to the participants.

Measured by TOMM(Test of Memory Malingering) which is visual memory test that measures level of effort. Test of Memory Malingering is a 50-item visual recognition test designed to help distinguish malingering from genuine memory impairments.

This will be measured by the Wechsler Memory Scale-IV (WMS-IV), Logical Memory subtest which is a measure of a person's ability to recall a story told to them.

This will be measured by the Wechsler Memory Scale-IV (WMS-IV), Digit Span subtest which is a measure of working memory in which the person maintains their attention to the list of spoken numbers and ask to recall and state the list of numbers.

This will be measured by the Wechsler Adult Intelligence Scale IV, Vocabulary subtest which measure the ability to define specific words.

This will be measured by the Wechsler Adult Intelligence Scale IV, Information subtest which assesses the ability to recall general knowledge and acquired facts on different topics related to science, geography, and history.

Measured by Wechsler Adult Intelligence Scale IV, Matrix Reasoning subtest which is a measure of abstract reasoning of visually presented stimuli.

The will be measured by Wechsler Test of Adult Reading which is a measure that reliably estimates levels of intelligence by asking the subject to read aloud the words on an established reading list.

This will be assessed by the Spatial Span which is a measure of spatial working memory test. Participants are required to recall and tap the top of blocks in the same order they tapped by the administrator.

Measured by REY Auditory Learning Test (RAVLT). This test is a measure of verbal memory. A list of words is read aloud to the participants five times. After each list of words, the participant recalls the words. The participants will also be asked to recall the words from the list 20 minutes later.

This will be measured by using the Trails Making Test- A & B which measures efficiency of visual search and set shifting while alternating between letters and numbers. The Trail Making Test is a neuropsychological test of visual attention and task switching. It consists of two parts in which the subject is instructed to connect a set of 25 dots as quickly as possible while still maintaining accuracy.

This will be measured with the Digit Cancellation Task. This is a timed test of attention that requires the participant to draw a slash through a targeted letter.

This will be assessed with the Paced Auditory Serial Addition Test (PASAT) - 3 & 2 second versions which measures complex mental manipulation by adding the two most recent numbers that are presented auditorily. There are two sets of numbers that are presented at two different speeds. The PASAT is a measure of cognitive function that assesses auditory information processing speed and flexibility, as well as calculation ability.

Will be assessed with the Woodcock-Johnson - Understanding Directions subtest which is a measure of verbal attention. Participant are provided oral directions to point to different parts of pictures.

Actual Reality Performance test is a measure of attention and verbal memory, which requires the participants to follow directions and sequence steps of computerized task.

Awareness of Social Inference Test (TASIT)- Short version: is a standard measure to recognize emotions and a speaker's intentions presented in a vignette.

This will be self reported using the Beck's Depression Inventory - II. This is a standardized instrument for the assessment of depression with a self-report questionnaire.

Measured by self reports with the Beck's Anxiety Inventory which is a self-report instrument for the assessment of anxiety.

Will be measured using the Lifetime Experience Questionnaire, \ a questionnaire to determine current and past mental.

The Functional Behavior Profile Questionnaire will be used to measure daily living status. This is a standardized questionnaire regarding activities of daily living, executive functioning, participation, problems solving and social relationships.

This may be assessed with the Participation Assessment with Recombined Tools-Objective Questionnaire: A standardized questionnaire about social participation.

Will be gauged by using the Promis Global Health Questionnaire. This is a standardized questionnaire that evaluates physical, mental and social health deficits common in people with brain injuries.

Inclusion Criteria: Medically documented moderate to severe TBI; All subjects will be older than 18 years of age; Free from schizophrenia or bipolar disorder, due to the potential influence of such disorders on cognitive functioning; Free of current alcohol or drug abuse; At least 3 months post-injury. Exclusion Criteria: Younger than 18 years old. A mild traumatic brain injury (Concussion) or a brain injury that is not medically documented. Being diagnosed with schizophrenia or bipolar disorder. Current alcohol or drug use diagnosis Less than 3 months post-injury

Individual participant data that underlie the results reported in this article, after deidentification (text, tables, figures, and appendices).

Beginning 9 months and ending 36 months following article publication or as required by a condition of awards and agreements supporting the research.

The investigator who proposed to use the data. Upon reasonable request. Requests should be directed to gv23@nyu.edu. To gain access, data requestors will need to sign a data access agreement.