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Neurocognitive Driving Rehabilitation in Virtual Environments (NeuroDRIVE) as an Adjunctive Intervention for Traumatic Brain Injury

Primary Purpose

Traumatic Brain Injury

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
VR Driving
Sponsored by
National Institutes of Health Clinical Center (CC)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Traumatic Brain Injury focused on measuring Neuropsychologic Testing, Neurocognitive, Virtual Reality, Rehabilitation, Driving

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers
  • INCLUSION CRITERIA:

Subjects eligible for participation must meet the following criteria:

  1. Currently has a valid driver s license, or had a valid driver s license prior to injury
  2. 18 years of age or older
  3. Able to effectively manipulate the steering wheel and the gas/brake pedals without adaptive equipment
  4. Able to read, write, and speak in English
  5. History of traumatic brain injury greater than 12 weeks prior to initiation into the current study
  6. Able to provide informed consent
  7. NBSI score greater than or equal to 16 (Mild TBI sub-group only)

EXCLUSION CRITERIA:

Subjects are not eligible for participation if any of the following conditions exist:

  1. Risk for injury from the MRI magnet, including:

    • Pacemakers or other implanted electrical devices.
    • Brain stimulators.
    • Some types of dental implants.
    • Aneurysm clips (metal clips on the wall of a large artery).
    • Metallic prostheses (including metal pins and rods, heart valves, and cochlear implants).
    • Permanent eyeliner (other non-metallic tattoos are permissible).
    • Implanted delivery pump.
    • Shrapnel fragments.
    • Welders and metal workers are also at risk for injury because of possible small metal fragments in the eye of which they may be unaware.
    • Fear of confined spaces.
    • Back problems that may result in back pain or discomfort from lying in the scanner.
    • Weight of over 350 pounds, due to the weight limit of the MRI table.
    • It is not known if MRI is completely safe for a developing fetus. Therefore, all women of childbearing potential will have a pregnancy test performed no more than 24 hours before each MRI scan. The scan will not be done if the pregnancy test is positive. Because neuroimaging is a key component of the current study, inability to participate in MRI scanning is a necessary exclusion criterion.
  2. History of penetrating brain injury
  3. History of serious medical condition other than TBI that could affect cognitive or motor abilities (e.g., multiple sclerosis, encephalitis, cerebrovascular disease)
  4. History of severe motion sickness and/or vertigo.
  5. Other medical or psychological instability that could create difficulty fulfilling the study requirements (e.g., untreated mental illness, auditory/visual hallucinations, narcolepsy)

To verify this information, study coordinators will request medical records (i.e., recent medical history, medication list, any neuroimaging, and records pertinent to the participant s recent injury) to further evaluate potential participants inclusion into the study. Medical records can be obtained in three ways:

  1. Participants can bring the records when they come to NIH for testing; it will be made clear if they do not bring this information with them and we cannot verify that they meet inclusion criteria, potential participants will not be enrolled into the study that day.
  2. Alternatively, the participants can also fax their medical records to a secured fax machine at the Recreational Therapy office at the NIH where access is only permitted to study staff (i.e., scheduler, physician, and nurse psychologist).
  3. Participants may also fill out a medical release document and submit it to the study coordinator.

Medical history data will be reviewed, and if it is clear that the patient does not meet the inclusion criteria, we will contact them and cancel their appointment. Data obtained in this manner may be used to evaluate participant eligibility; however, it will not be used for any research purposes. Additionally, for any patients who are deemed not eligible to participate, their medical history data will be destroyed in accordance with NIH regulations.

As a condition of receiving funding from CNRM, de-identified imaging and phenotyping data (i.e., neurocognitive test results and behavioral questionnaires) from funded studies must be made available within a centralized repository (the CNRM Informatics Core) one year after the completion of the study. This is intended to facilitate use and analysis of this data for future research questions or projects. As such, potential subjects will be informed that they should not participate in this study if they do not want their data used for other projects.

Sites / Locations

  • National Institutes of Health Clinical Center, 9000 Rockville Pike

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

1

2

Arm Description

Immediate Intervention

Wait list

Outcomes

Primary Outcome Measures

VR Driving, Cognitive test, and Symptoms
-Results from the Virtual Reality Driving Assessment (baseline and post- intervention Tactical scenario composite scores)-Total scores on the Neurobehavioral Symptom Inventory-Standard and scaled scores from the following cognitive assessments (from the TBI Common Data Elements identified by NINDS):--WAIS-IV Digit Span subtest--WAIS-IV Digit-Symbol--Coding subtest

Secondary Outcome Measures

MRI, Phenotyping, & Driving evals

Full Information

First Posted
April 7, 2015
Last Updated
July 13, 2020
Sponsor
National Institutes of Health Clinical Center (CC)
Collaborators
The Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences
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1. Study Identification

Unique Protocol Identification Number
NCT02411227
Brief Title
Neurocognitive Driving Rehabilitation in Virtual Environments (NeuroDRIVE) as an Adjunctive Intervention for Traumatic Brain Injury
Official Title
Evaluation of Neurocognitive Driving Rehabilitation in Virtual Environments (NeuroDRIVE) as an Adjunctive Intervention for Traumatic Brain Injury
Study Type
Interventional

2. Study Status

Record Verification Date
July 2020
Overall Recruitment Status
Completed
Study Start Date
April 7, 2015 (Actual)
Primary Completion Date
July 20, 2017 (Actual)
Study Completion Date
July 10, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institutes of Health Clinical Center (CC)
Collaborators
The Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
Background: - People with traumatic brain injury (TBI) can have problems with thinking and everyday activities. They may have a higher risk for car accidents. NeuroDRIVE uses a virtual reality driving simulator. Researchers think it can help test and improve how people think and drive after TBI. Objective: - To test how NeuroDRIVE affects brain performance and driving safety. Eligibility: - People at least 18 years old with a history of TBI and who had a driver s license at some point. They must speak, read, and write English and be physically able to drive. Design: Participants will be asked to release their driving records, but they do not have to do this to be in the study. Visit 1: Screening physical exam. Visit 2: Magnetic resonance imaging (MRI) scan. Participants will lie on a table that slides into a cylinder with a strong magnetic field. A device will be placed over the head. Participants may do computer tasks during the scan. Participants will have tests of memory, attention, and thinking. They may be asked questions, take tests, and do simple actions. Visit 3: Tests of memory, attention, and thinking, plus a virtual reality driving assessment. Participants will be assigned to Group 1 to start NeuroDRIVE training immediately or Group 2 to start 10 weeks later. Visits 4 9, over 4 weeks: Participants will practice driving skills and mental exercises in the simulator. They will complete a driving questionnaire online each week. Visit 10: Repeat of Visit 3, with some small changes. Visits 11-12: Very similar to Visits 1-2. Includes MRI scan; physical exam; questionnaires; and tests of thinking, memory, and attention.. After Visit 12: Participants will fill out a weekly driving survey online for 4 weeks.
Detailed Description
OBJECTIVE: The primary objective of this study is to evaluate the NeuroDRIVE behavioral intervention for enhancement of driving abilities, cognitive abilities, and neurobehavioral symptoms after traumatic brain injury (TBI). For the purposes of this protocol, NeuroDRIVE refers to the novel combined approach of driving training and cognitive rehabilitation in a virtual reality environment. While NeuroDRIVE utilizes the VR system as the method through which the intervention is administered, NeuroDRIVE is not the VR system itself. STUDY POPULATION: 30 adult patients with a history of mild TBI and 30 adult patients with a history of moderate-to-severe TBI. Participants will be recruited from the National Institutes of Health (NIH), WRNMMC, and the broader community. DESIGN: The current study is a Clinical Trial Phase II interventional research study. The primary purpose of the study is for treatment, and it will employ a parallel intervention model. There will be no masking (i.e., open label). Participants will be classified into two groups by TBI severity: those with history of mild TBI and those with history of moderate-tosevere TBI. These different severities are known to have distinct cognitive sequelae. Within each severity group, participants will be in a 2 (pre-post) x 2 (treatment vs. wait list) experimental design. OUTCOME MEASURES: Primary outcome measures will include: Results from the Virtual Reality Driving Assessment (baseline and postintervention Tactical scenario composite scores) Total scores on the Neurobehavioral Symptom Inventory Standard and scaled scores from the following cognitive assessments (from the TBI Common Data Elements identified by NINDS): WAIS-IV or WMS-IV Digit Span subtest WAIS-IV Digit-Symbol Coding subtest Secondary outcome measures will include: -Neuroimaging results: Regions of Interest for FMRI: Bilateral dorsolateral prefrontal cortex Regions of Interest for DTI: Corpus callosum, bilateral frontal white matter horns, and bilateral longitudinal fasciculi -Total scores on the following symptom questionnaires: Glasgow Outcome Scale-Extended (GOS-E) Ohio State University TBI Identification Method Brief Symptom Inventory- 18 Satisfaction with Life Scale (SWLS) PTSD Checklist- Civilian (PCL-C) SF-36v2 Health Survey (SF-36v2) Fatigue Severity Scale (FSS) Epworth Sleepiness Scale (ESS) Beck Depression Inventory-II (BDI-II) Combat Exposure Scale (CES) Dual Dangerous Driving Index (DDDI) -Standard and scaled scores from the following cognitive phenotyping assessments (from the TBI Common Data Elements identified by NINDS): California Verbal Learning Test- Second Edition (CVLT-II) WAIS-IV Symbol Search subtest Medical Symptom Validity Test (MSVT) -Standard and scaled scores from the following additional cognitive phenotyping assessments: Trail Making Test (TMT) Test of Premorbid Functioning (ToPF) Grooved Pegboard Controlled Oral Word Association Test (COWAT) Bethesda Eye and Attention Measure (BEAM)

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Traumatic Brain Injury
Keywords
Neuropsychologic Testing, Neurocognitive, Virtual Reality, Rehabilitation, Driving

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
37 (Actual)

8. Arms, Groups, and Interventions

Arm Title
1
Arm Type
Experimental
Arm Description
Immediate Intervention
Arm Title
2
Arm Type
No Intervention
Arm Description
Wait list
Intervention Type
Behavioral
Intervention Name(s)
VR Driving
Intervention Description
Baseline: Tactical A3 scenario, composite score Post-Assessment: Tactical A4 scenario composite score
Primary Outcome Measure Information:
Title
VR Driving, Cognitive test, and Symptoms
Description
-Results from the Virtual Reality Driving Assessment (baseline and post- intervention Tactical scenario composite scores)-Total scores on the Neurobehavioral Symptom Inventory-Standard and scaled scores from the following cognitive assessments (from the TBI Common Data Elements identified by NINDS):--WAIS-IV Digit Span subtest--WAIS-IV Digit-Symbol--Coding subtest
Time Frame
pre/post after 16 weeks of intervention
Secondary Outcome Measure Information:
Title
MRI, Phenotyping, & Driving evals
Time Frame
Ongoing

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: Subjects eligible for participation must meet the following criteria: Currently has a valid driver s license, or had a valid driver s license prior to injury 18 years of age or older Able to effectively manipulate the steering wheel and the gas/brake pedals without adaptive equipment Able to read, write, and speak in English History of traumatic brain injury greater than 12 weeks prior to initiation into the current study Able to provide informed consent NBSI score greater than or equal to 16 (Mild TBI sub-group only) EXCLUSION CRITERIA: Subjects are not eligible for participation if any of the following conditions exist: Risk for injury from the MRI magnet, including: Pacemakers or other implanted electrical devices. Brain stimulators. Some types of dental implants. Aneurysm clips (metal clips on the wall of a large artery). Metallic prostheses (including metal pins and rods, heart valves, and cochlear implants). Permanent eyeliner (other non-metallic tattoos are permissible). Implanted delivery pump. Shrapnel fragments. Welders and metal workers are also at risk for injury because of possible small metal fragments in the eye of which they may be unaware. Fear of confined spaces. Back problems that may result in back pain or discomfort from lying in the scanner. Weight of over 350 pounds, due to the weight limit of the MRI table. It is not known if MRI is completely safe for a developing fetus. Therefore, all women of childbearing potential will have a pregnancy test performed no more than 24 hours before each MRI scan. The scan will not be done if the pregnancy test is positive. Because neuroimaging is a key component of the current study, inability to participate in MRI scanning is a necessary exclusion criterion. History of penetrating brain injury History of serious medical condition other than TBI that could affect cognitive or motor abilities (e.g., multiple sclerosis, encephalitis, cerebrovascular disease) History of severe motion sickness and/or vertigo. Other medical or psychological instability that could create difficulty fulfilling the study requirements (e.g., untreated mental illness, auditory/visual hallucinations, narcolepsy) To verify this information, study coordinators will request medical records (i.e., recent medical history, medication list, any neuroimaging, and records pertinent to the participant s recent injury) to further evaluate potential participants inclusion into the study. Medical records can be obtained in three ways: Participants can bring the records when they come to NIH for testing; it will be made clear if they do not bring this information with them and we cannot verify that they meet inclusion criteria, potential participants will not be enrolled into the study that day. Alternatively, the participants can also fax their medical records to a secured fax machine at the Recreational Therapy office at the NIH where access is only permitted to study staff (i.e., scheduler, physician, and nurse psychologist). Participants may also fill out a medical release document and submit it to the study coordinator. Medical history data will be reviewed, and if it is clear that the patient does not meet the inclusion criteria, we will contact them and cancel their appointment. Data obtained in this manner may be used to evaluate participant eligibility; however, it will not be used for any research purposes. Additionally, for any patients who are deemed not eligible to participate, their medical history data will be destroyed in accordance with NIH regulations. As a condition of receiving funding from CNRM, de-identified imaging and phenotyping data (i.e., neurocognitive test results and behavioral questionnaires) from funded studies must be made available within a centralized repository (the CNRM Informatics Core) one year after the completion of the study. This is intended to facilitate use and analysis of this data for future research questions or projects. As such, potential subjects will be informed that they should not participate in this study if they do not want their data used for other projects.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Leighton Chan, M.D.
Organizational Affiliation
National Institutes of Health Clinical Center (CC)
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Institutes of Health Clinical Center, 9000 Rockville Pike
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
21897289
Citation
Ortoleva C, Brugger C, Van der Linden M, Walder B. Prediction of driving capacity after traumatic brain injury: a systematic review. J Head Trauma Rehabil. 2012 Jul-Aug;27(4):302-13. doi: 10.1097/HTR.0b013e3182236299.
Results Reference
background
PubMed Identifier
20572473
Citation
Cox DJ, Davis M, Singh H, Barbour B, Nidiffer FD, Trudel T, Mourant R, Moncrief R. Driving rehabilitation for military personnel recovering from traumatic brain injury using virtual reality driving simulation: a feasibility study. Mil Med. 2010 Jun;175(6):411-6. doi: 10.7205/milmed-d-09-00081.
Results Reference
background
Links:
URL
https://clinicalstudies.info.nih.gov/cgi/detail.cgi?B_2015-CC-0103.html
Description
NIH Clinical Center Detailed Web Page

Learn more about this trial

Neurocognitive Driving Rehabilitation in Virtual Environments (NeuroDRIVE) as an Adjunctive Intervention for Traumatic Brain Injury

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