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What does the brain look like after cognitive treatment?

What does the brain look like after cognitive treatment?. Helen M. Genova, Ph.D. Brain Injury Alliance of New Jersey May 15, 2014. Outline of the Talk. What is Cognitive Rehabilitation? Why do we need fMRI ? Results of Studies using fMRI to study effects of cognitive rehabilitation

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What does the brain look like after cognitive treatment?

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  1. What does the brain look like after cognitive treatment? Helen M. Genova, Ph.D. Brain Injury Alliance of New Jersey May 15, 2014

  2. Outline of the Talk • What is Cognitive Rehabilitation? • Why do we need fMRI? • Results of Studies using fMRI to study effects of cognitive rehabilitation • Discussion – where do we go from here?

  3. Rehabilitation Restore some or all of a person’s capabilities that were lost due to injury, illness, or disease.

  4. Cognitive Rehabilitation • A program to help individuals: • Restorecognitive functioning • Compensatefor cognitive deficits

  5. Example: Memory Rehabilitation • Restorative: Technique to help individuals perform as they used to, bring skills back • Tasks/drills to help restore memory processes • Compensatory: Technique which uses alternative strategies to skills that cannot be brought back • Assistive device (notebook, tape recorder)

  6. Is Cognitive Rehabilitation Effective? • We think so! • Numerous studies to show significant benefit • There are studies which have shown less benefit • It is unclear why this is: • Maybe the rehabilitation works for some, but not all • Maybe different individuals require different types of rehabilitation

  7. How do we know if cognitive rehab is effective? • We test subjects before and after • CognitiveTests • Mood Questionnaires • Quality of Life Questionnaires

  8. Why do we need fMRI?

  9. Why do we need fMRI? • Helps us understand who benefits and who doesn’t • Damage to brain could have been anywhere • Imaging will allow us to examine patterns of damage and how they affect outcome

  10. Why do we need fMRI? • fMRI allows us to understand why something works, not just if it works. • Does rehab lead to more activation? Less activation? • Are some networks being strengthened?

  11. Why do we need fMRI? • Are effects of cognitive rehab restorative or compensatory? • Restorative: brain regions previously damaged are able to work as before • Compensatory: new brain regions are taking over for ones that are no longer able to function as before.

  12. Results Memory Retraining Processing Speed Training

  13. Memory Retraining Shopping List Eggs Milk Shampoo Bagels To Do: Buy Groceries Take Medicine Pick up Kids Go to Cleaners

  14. Story Example

  15. Memory Retraining • Modified Story Memory Technique • 10 sessions • 2x per week for 5 weeks • 45-60 minutes in duration • Skills taught • Imagery • Putting things in Context

  16. Sample

  17. Learning Performance ? Items Remembered p<.05 Paragraph Learning

  18. Imaging Data (preliminary) Brain Activation p<.05 *Possible explanation: Participants are now visualizing

  19. What does it mean? • Activation was increased in visual areas of the brain following treatment • May indicate that there was a strategy shift - visual areas of the brain utilized more • Can visual areas be targeted for future interventions?

  20. Speed of Processing Training (SPT)

  21. Speed of Processing Training • 80 participants • moderate – severe TBI • At least 1 year post-injury • Randomized • Treatment Group • Control Group

  22. Speed of Processing Training • 10 session computerized PS treatment • Laptop administration • 3 levels of training • Used extensively in normal aging • Improves standard assessments of PS • Impact on everyday life

  23. Speed of Processing Training • Assessments • Baseline • Within one week post-treatment • 6 months post-treatment

  24. Processing Speed Task Treatment Control Accuracy on Task Before Intervention After Intervention Letter Comparison Test, p<.05

  25. SPT: Pilot Imaging Data in TBI

  26. What does it mean?

  27. What does it mean? • Following treatment, there was a significant increase in activation throughout the brain • May indicate: • New neural networks becoming active • Neural networks working harder

  28. Future Directions

  29. Future Directions • Look at structural imaging pre and post cognitive rehabilitation to see if structure (not just function) is changing • Look at other factors (aging, gender, mood) to see their influence on neuroimaging • To look at changes in functional activity in long term

  30. Summary • fMRI allows us to understand not just IF a cognitive intervention worked but WHY it worked • fMRI can help us target subjects who may most benefit from treatment • fMRI can help us tailor interventions to increase activation in areas which would help with certain skills • For example, tailoring interventions to rely on visual systems to improve memory

  31. Acknowledgements Principal Investigator: Nancy Chiaravalloti, Ph.D. Co-Investigators: Angela Smith, M.S. Nancy Moore, M.A. Ekaterina Dobryakova, Ph.D. Research Assistants NIDRR H133A120030 H133A070037 H133G090078

  32. Acknowledgements Thank you to all the persons involved in research! Without you, none of these studies would be possible

  33. Thank you!

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