Behavioral and neural effects of intensive cognitive and communication rehabilitation in young college-bound adults with acquired brain injury

• Main Author: Gilmore, Natalie Marie
• Other Authors: Kiran, Swathi
• Language: en_US
• Published: 2021
• Subjects: Speech therapy; Functional near-infrared spectroscopy; Stroke; Traumatic brain injury
• Online Access: https://hdl.handle.net/2144/42853

The Intensive Cognitive and Communication Rehabilitation program (ICCR), developed to advance young adults with acquired brain injury (ABI) to college, targets a range of cognitive domains (e.g., memory, writing, verbal expression) via classroom-style lectures, individual therapy, and technology- and computer-based interventions on an intensive schedule (i.e., six hours/day, four days/week, 12-week iterations). One of the driving hypotheses of this dissertation work is that cognitive rehabilitation programs that are embedded with principles of experience-dependent neuroplasticity (i.e., repetition, intensity, specificity, salience), like ICCR, should lead to changes in behavior and the brain. The initial two studies of this dissertation focused on the first aspect of this hypothesis (i.e., assessing the impact of ICCR on overall cognitive-linguistic function and specific cognitive domains important for academic success in young adults with ABI), while the final two studies addressed the second aspect (i.e., using fNIRS to measure brain activation during language and domain-general cognitive tasks in neurotypicals and individuals with ABI at a single timepoint and over time). In Study 1, young adults with ABI who participated in ICCR demonstrated significant gains in at least one standardized assessment of global cognitive-linguistic function, while control participants did not. Yet, the study did not reveal what specific cognitive domains important for academic success improved after the ICCR program—an essential intermediate step in evaluating the utility of these programs in preparing young adults with ABI for academic reentry. Study 2 addressed this unanswered question with a novel approach that aggregated items from standardized neuropsychological assessments into specific cognitive domains (e.g., attention, verbal expression, memory) and then, applied growth curve modeling to assess whether those domains improved significantly over time in young adults with ABI participating in the ICCR program. This study also directly compared whether the treatment group improved at a significantly faster rate in overall item accuracy and subdomain item accuracy than a deferred treatment/control usual care group, extending the findings from Study 1 with a larger participant sample. Study 3 was a pilot study using fNIRS to capture brain activation in expected regions during language and domain-general cognitive processing in neurotypicals and individuals with stroke-induced aphasia. Findings from the young healthy control group in this study would serve as a reference for interpreting brain activation patterns in the damaged brain in future work. This study also provided opportunities to determine the acceptability of the fNIRS behavioral tasks and acquisition procedures for individuals with stroke-induced aphasia and to assess the utility of a novel method for managing areas of lesion. Based on the robust findings of Study 1 and 2 (i.e., ICCR promoted gains in overall cognitive domains and specific cognitive processes important for college success) and the promising results of Study 3 (i.e., activation patterns during language and domain-general cognitive processing could be captured in neurotypicals and individuals with brain damage at a single timepoint using fNIRS), Study 4 was undertaken to assess pre- to post-treatment activation changes following ICCR participation via fNIRS. Five young adults with ABI underwent fNIRS measurement while performing the same behavioral task battery used in Study 3 (i.e. semantic feature, picture naming, arithmetic) before and after a 12-week semester of ICCR. This preliminary work provided opportunities 1) to apply fNIRS to measure treatment-related neuroplasticity in the ABI population; 2) to examine the extent to which treatment participants demonstrated changes in the brain following ICCR in conjunction with a positive treatment response and improved behavioral task accuracy; and 3) to identify methodological considerations for future studies in this area. In closing, this dissertation reviews key findings from each of these studies and discusses their implications for studying rehabilitation-induced recovery in adults with ABI in future work. === 2023-08-06T00:00:00Z