Modifying Treatment for TBI Patients

For the MS patients, the treatment prompted increases in brain activity in the regions associated with memory and cognition. Functional MRIs taken post-training, showed significantly more activity in the hippocampus, occipital region and parietal regions of the brain, as well as in the frontal lobe.

“This shows the patients were using both imagery and context to improve learning,” Chiaravalloti said.

She decided to find out if the technique would work on TBI patients, whose cognitive difficulties are the result of injury and not disease.

Chiarvalloti has 62 TBI patients enrolled in a study where their brains will be imaged both before and after treatment. The study is in the very early stages, but Chiarvalloti said that preliminary data shows the treatment group improved in the early sessions, in which they were tasked with memorizing the paragraph.

“What we’re not showing is an improvement in the list-learning task,” she said. Imaging shows that the control group is using a larger area of the frontal lobe than the treatment group, which suggests that they’re not employing contextual skills to facilitate learning.

“When they have the paragraph, they can apply the imagery, but they can’t apply the context themselves,” Chiaravalloti said.

Researchers are parsing through the data to see what differentiates those TBI patients who did respond to treatment with those who did not. Early analysis shows that the responders seem to be farther post-injury, with the longest being 16 years after the initial TBI.

Responders also had better verbal comprehension but poorer spatial reasoning at the start of treatment. “There seems to be more room to improve in terms of spatial reasoning capability,” Chiaravalloti said.

The treatment process also has considerable room for improvement, she noted. One possibility is increasing the number of sessions that teach contextual learning. Also, researchers have yet to take into account the location and degree of the injury that caused the TBI in designing each patient’s treatment program.

“There are lots of questions, but we’re also getting lots of data,” Chiaravalloti said. “This is going to keep me busy for years.”

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