Dynamic cognitive remediation for a Traumatic Brain Injury (TBI) significantly improves attention, working memory, processing speed, and reading fluency

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Abstract
Background: In the U.S. 3.8 million people have a Traumatic Brain Injury (TBI) each year. Rapid brain training exercises to improve cognitive function after a mild TBI are needed. Objective: This study determines whether cognitive remediation by discriminating the direction a test pattern moves relative to a stationary background (movement figure-ground discrimination) improves the vision and cognitive deficits that result from a TBI, providing a paradigm shift in treatment methods. Methods: Movement-discrimination neurotraining was used to remediate low-level visual timing deficits in the dorsal stream to determine whether it improved high-level cognitive functions, such as processing speed, reading fluency, and the executive control functions of attention and working memory in four men with a TBI between the ages of 15–68. Standardized tests, as well as Magnetoencephalography (MEG) brain imaging, were administered at the beginning and end of 8–16 weeks of intervention training to evaluate improvements in cognitive skills. Results: Movement-discrimination cognitive neurotraining remediated both low-level visual timing deficits and high-level cognitive functioning, including selective and sustained attention, reading fluency, processing speed, and working memory for all TBI patients we studied. MEG brain imaging, using the Fast-VESTAL procedure, showed that this movement-discrimination training improved time-locked activity in the dorsal stream, attention, and executive control networks. Conclusions: Remediating visual timing deficits in the dorsal stream revealed the causal role of visual movement discrimination training in improving high-level cognitive functions such as focusing and switching attention, working memory, processing speed, and reading. This study found that movement-discrimination training was very rapid and effective in remediating cognitive deficits, providing a new approach that is very beneficial for treating a mild TBI.

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