A study has identified the first effective and highly scalable intervention to address cognitive deficits that can persist for years after a mild traumatic brain injury especially after a concussion or blast exposure.
The traumatic brain injury study utilised the computerised brain training app BrainHQ made by Posit science via Telehealth. The peer-reviewed study results were published in Brain: A Journal of Neurology.
The Department of Defense (DoD) funded the BRAVE study. It aims to determine if a computerised, brain training intervention based on the science of brain plasticity could be broadly or remotely applied. It tested to see if it could produce significant improvements in persistent cognitive defects across those with broad mild TBIs.
The study included 83 participants with a history of mild BTIs who had been diagnosed with cognitive impairment for more than seven years. These participants had typically been deployed to combat areas. Before training, they tested, on average, about two standard deviations below normal on the ANAM. The ANAM is a test used by the military to screen for cognitive impairment.
The participants were randomly placed into treatment groups (BrainHQ) and an active control group (computer games). Both activities were expected to have a positive impact due to their demands on cognitive realms such as attention, memory and reasoning. Each group self-administered the training online while at home with weekly telephone supervision from trained coaches. They were asked to train for one hour per day, five days a week over twelve weeks. This was followed by a twelve-week, no training follow-up period.
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It was conducted through a network of five military and veterans’ medical centres in Bethesda, Honolulu, Houston, West Haven, Boston and with Posit Science in San Francisco.
The results showed that the BrainHQ group reported clinically significant improvement in overall cognitive function in comparison to the computer games group. The benefits lasted for at least twelve weeks after training was completed. Cognitive function was 3.9 times larger in the BrainHQ group than the control group. It was 4.9 times larger when measured again twelve weeks after training ended.
The US military have recorded more than 413,000 members who have been diagnosed with a traumatic brain injury (TBI). Of these, more than 82 per cent are classified as mild TBI referred to as a ‘signature injury’ of recent conflicts. In many cases, service members can experience a full recovery from this but for those who do not, cognitive consequences can persist for years. This can have life altering results.
Physician, Colonel (Ret.) Dallas Hack, said “When this study was selected for funding, we were hoping it would help troops impacted by mTBI. These results exceed my fondest expectations. The broad applicability, modest cost, and self-directed nature of the intervention mean it could be scaled very quickly.”
Currently, the best practice for the treatment of persistent cognitive deficits following a mild TBI focuses on in-person, customised cognitive rehabilitation. This can be helpful but is also costly and time-consuming as it requires travel for treatment and relies on healthcare expertise. No computerised cognitive training has previously been shown effective in a gold-standard trial.
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BrainHQ has been used in many military and Veterans’ facilities for cognitive rehabilitation, under the supervision of healthcare professionals. With the release of these results, Posit Science (maker of BrainHQ) has indicated it intends to work with clinicians, payors, patient advocacy groups, legislators, and administrators to make this intervention widely available, as quickly as possible.
Dr Henry Mahncke, CEO of Posit Science, said: “These are long-awaited and important results. This study provides strong evidence that this intervention could be deployed on a massive scale through military and veterans’ health facilities to meet our nation’s obligation to address persistent real (but often invisible) life-altering challenges for wounded servicemembers and veterans – even those in remote locations.”
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