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Optimisingbrain and
1-11-2021
behaviour
Period 2 – Master Neuropsychology
jody starmans
[BEDRIJFSNAAM]
, Tutorial 1
Han, K., (2018). Neuroplasticity of cognitive control
networks following cognitive training for chronic
traumatic brain injury.
Abstract
Cognitive control is the ability to coordinate thoughts and actions to achieve goals. Cognitive control impairments
are one of the most persistent and devastating sequalae of traumatic brain injuries (TBI). There have been efforts
to improve cognitive control in individuals with post-acute TBI. Several studies have reported changes in
neuropsychological measures suggesting the efficacy of cognitive training in improving cognitive control. Yet, the
neural substrates of improved cognitive control after training remains poorly understood.
In the current study, we identified neural plasticity induced by cognitive control training for TBI using resting-state
functional connectivity (rsFC). Fifty-six individuals with chronic mild TBI (9 years post-injury on average) were
randomized into either a strategy-based cognitive training group (N = 26) or a knowledge-based training group
(active control condition; N = 30) for 8 weeks. We acquired a total of 109 resting-state functional magnetic
resonance imaging from 45 individuals before training, immediately post-training, and 3 months post-training.
Results: (1) Relative to the controls, the strategy-based cognitive training group showed monotonic increases in
connectivity in two cognitive control networks (i.e., cingulo-opercular and fronto-parietal networks) across time
points in multiple brain regions (2) Analyses of brain-behavior relationships revealed that frontoparietal network
connectivity over three time points within the strategy-based cognitive training group was positively associated
with the trail making scores
Conclusion: These findings suggest that training-induced neuroplasticity continues through chronic phases of TBI
and that rsFC can serve as a neuroimaging biomarker of evaluating the efficacy of cognitive training for TBI.
Introduction
A TBI incident can be the beginning of a chronic disease process rather than a final outcome.
→ A number of individuals with TBI sustain TBI-related disabilities
Resting state functional connectivity (rsFC) measures the BOLD signal coming from anatomically
separated brain regions that are acquired at rest
→ rsFC is well positioned to identify patterns of injury and the associations between injury and
behavioural impairments in TBI.
→ rsFC is also a promising technique to measure neuroplasticity
Strategy-based cognitive training for chronic TBI is an integrative program to improve cognitive control
by exerting more efficient thinking strategies for selective attention & abstract reasoning
→ Cognitive control is critical to successfully perform daily life tasks -> impairment in this domain is
therefore one of the most persistent and devastating sequalae of TBI
Current study: describes the rehabilitation-induced changes in brain connectivity
2 resting state networks that are related to cognitive control:
1. Cingulo-opercular network: supports stable maintenance of task mode and strategy during
cognitive processes
2. Fronto-parietal network: supports active, adaptive online control during cognitive control
processes
o These are also referred to as the salience and central executive network. These
networks also interact with the DMN
o TBI has an impact on these networks and connectivity between these networks
This study uses rsfMRI to identify the effects of a strategy-based cognitive training for chronic
TBI on the cognitive control networks: the cingulo-opercular and fronto-parietal networks.
1
,Methods
Individuals with chronic mild TBI were randomized into two 8 week training groups (strategy vs
knowledge based) and acquired their MRI scans over 3 time points (prior to training, after training and
3-month follow up after the training)
Discussion
There are changes in the cingulo-opercular and fronto-parietal networks connectivity of individuals with
chronic mild TBI following strategy-based training this study provides also evidence for brain changes
after cognitive training for chronic TBI
→ Increased cingulo-opercular and fronto-parietal networks connectivity after cognitive training
for TBI this highlights that previously impaired cognitive control networks by a TBI can be
influenced by training-related neuroplasticity
→ TBI related abnormalities are hard to capture using conventional measures because of the low
sensitivity
o Use of SMART program. After the use of SMART program, in comparison to the BHW
intervention, there were significant increases in rsFC
Results after application of SMART
→ Changes in the cingulo-opercular network primarily occurred between connectivity with the
default mode network
→ Changes in the fronto-parietal network connectivity primarily occurred in association with the
visual, somatomotor, and default mode networks
o This increased between-network connectivity with the cingulo-opercular and fronto-
parietal networks following SMART for TBI may indicate improved integration of
information processing for higher-level cognitive functions.
→ An increased connectivity between the cingulo-opercular and fronto-parietal networks
connectivity after training
→ (2) Regarding brain + behaviour relationships; there are associations between the trial-making
scores and cognitive control networks within the regions of the DMN
o Trial making involves a combi of WM, task switching and visuoperceptual abilities
o Thus it was not a surprise that trail-making scores were correlated with the fronto-
parietal network connectivity within the SMART group
In conclusion, we utilized resting-state functional connectivity to elucidate neuroplasticity following
cognitive training for chronic TBI. Specifically, we demonstrated that strategy-based cognitive training
led to increases in connectivity with the cingulo-opercular and frontoparietal networks in individuals
with chronic TBI relative to an information-based training group, even 3 months after training was
completed. Our findings suggest that training-induced neuroplasticity continues through the chronic
phases of TBI, and resting-state functional connectivity may be a potential neuroimaging biomarker for
evaluating cognitive training for chronic TBI linked to improved cognitive control.
McCarron. (2019). What do Kids with Acquired Brain Injury
Want? Mapping Neuropsychological Rehabilitation Goals
to the International Classification of Functioning,
Disability and Health.
Abstract
Objective: To increase understanding of the community neuropsychological rehabilitation goals of
young people with acquired brain injuries (ABIs).
2
, Method: Three hundred twenty-six neuropsychological rehabilitation goals were extracted from the
clinical records of 98 young people with ABIs. The participants were 59% male, 2–19 years old, and 64%
had a traumatic brain injury. Goals were coded using the International Classification of Functioning,
Disability and Health: Children and Youth Version (ICF-CY). Descriptive statistical analysis was performed
to assess the distribution of goals across the ICF-CY. Chi-squared and Cramer’s V were used to identify
demographic and injury-related associations of goal type.
Results: The distribution of goals was 52% activities and participation (AP), 28% body functions (BF), 20%
environmental factors (EF), and <1% body structures (BS). The number of EF goals increased with age at
assessment. Non-traumatic causes of ABI were associated with more EF goals. There was no association
between sex or time post-injury and the distribution of goals across the ICF-CY.
Conclusions: Young people with ABIs have a wide range of community neuropsychological rehabilitation
goals that require an individualized, context-sensitive, and interdisciplinary approach. Community
neuropsychological rehabilitation services may wish to ensure they are resourced to focus intervention
on AP, with increasing consideration for EF as a young person progresses through adolescence. The
findings of this research support models of community neuropsychological rehabilitation that enable
wellness by combining direct rehabilitative interventions with attention to social context and systemic
working across agencies
Introduction
Acquired brain injury (ABI) is defined as any injury to the brain after birth due to traumatic or non-
traumatic causes.
→ Rehabilitation of the “cognitive, emotional, psychosocial, and behavioral deficits caused by an
insult to the brain” is termed neuropsychological rehabilitation.
Recent advances in rehabilitation in younger people with ABI: a shift in emphasis away from traditional
views of rehabilitation as a means to restore function and reduce the impact of disability and instead
more emphasis on participation, environment and relationships.
→ The focus of NR in younger people is on goal setting. However, young people with ABI are very
heterogeneous: differences in sex, age and type of ABI result in different goals. Also, goals may
change as the young people are still developing.
The ICF-children and youth version (ICF-CY) was designed to facilitate consideration of interrelationship
between contextual factors (environmental factors EF) and components of functioning and disability
(body structures BS, body functions BF and activities and participation AP) while accommodating the
developmental processes occurring during childhood and adolescence.
Aims of the study: (1) understanding NR goals in young people with ABI and how these goals map onto
the ICF-CY and (2) identify if there is an association between demographic and injury-related factors and
the types of community neuropsychological rehabilitation goals.
Multiple hypothesis were set-up (see discussion section)
Methods
Study was executed in a specialist community of an NR institute with younger individuals up to 19 years.
NR goals, sex, age, ABI type and post-injury information were assessed.
The ICF-CY is structured into four domains; BF, BS, AP, and EF and each domain is structured into
chapters (first level). Then, each chapter consists of further descriptions of components of functioning
and disability, called branching levels. The concise form of the ICF-CY consists of one branching level
(second level) within the chapters, to give a two-level classification of chapter headings and first
branching level. The ICF-CY utilizes an alphanumeric coding system. The letters b, s, d, and e denote the
domains BF, BS, AP, and EF, respectively. This is followed by a numeric code denoting the chapter
number (one digit) and second level (two digits).
Results
3
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