Feasibility of online self-administered cognitive training in moderate–severe brain injury

Abstract

Purpose: Cognitive environmental enrichment (C-EE) offers promise for offsetting neural decline that is observed in chronic moderate–severe traumatic brain injury (TBI). Brain games are a delivery modality for C-EE that can be self-administered over the Internet without therapist oversight. To date, only one study has examined the feasibility of self-administered brain games in TBI, and the study focused predominantly on mild TBI. Therefore, the primary purpose of the current study was to examine the feasibility of self-administered brain games in moderate–severe TBI. A secondary and related purpose was to examine the feasibility of remote monitoring of any C-EE-induced adverse symptoms with a self-administered evaluation tool.

Method: Ten patients with moderate–severe TBI were asked to complete 12 weeks (60 min/day, five days/week) of online brain games with bi-weekly self-evaluation, intended to measure any adverse consequences of cognitive training (e.g., fatigue, eye strain).

Results: There was modest weekly adherence (42.6% ± 4.4%, averaged across patients and weeks) and 70% patient retention; of the seven retained patients, six completed the self-evaluation questionnaire at least once/week for each week of the study.

Conclusions: Even patients with moderate–severe TBI can complete a demanding, online C-EE intervention and a self-administered symptom evaluation tool with limited therapist oversight, though at daily rate closer to 30 than 60 min per day. Further self-administered C-EE research is underway in our lab, with more extensive environmental support.

Implications for Rehabilitation

• Online brain games (which may serve as a rehabilitation paradigm that can help offset the neurodegeneration observed in chronic TBI) can be feasibly self-administered by moderate-to-severe TBI patients.

• Brain games are a promising therapy modality, as they can be accessed by all moderate-to-severe TBI patients irrespective of geographic location, clinic and/or therapist availability, or impairments that limit mobility and access to rehabilitation services.

• Future efficacy trials that examine the effect of brain games for offsetting neurodegeneration in moderate-to-severe TBI patients are warranted.

Keywords:

• Brain games
• cognitive rehabilitation
• cognitive training
• environmental enrichment
• feasibility
• neurodegeneration
• TBI
• traumatic brain injury

Acknowledgements

The study was approved the by Research Ethics Board at the University Health Network, and all patients provided informed consent.

Disclosure statement

The authors report no declaration of interest.

Funding information

This work was supported by the Physicians’ Services Incorporated Foundation under Grant #12-43, the Canada Research Chair in Traumatic Brain Injury under Grant 950-211602, and the Canadian Institutes for Health Research Post-Doctoral Fellowship.