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10 to 15 Year Longitudinal Follow-up of Moderate to Severe Traumatic Brain Injury Inception Cohort.

Moderate-severe TBI (msTBI) sets in motion a neurodegenerative processes. In our Toronto Rehab TBI Recovery Study, we longitudinally followed 197 patients from a single centre, observing progressive and substantive deterioration, with substantive brain volume loss from 5 to 12 to 30+ months post-injury in the majority of patients, and significant cognitive decline from 12 to 30+ months in more than a quarter of patients. We also found an increasing number of patients with significant depression and anxiety, which was associated with reduced return to work in young males. The goal of the current study is to re-analyze this richly characterized sample. All patients will be followed approximately 10-15 years from their last assessment. We will measure their current functioning and assess whether the early deterioration of cognition and the brain continues, abates or accelerates (controlling for aging related changes). Even though msTBI disproportionately affects young adults, an ever-increasing number of Canadians (young and older) live with it's life-long disability. The findings from this study will be critical to understanding the chronic stages of msTBI, which is understudied and under-treated.


Remotely Delivered Environmental Enrichment Intervention for Traumatic Brain Injury: A Randomized Controlled Trial

The Cognitive Neurorehabilitation Sciences lab in collaboration with the Gilboa lab developed a promising behavioural intervention for potentially enhancing the integrity of the hippocampus and improving memory function. This study examines the behavioural and neurophysiological efficacy and feasibility of an online spatial navigation intervention for improving memory and brain health in individuals who have sustained msTBI. Participants engage in novel, continuous and challenging allocentric spatial navigation, which involves learning and mentally mapping new city routes.

Intensified Physical Exercise and Cognitive Enrichment (IPEACE): A feasibility study for moderate-to-severe TBI

IPEACE aims to determine the feasibility (including preliminary efficacy) of a multimodal (cognitive enrichment, aerobic exercise) intervention for patients with msTBI within the first year of injury. The 12-week intervention comprises three delivery formats: (i) remote model, where exercise is self-administered and completed at home, (ii) hybrid model, where remote exercise sessions are supplemented with an in-person supervised session once a week, and (iii) fully in-person model. The long-term aim of this research study is to establish the proof of principle of this combined intervention protocol through its efficacy in patients with msTBI, including the dose and intensity of cognitive and aerobic exercise needed to promote brain and cognitive recovery.

Role of aerobic intensity in combined aerobic exercise and cognitive enrichment interventions: a feasibility study

The overarching aim of this feasibility study is to lay the groundwork for a larger-scaled randomized controlled trial (RCT) in older adults that examines the effect of aerobic intensity in combined aerobic exercise and cognitive environmental enrichment therapy. Participants will be asked to engage in aerobic exercise and cognitive enrichment, each for 30 minutes, 3 times per week, for 12 weeks. The aerobic exercise will be performed at Toronto Rehabilitation Institute, supervised by a physiotherapist. Participants will either follow a high or moderate aerobic intensity exercise protocol. The cognitive enrichment will be performed at home, on an online brain game platform. The primary objective is to determine the feasibility of aerobic exercise – of two different intensities – combined with cognitive enrichment in healthy older adults. The secondary objectives are to determine the preliminary efficacy of combined aerobic exercise and cognitive training on cognitive and hippocampal outcomes.

An intervention to teach self-management skills for persisting symptoms of COVID-19:

Minimizing impact of symptoms on everyday functioning and on healthcare usage/utilization

Can long-COVID symptoms be better managed through behavioral intervention?

A research team comprised of scientists and clinical experts in neurology, cardiology, respirology, rheumatology and psychology are examining the impact of education and self management strategies on changes in Long-COVID symptoms. The 8-week intervention involves weekly 2-hour virtual sessions facilitated by neuropsychologists and subject experts.

Longitudinal patterns of functional connectivity in moderate-to-severe traumatic brain injury

This inception cohort study of prospectively-collected data used resting-state fMRI to characterize functional connectivity patterns in the frontoparietal and default mode networks in patients with msTBI. Forty adults with msTBI were scanned at approximately 0.5, 1-1.5, and 3+ years post-injury. Seventeen healthy, uninjured participants were scanned at baseline and approximately 11 months afterwards. Group independent component analyses and linear mixed-effects modeling with linear splines that contained a knot at 1.5 years post-injury were employed to investigate longitudinal network changes, and associations with covariates, including age, sex, and injury severity. In the msTBI patients, functional connectivity in the all three networks increased from approximately 0.5 to 1.5 years post-injury and contained a slope change in the opposite direction, from positive to negative at 1.5 years post-injury. We additionally observed marginally declined functional connectivity after 1.5 years post-injury in the right frontoparietal network, but no significant change in the left frontoparietal network or the default mode network. Findings of early improvement but a tapering and possible decline in connectivity thereafter suggest that compensatory effects are time-limited. These later reductions in connectivity mirror growing evidence of behavioural and structural decline in chronic msTBI. Targeting such declines represents a novel avenue of research and offers potential for improving clinical outcomes.

Research studies with the goal of maximizing impacts of interventions

Several research studies conducted at the Telerehab centre focus on identifying the underlying predictors of response to treatment and retention. We are also interested in measuring feasibility and the long term retention of the interventions offered the center. For example we are evaluating outcomes of Goal Management Training and Concussion intervention.

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