Strengthening Neuro-Cognitive Skills for Success in School, Work and Beyond
Strengthening Neuro-Cognitive Skills for Success in School, Work and Beyond
For many Veterans, success in achieving goals at work, school and in other aspects of life
 are top priorities. The abilities to regulate attention, remember key information, and stay
 calm and on track are fundamental to this success. Unfortunately, Veterans who have
 experienced a traumatic brain injury (TBI) often struggle with these very abilities, and a
 number of barriers can make it difficult for them to access the help Veterans need.
 Tele-rehabilitation has the potential to overcome some of these barriers and increase access
 to care, enabling providers to better reach Veterans 'where they are' in their communities.
 This project will assess two different approaches to brain injury rehabilitation that seek to
 help Veterans build personal strengths to better accomplish their goals. Both approaches will
 be delivered remotely via tele-rehabilitation and augmented by digital apps to best support
 Veterans' learning in community settings outside the VA.
This project will offer two training approaches targeting difficulties with goal-directed
 functioning associated with traumatic brain injury. Both approaches will be delivered
 remotely via tele-rehabilitation and augmented by digital apps - an intervention framework
 that addresses known barriers to engagement (e.g., convenience and access) and provides tools
 to intensify training. The study will be open to eligible Veterans (ages 21-60 years old)
 with history of mild-to-moderate TBI who experience difficulties with cognitive-emotional
 regulation and goal-directed functioning. After screening for eligibility and providing
 informed consent, participants will be allocated by permuted block randomization into one of
 two treatments: Education to optimize brain functioning (OPT), which will teach Veterans
 about brain health, brain injury and factors that affect brain functioning, or training in
 goal-directed state regulation skills (GSR), which will teach Veterans skills for regulating
 cognitive-emotional functioning during goal pursuit. A special emphasis on outreach will be
 to recruit student Veterans with TBI.

 Each intervention will be matched for delivery method, expectation of benefit, workload and
 attention, and overall duration. Training will last approximately five weeks, accommodating
 typical academic schedules. Participants will undergo multi-level assessments at baseline
 (prior to interventions), immediately after training, and at 3 months follow-up, administered
 in-person by staff at study sites. In order to investigate effects on goal-directed
 functioning at multiple levels, assessments will include (1) measures of performance on
 neurocognitive tasks; (2) functional performance on complex, goal-based tasks; (3) ratings of
 changes in functioning in personal life, and (4) progress toward personal goals as measured
 with goal attainment scaling procedures. Data will be analyzed to assess immediate and long
 term changes associated with each intervention; immediate and long-term differences between
 the interventions; and moderators and mediators of intervention effects.
Inclusion Criteria:

 -  Post 9/11 Veterans

 -  age 21-60; with history of mild-moderate TBI (including reported mechanism of head
 injury and alteration of consciousness);

 -  in the chronic, stable phase of recovery (>6 months from injury); with at least 1
 self-reported cognitive symptom, --including difficulties with working memory; and
 interested in goal-setting and intensive training.

 Exclusion Criteria:

 -  Severely apathetic/abulic, aphasic, or other reasons for being unable or unwilling to
 participate in training;

 -  severe cognitive dysfunction (below 2 standard deviations on two composite cognitive
 domains);

 -  schizophrenia;

 -  bipolar disorder;

 -  history of other neurological disorders;

 -  current medical illnesses that may alter mental status or disrupt participation in the
 study;

 -  active psychotropic medication changes;

 -  symptom magnification or malingering.