The proposed study will evaluate a new approach to cognitive rehabilitation of mTBI using a brain stimulation technique called "Remotely Supervised Transcranial Direct Current Stimulation combined with Cognitive Training" (RS-tDCS+) which has shown promise for improving complex attention in both healthy and clinical populations. RS-tDCS+ is a home-based, low-risk, non-invasive technique that is designed to boost cognitive training by enhancing learning and the brain's ability to reorganize connections. This study will evaluate RS-tDCS+ for improving complex attention in Active Duty Service Members (ADSM) and Veterans with a history of mTBI. Different tests of complex attention and symptom questionnaires will be used to determine the effects of real versus sham (placebo) RS-tDCS+. Second, the investigators will investigate electrical and connectivity changes in the brain associated with RS-tDCS+ using electroencephalogram (EEG) and magnetic resonance imaging (MRI). Third, the investigators will investigate the lasting effects of any observed changes by evaluating participants at 1 and 6 weeks post-treatment. Lastly, the investigators will explore the impact of individual differences (e.g., PTSD, depression, sleep quality, time since injury, baseline impairment, age, sex, ADSM versus Veteran) on treatment outcome.
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Symbol Digit Modalities Test (SDMT)
Timeframe: Baseline, 1-week post, & 6-weeks post intervention
Neuropsychological Assessment Battery (NAB) Attention Module
Timeframe: Baseline, 1-week post, & 6-weeks post intervention
Neurobehavioral Symptom Inventory (NSI)
Timeframe: Baseline, 1-week post, & 6-weeks post intervention
Electroencephalogram (EEG) - Resting State Functional Connectivity
Timeframe: Baseline, 1-week post, & 6-weeks post intervention
Electroencephalogram (EEG) - Resting State Spectral Power
Timeframe: Baseline, 1-week post, & 6-weeks post intervention
Magnetic Resonance Imaging (MRI) - T1 (optional)
Timeframe: Baseline & 1-week post intervention
Magnetic Resonance Imaging (MRI) - T2 (optional)
Timeframe: Baseline & 1-week post intervention
Magnetic Resonance Imaging (MRI) - T2* (optional)
Timeframe: Baseline & 1-week post intervention
Magnetic Resonance Imaging (MRI) - DWI (optional)
Timeframe: Baseline & 1-week post intervention
Magnetic Resonance Imaging (MRI) - ASL (optional)
Timeframe: Baseline & 1-week post intervention
Magnetic Resonance Imaging (MRI) - ROI Analysis (optional)
Timeframe: Baseline & 1-week post intervention
NIH Toolbox Quality of Life Assessment (NeuroQoL)
Timeframe: Baseline, 1-week post, & 6-weeks post intervention
Insomnia Severity Index (ISI)
Timeframe: Baseline, 1-week post, & 6-weeks post intervention
Patient Health Questionnaire (PHQ-8)
Timeframe: Baseline, 1-week post, & 6-weeks post intervention
PTSD Checklist- Civilian Version (PCL-C)
Timeframe: Baseline, 1-week post, & 6-weeks post intervention
Patient Global Impression of Change (PGIC)
Timeframe: 1-week post & 6-weeks post intervention
Information Sampling Task (IST)
Timeframe: Baseline, 1-week post, & 6-weeks post intervention
Groton Maze Learning Task (GMLT)
Timeframe: Baseline, 1-week post, & 6-weeks post intervention
Fusion Task: BEAM
Timeframe: Baseline, 1-week post, & 6-weeks post intervention
Fusion Task: N-Back
Timeframe: Baseline, 1-week post, & 6-weeks post intervention
tDCS Symptom Rating Questionnaire (SRQ)
Timeframe: Assessment collected daily during the intervention block (b/t baseline & 1-week post)
Ecological Momentary Assessment (EMA)
Timeframe: Assessment collected daily during the intervention block (b/t baseline & 1-week post)