title: Feasibility of online self-administered cognitive training in moderate-severe brain injury.
abstract: 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.
  
  
  
  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).
  
  
  
  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.
  
  
  
  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.
authors.affiliation: a Rehabilitation Sciences Institute (Formerly Graduate Department of Rehabilitation Science) , University of Toronto , Toronto , Ontario , Canada.|b Toronto Rehabilitation Institute , University Health Network , Toronto , Ontario , Canada.
authors.forename: Bhanu
authors.initials: B
authors.lastname: Sharma
authors.affiliation: b Toronto Rehabilitation Institute , University Health Network , Toronto , Ontario , Canada.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Tomaszczyk
authors.affiliation: a Rehabilitation Sciences Institute (Formerly Graduate Department of Rehabilitation Science) , University of Toronto , Toronto , Ontario , Canada.|b Toronto Rehabilitation Institute , University Health Network , Toronto , Ontario , Canada.|c Rotman Research Institute, Baycrest , Toronto , Ontario , Canada.|d Department of Occupational Science & Occupational Therapy , University of Toronto , Toronto , Ontario , Canada.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Dawson
authors.affiliation: e Department of Psychology , York University , Toronto , Ontario , Canada.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Turner
authors.affiliation: b Toronto Rehabilitation Institute , University Health Network , Toronto , Ontario , Canada.
authors.forename: Brenda
authors.initials: B
authors.lastname: Colella
authors.affiliation: a Rehabilitation Sciences Institute (Formerly Graduate Department of Rehabilitation Science) , University of Toronto , Toronto , Ontario , Canada.|b Toronto Rehabilitation Institute , University Health Network , Toronto , Ontario , Canada.
authors.forename: Robin E A
authors.initials: REA
authors.lastname: Green
mesh_terms: D000328:Adult; D001921:Brain / Q000502:physiology*; D000070642:Brain Injuries, Traumatic / Q000534:rehabilitation*; D003071:Cognition; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D020407:Internet; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010349:Patient Compliance / Q000706:statistics & numerical data*; D000073278:Self-Management / Q000379:methods; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D018910:Video Games; D055815:Young Adult
keywords: Brain games; TBI; cognitive rehabilitation; cognitive training; environmental enrichment; feasibility; neurodegeneration; traumatic brain injury