Dynamic cognitive remediation for a Traumatic Brain Injury (TBI) significantly improves attention, working memory, processing speed, and reading fluency

Restor Neurol Neurosci. 2019;37(1):71-86. doi: 10.3233/RNN-180856.


Background: In the U.S. 3.8 million people have a Traumatic Brain Injury (TBI) each year. Rapid brain training exercises to improve cognitive function after a mild TBI are needed.

Objective: This study determines whether cognitive remediation by discriminating the direction a test pattern moves relative to a stationary background (movement figure-ground discrimination) improves the vision and cognitive deficits that result from a TBI, providing a paradigm shift in treatment methods.

Methods: Movement-discrimination neurotraining was used to remediate low-level visual timing deficits in the dorsal stream to determine whether it improved high-level cognitive functions, such as processing speed, reading fluency, and the executive control functions of attention and working memory in four men with a TBI between the ages of 15-68. Standardized tests, as well as Magnetoencephalography (MEG) brain imaging, were administered at the beginning and end of 8-16 weeks of intervention training to evaluate improvements in cognitive skills.

Results: Movement-discrimination cognitive neurotraining remediated both low-level visual timing deficits and high-level cognitive functioning, including selective and sustained attention, reading fluency, processing speed, and working memory for all TBI patients we studied. MEG brain imaging, using the Fast-VESTAL procedure, showed that this movement-discrimination training improved time-locked activity in the dorsal stream, attention, and executive control networks.

Conclusions: Remediating visual timing deficits in the dorsal stream revealed the causal role of visual movement discrimination training in improving high-level cognitive functions such as focusing and switching attention, working memory, processing speed, and reading. This study found that movement-discrimination training was very rapid and effective in remediating cognitive deficits, providing a new approach that is very beneficial for treating a mild TBI.

Keywords: MEG; Traumatic brain injuries; attention; brain exercise; cortical plasticity; dorsal stream; neurorehabilitation; perceptual learning; processing speed; reading; visual timing; working memory.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Aged
  • Brain / diagnostic imaging
  • Brain / physiopathology
  • Brain Injuries, Traumatic / diagnostic imaging
  • Brain Injuries, Traumatic / physiopathology
  • Brain Injuries, Traumatic / psychology*
  • Brain Injuries, Traumatic / therapy*
  • Cognitive Remediation*
  • Humans
  • Male
  • Mental Processes*
  • Middle Aged
  • Neurological Rehabilitation / methods
  • Reading*
  • Treatment Outcome