Remotely delivered environmental enrichment intervention for traumatic brain injury: Study protocol for a randomised controlled trial
Introduction Individuals with moderate-severe traumatic brain injury (m-sTBI) experience progressive brain and behavioural declines in the chronic stages of injury. Longitudinal studies found that a majority of patients with m-sTBI exhibit significant hippocampal atrophy from 5 to 12 months post-inj...
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BMJ Publishing Group
2021-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/2/e039767.full |
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| author | Robin Green Zorry Belchev Mary Ellene Boulos Julia Rybkina Kadeen Johns Eliyas Jeffay Brenda Colella Jason Ozubko Michael Johnathan Charles Bray Nicholas Di Genova Adina Levi Alana Changoor Thomas Worthington Asaf Gilboa |
| author_facet | Robin Green Zorry Belchev Mary Ellene Boulos Julia Rybkina Kadeen Johns Eliyas Jeffay Brenda Colella Jason Ozubko Michael Johnathan Charles Bray Nicholas Di Genova Adina Levi Alana Changoor Thomas Worthington Asaf Gilboa |
| author_sort | Robin Green |
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| description | Introduction Individuals with moderate-severe traumatic brain injury (m-sTBI) experience progressive brain and behavioural declines in the chronic stages of injury. Longitudinal studies found that a majority of patients with m-sTBI exhibit significant hippocampal atrophy from 5 to 12 months post-injury, associated with decreased cognitive environmental enrichment (EE). Encouragingly, engaging in EE has been shown to lead to neural improvements, suggesting it is a promising avenue for offsetting hippocampal neurodegeneration in m-sTBI. Allocentric spatial navigation (ie, flexible, bird’s eye view approach), is a good candidate for EE in m-sTBI because it is associated with hippocampal activation and reduced ageing-related volume loss. Efficacy of EE requires intensive daily training, prohibitive within most current health delivery systems. The present protocol is a novel, remotely delivered and self-administered intervention designed to harness principles from EE and allocentric spatial navigation to offset hippocampal atrophy and potentially improve hippocampal functions such as navigation and memory for patients with m-sTBI.Methods and analysis Eighty-four participants with chronic m-sTBI are being recruited from an urban rehabilitation hospital and randomised into a 16-week intervention (5 hours/week; total: 80 hours) of either targeted spatial navigation or an active control group. The spatial navigation group engages in structured exploration of different cities using Google Street View that includes daily navigation challenges. The active control group watches and answers subjective questions about educational videos. Following a brief orientation, participants remotely self-administer the intervention on their home computer. In addition to feasibility and compliance measures, clinical and experimental cognitive measures as well as MRI scan data are collected pre-intervention and post-intervention to determine behavioural and neural efficacy.Ethics and dissemination Ethics approval has been obtained from ethics boards at the University Health Network and University of Toronto. Findings will be presented at academic conferences and submitted to peer-reviewed journals.Trial registration number Version 3, ClinicalTrials.gov Registry (NCT04331392). |
| format | Article |
| id | doaj-art-3d832dbd158d43018a396f3670a419bf |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-02-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-3d832dbd158d43018a396f3670a419bf2024-11-17T15:55:08ZengBMJ Publishing GroupBMJ Open2044-60552021-02-0111210.1136/bmjopen-2020-039767Remotely delivered environmental enrichment intervention for traumatic brain injury: Study protocol for a randomised controlled trialRobin Green0Zorry Belchev1Mary Ellene Boulos2Julia Rybkina3Kadeen Johns4Eliyas Jeffay5Brenda Colella6Jason Ozubko7Michael Johnathan Charles Bray8Nicholas Di Genova9Adina Levi10Alana Changoor11Thomas Worthington12Asaf Gilboa13KITE, Toronto Rehabilitation Institute, Toronto, Ontario, CanadaDepartment of Psychology, University of Toronto, Toronto, Ontario, CanadaKITE, Toronto Rehabilitation Institute, Toronto, Ontario, CanadaKITE, Toronto Rehabilitation Institute, Toronto, Ontario, CanadaKITE, Toronto Rehabilitation Institute, Toronto, Ontario, CanadaDepartment of Psychology, University of Toronto, Toronto, Ontario, CanadaKITE, Toronto Rehabilitation Institute, Toronto, Ontario, CanadaDepartment of Psychology, The State University of New York, Geneseo, New York, USAKITE, Toronto Rehabilitation Institute, Toronto, Ontario, CanadaKITE, Toronto Rehabilitation Institute, Toronto, Ontario, CanadaRotman Research Institute at Baycrest, Toronto, Ontario, CanadaKITE, Toronto Rehabilitation Institute, Toronto, Ontario, CanadaKITE, Toronto Rehabilitation Institute, Toronto, Ontario, CanadaDepartment of Psychology, University of Toronto, Toronto, Ontario, CanadaIntroduction Individuals with moderate-severe traumatic brain injury (m-sTBI) experience progressive brain and behavioural declines in the chronic stages of injury. Longitudinal studies found that a majority of patients with m-sTBI exhibit significant hippocampal atrophy from 5 to 12 months post-injury, associated with decreased cognitive environmental enrichment (EE). Encouragingly, engaging in EE has been shown to lead to neural improvements, suggesting it is a promising avenue for offsetting hippocampal neurodegeneration in m-sTBI. Allocentric spatial navigation (ie, flexible, bird’s eye view approach), is a good candidate for EE in m-sTBI because it is associated with hippocampal activation and reduced ageing-related volume loss. Efficacy of EE requires intensive daily training, prohibitive within most current health delivery systems. The present protocol is a novel, remotely delivered and self-administered intervention designed to harness principles from EE and allocentric spatial navigation to offset hippocampal atrophy and potentially improve hippocampal functions such as navigation and memory for patients with m-sTBI.Methods and analysis Eighty-four participants with chronic m-sTBI are being recruited from an urban rehabilitation hospital and randomised into a 16-week intervention (5 hours/week; total: 80 hours) of either targeted spatial navigation or an active control group. The spatial navigation group engages in structured exploration of different cities using Google Street View that includes daily navigation challenges. The active control group watches and answers subjective questions about educational videos. Following a brief orientation, participants remotely self-administer the intervention on their home computer. In addition to feasibility and compliance measures, clinical and experimental cognitive measures as well as MRI scan data are collected pre-intervention and post-intervention to determine behavioural and neural efficacy.Ethics and dissemination Ethics approval has been obtained from ethics boards at the University Health Network and University of Toronto. Findings will be presented at academic conferences and submitted to peer-reviewed journals.Trial registration number Version 3, ClinicalTrials.gov Registry (NCT04331392).https://bmjopen.bmj.com/content/11/2/e039767.full |
| spellingShingle | Robin Green Zorry Belchev Mary Ellene Boulos Julia Rybkina Kadeen Johns Eliyas Jeffay Brenda Colella Jason Ozubko Michael Johnathan Charles Bray Nicholas Di Genova Adina Levi Alana Changoor Thomas Worthington Asaf Gilboa Remotely delivered environmental enrichment intervention for traumatic brain injury: Study protocol for a randomised controlled trial BMJ Open |
| title | Remotely delivered environmental enrichment intervention for traumatic brain injury: Study protocol for a randomised controlled trial |
| title_full | Remotely delivered environmental enrichment intervention for traumatic brain injury: Study protocol for a randomised controlled trial |
| title_fullStr | Remotely delivered environmental enrichment intervention for traumatic brain injury: Study protocol for a randomised controlled trial |
| title_full_unstemmed | Remotely delivered environmental enrichment intervention for traumatic brain injury: Study protocol for a randomised controlled trial |
| title_short | Remotely delivered environmental enrichment intervention for traumatic brain injury: Study protocol for a randomised controlled trial |
| title_sort | remotely delivered environmental enrichment intervention for traumatic brain injury study protocol for a randomised controlled trial |
| url | https://bmjopen.bmj.com/content/11/2/e039767.full |
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