This news release from the Center for BrainHealth at the University of Texas at Dallas describes findings from a recent study on the effects of brain training for people with chronic traumatic brain injury (TBI). The release is a little fuzzy on the details.
The news release should have included numbers to put the benefits in context and explained how changes in cortical thickness — the main outcome studied — translates to cognitive improvements (and what types of improvements) for a person living with long-term TBI.
TBI is a serious and prevalent condition, with an estimated 2.5 million new cases in 2010. Since treatments are limited, it’s in the public interest to find treatments that might improve brain function and to find reliable ways to measure this improvement.
The study concerns a unique population of TBI patients. On average, the patients recruited have suffered from TBI symptoms for eight years. The findings show that brain training can still stimulate changes in the brain (in terms of cortical thickness and neural connectivity) even after so many years. This challenges the widely held belief that recovery from TBI is limited to two years after the initial injury.
The news release suggests that an MRI-based measure of brain physiology is somehow superior to a neuropsychological test-based measure (ie. asking patients to name colors or read words). But a case can also be made that neuropsychological outcomes are actually more relevant since they are closer to what the patient experiences and to the outcomes we are trying to achieve with TBI treatments.
The news release does not mention how much the brain training costs. The release could have stated that the cost of cognitive training usually includes repeat visits to a therapist.
The release said that brain training “can stimulate structural changes in the brain and neural connections even years after a traumatic brain injury.” But how do these structural and neural changes translate to meaningful patient outcomes? The release said the training is correlated to “an individual’s ability to switch between tasks quickly and consistently to achieve a specific goal.” Which tasks? Which goal? To make the study findings meaningful to people with TBI or their caregivers, the release should have included some specific examples of how patients benefited from the therapy.
The lack of numbers to put the findings in context is another weakness of the release. There are no numbers to show the differences in neural connectivity or cortical thickness between the two treatment arms. Ideally we would be told the absolute difference in outcomes between the two groups, the clinical significance of any difference, and the statistical significance.
The only quantitative figures come from the image included in the news news release. The news release might have done a better job explaining this figure.
Harms are not discussed. While presumably there is little risk from participating in brain training, cognitive training can have its downsides. Harms such as the time investment, frustration over speed or lack of progress, costs, etc. could have been mentioned.
The study design is explained well — the number of patients, the treatment and control groups, the longitudinal aspect of the outcome measures. What is unclear is why the result matters. The release states:
“Individuals in the strategy-based reasoning training showed a greater change in cortical thickness and connectivity compared to individuals who received the knowledge-based training.”
A change can be in either direction. In fact because we have here three time points, a change could be 1) increase followed by increase, 2) increase followed by decrease, 3) decrease followed by decrease. Are all of these changes desirable? Are all of them correlated with cognitive ability? The release doesn’t tell us.
We found no indication of disease-mongering. The release provides good context on how TBI disrupts the structure of the brain.
The funding sources are disclosed at the end of the news release.
The release compares strategy-based training against knowledge-based training. But the release neglected to mention other approaches to treating TBI. Since the focus here is on cognitive impairments, the release might have mentioned some common treatments such cognitive behavior therapy and occupational therapy.
From the news release alone, it is not entirely clear if the brain training program already existed and was simply now applied to those with chronic TBI for the first time.
The novelty of the findings is clearly established early on in the news release. One finding is that changes in cortical thickness and neural network connectivity may serve as good surrogate markers for treatment efficacy. A further finding is that TBI patients may stand to gain from brain training well beyond the initial injury.
The releases employs a balanced tone.