Presented by:Tatjana Novakovic-Agopian & Gary AbramsPNS Teleconference 11/23/15

Support: VA R&D

SFVA Brain Injury Rehabilitation Research

Strengthening Cognitive ControlFunctions

Attentional Regulation and Problem SolvingApplied to Individual Goals

SFVA Brain Injury Rehabilitation Research

Gary Abrams, M.D.Katelyn Begany, BSDebra Binder, MSJoaquin Burciaga, PhDGerald Carlin, OTR/LHolli Castelli, OTR/LAnthony Chen, MDMark D’Esposito, M.D.Rich Fitzsimmons, MSJohn Garfinkle, M.S.

Cathy Kennedy, PTErica Kornblith, PhDAudrey Kossman, MSMelissa Loughlin, PTKaren Lau, PhDFred Loya, PhDMichelle Madore, PhDCharles MayerKacey Marton, MAJohn McQuaid, PhD

James Muir, PhDMichelle Murphy, PsyDThomas Neylan, MDTatjana Novakovic-Agopian, PhDErica Pool, BSSarah Ramsdale, OTR/LNick Rodriguez, BSScott Rome, MDAnnemarie Rossi, OTR/LGary Turner, PhD

1. Brain injury rehabilitation interventions targetingexecutive control functions

2. Multi-level behavioral outcome assessments,including ecologically valid functional outcomemeasurements

3. Long term outcome assessment4. Determination of neural mechanisms of plasticity

SFVA Brain Injury Rehabilitation Research

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Cognitive Training Method:Group and individual manualized (therapist and participant) training.Participants’ practice applying attention regulation and problem solvingstrategies on progressively more challenging tasks and situations intheir daily life, and on selection and execution of feasible individual and group projects.Duration/intensity: 5 weeks: 20hrs (10 group mtgs), 3 hrs individual training, 20hrs of homework

Goal-Oriented Attentional Self-regulation - GOALSTraining in attention regulation and problemsolving applied to individually defined goals.

Multi level outcomes assessed (some variation depending on study) :Neuropsychological measures of attention/executive function and memory;Performance on complex ‘real life’ functional taskassessing subcomponents of executive functioning;Self-report on measures of daily functioning andemotional regulationGoal-directed control over neural processing;

Populations studied: Adults with mild tomoderate functional deficits in executive control(concentration, multitasking, planning, organization)2 to: chronic ABI; TBI; co-morbid mTBI/PTSD;healthy aging

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1) Completed: Pilot study with 16 individuals with chronic ABI showed significantimprovements post GOALS but not brief control on (Novakovic-Agopian, et.alJHTR, 2011; Chen, Novakovic-Agopian, et al Brain, 2011):

Neuropsychological measures of attention/executive function and memory;Performance on complex functional task;Goal-directed control over neural processing;Long term follow-up (6 months - 2 yrs; 16/16 completed): 50% (8/16 reportedreturning to work (6 work for pay; 2 volunteer), as compared to 13% (2/16) priorto training. 87% reported continuing using some trained strategies

GOALS Studies

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2) Recently Completed: Randomized control study with Veterans with chronicTBI. Preliminary results from 32 Veterans indicate significant improvements postGOALS, but not matched control Brain Health EDU training on (Novakovic-Agopian,et al., ACRM , 2015):

Neuropsychological measures of attention/executive function;Performance on complex ‘real life’ functional task (Novakovic-Agopian, et.alJHTR, 2014)Self report measures of emotional regulation and daily functioning

Ongoing Long Term Follow-up (6 ms -18ms; 22 /28 completed): Participantscontinued to demonstrate significant post -training improvements relative tobaseline on all above assessed domains.45% (10/22) reported returning to competitive work, as compared to 23% (5/22)

prior to training .

GOALS as preparation for return to work/school?

GOALS Studies

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3) Ongoing: Randomized control study of GOALS vs matched Brain HealthEDU training in Veterans with co-morbid PTSD/mTBI.Does strengthening cognitive control functions improves functioning in other functional

domains such as emotional regulation?Preliminary results from 12 Veterans indicate significant improvementspost GOALS, but not matched control Brain Health EDU training on(Novakovic-Agopian, Abrams. et al., to be presented at INS , 2016):

Neuropsychological measures of attention/executive function;Performance on complex ‘real life’ functional taskSelf report measures of emotional regulation and daily functioning

GOALS Studies

Novakovic-Agopian, T., Abrams G., Chen, A., et.al. Executive Function Training inVeterans with Chronic TBI: Short and Longer Term Outcomes. Presentation at theACRM Conference, Dallas, TX, October 2015Novakovic-Agopian, T., Abrams G., Chen, A., et.al Goal-Oriented Attentional Self-Regulation Training in Veterans with Chronic TBI- Long Term Outcomes.Presentation at the International Neuropsychological Conference, Denver CO, February2015Novakovic-Agopian, T., Chen, A., Abrams G., et.al Goal-Oriented Attention andProblem Solving Training in Veterans with Chronic TBI. Presentation at the NationalAcademy of Neuropsychology Conference, Puerto Rico, November, 2014.Novakovic-Agopian, T., Chen, A., Abrams G., et.al. Goal-Oriented Executive FunctionTraining in Veterans with Chronic TBI: Short and Longer Term Outcomes. Paperpresentation at the 10th World Congress on Brain Injury, March 2014, San Francisco,CANovakovic-Agopian, T., Chen, A. Goal-Directed Attention Regulation and ProblemSolving. VA Cyber seminar, March 2014.Novakovic-Agopian, T., Chen, A., Abrams G., et.al. Short and Long Term Outcomesof GOALS Executive Function Training in Veterans with Chronic TBI. InternationalNeuropsychological Conference, Seattle WA, February 2014

GOALS Studies- Presentations 2014-2015