Bender Pape Theresa L, Livengood Sherri L, Kletzel Sandra L, Blabas Brett, Guernon Ann, Bhaumik Dulal K, Bhaumik Runa, Mallinson Trudy, Weaver Jennifer A, Higgins James P, Wang Xue, Herrold Amy A, Rosenow Joshua M, Parrish Todd
The Department of Veterans Affairs (VA), Center for Innovation in Complex Chronic Healthcare & Research Service, Edward Hines Jr. VA Hospital, Hines, IL, United States.
Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
Front Neurol. 2020 Oct 8;11:1027. doi: 10.3389/fneur.2020.01027. eCollection 2020.
For people with disordered consciousness (DoC) after traumatic brain injury (TBI), relationships between treatment-induced changes in neural connectivity and neurobehavioral recovery have not been explored. To begin building a body of evidence regarding the unique contributions of treatments to changes in neural network connectivity relative to neurobehavioral recovery, we conducted a pilot study to identify relationships meriting additional examination in future research. To address this objective, we examined previously unpublished neural connectivity data derived from a randomized clinical trial (RCT). We leveraged these data because treatment efficacy, in the RCT, was based on a comparison of a placebo control with a specific intervention, the familiar auditory sensory training (FAST) intervention, consisting of autobiographical auditory-linguistic stimuli. We selected a subgroup of RCT participants with high-quality imaging data (FAST = 4 and placebo = 4) to examine treatment-related changes in brain network connectivity and how and if these changes relate to neurobehavioral recovery. To discover promising relationships among the FAST intervention, changes in neural connectivity, and neurobehavioral recovery, we examined 26 brain regions and 19 white matter tracts associated with default mode, salience, attention, and language networks, as well as three neurobehavioral measures. Of the relationships discovered, the systematic filtering process yielded evidence supporting further investigation of the relationship among the FAST intervention, connectivity of the left inferior longitudinal fasciculus, and auditory-language skills. Evidence also suggests that future mechanistic research should focus on examining the possibility that the FAST supports connectivity changes by facilitating redistribution of brain resources. For a patient population with limited treatment options, the reported findings suggest that a simple, yet targeted, passive sensory stimulation treatment may have altered functional and structural connectivity. If replicated in future research, then these findings provide the foundation for characterizing the unique contributions of the FAST intervention and could inform development of new treatment strategies. For persons with severely damaged brain networks, this report represents a first step toward advancing understanding of the unique contributions of treatments to changing brain network connectivity and how these changes relate to neurobehavioral recovery for persons with DoC after TBI. NCT00557076, The Efficacy of Familiar Voice Stimulation During Coma Recovery (http://www.clinicaltrials.gov).
对于创伤性脑损伤（TBI）后意识障碍（DoC）患者，治疗引起的神经连接变化与神经行为恢复之间的关系尚未得到探索。为了开始建立关于治疗对神经网络连接变化相对于神经行为恢复的独特贡献的证据体系，我们进行了一项试点研究，以确定值得在未来研究中进一步检验的关系。为实现这一目标，我们检查了来自一项随机临床试验（RCT）的先前未发表的神经连接数据。我们利用这些数据是因为在RCT中，治疗效果基于安慰剂对照与一种特定干预措施的比较，即熟悉的听觉感觉训练（FAST）干预，该干预由自传性听觉语言刺激组成。我们从RCT参与者中选择了一组具有高质量成像数据的亚组（FAST组 = 4人，安慰剂组 = 4人），以检查与治疗相关的脑网络连接变化，以及这些变化如何以及是否与神经行为恢复相关。为了发现FAST干预、神经连接变化和神经行为恢复之间有前景的关系，我们检查了与默认模式、突显、注意力和语言网络相关的26个脑区和19条白质束，以及三项神经行为指标。在发现的关系中，系统筛选过程产生了证据，支持进一步研究FAST干预、左颞下回纵束的连接性和听觉语言技能之间的关系。证据还表明，未来的机制研究应侧重于研究FAST通过促进脑资源重新分配来支持连接性变化的可能性。对于治疗选择有限的患者群体，报告的研究结果表明，一种简单但有针对性的被动感觉刺激治疗可能改变了功能和结构连接性。如果在未来研究中得到重复验证，那么这些发现为描述FAST干预的独特贡献奠定了基础，并可为新治疗策略的开发提供信息。对于脑网络严重受损的患者，本报告代表了朝着推进理解治疗对改变脑网络连接性的独特贡献以及这些变化如何与TBI后DoC患者的神经行为恢复相关迈出的第一步。NCT00557076，昏迷恢复期间熟悉声音刺激的疗效（http://www.clinicaltrials.gov）
