LED Therapy Improves Sleep and Cognition In Chronic Moderate TBI: Pilot Case Studies

Brain Injury the use of computerized treatment programs as a rehabilitation tool in ABI. We conducted a systematic review of empirical research on computerized cognitive rehabilitation for attention and executive function after ABI. Design: Systematic Review. Data Sources: A literature search of Pubmed and PsychINFO was conducted using the key terms: computerized cognitive rehabilitation, traumatic brain injury (TBI), stroke, ABI, and executive functioning. Study Selection: Studies reporting on cognitive outcomes following computerized rehabilitation in adult participants with an ABI of any severity were included. Data Extraction: Articles were independently assessed by two reviewers, using Cicerone et al criteria. Data collected included sample size, diagnosis, intervention info, treatment schedule, assessment methods, and results. Data Synthesis: The initial searches yielded a total of 1075 hits; reduced to 121 after title review, which was further reduced to 27 once doubles were eliminated and abstracts were reviewed. Fourteen met inclusion criteria after being read. Nine studies met criteria for Class I, two met criteria for Class II, and three met Class III evidence criteria. There is evidence of improvement in executive functioning in ABI following computerized treatment. Studies were more commonly conducted in stroke patients. TBI studies often included smaller sample sizes and less adequate control groups. Conclusions: The evidence indicates improvements in executive functioning following computerized cognitive rehabilitation training. Additional studies are needed, especially in TBI. Key Words: Rehabilitation, Executive Function, TBI, Computerized cognitive training Disclosure(s): None Disclosed. Poster 235 LED Therapy Improves Sleep and Cognition In Chronic Moderate TBI: Pilot Case Studies Yelena Bogdanova (Boston University), Paula I. Martin, Michael D. Ho, Maxine H. Krengel, Vivian T. Ho, Megan K. Yee, Jeffrey A. Knight, Michael Hamblin, Margaret Naeser Objective: To probe the effect of noninvasive transcranial red/near-infrared (NIR) light-emitting diode (LED) treatment on sleep and cognitive function in patients with chronic moderate traumatic brain injury (TBI). Design: Case study. Setting: Outpatient clinical research unit. Participants: Two patients (1 female) with moderate TBI (medical records and clinical evaluation) and persistent cognitive dysfunction (at least 2 SD below average on one, or 1 SD below average on at least two neuropsychological tests of executive function and memory). Interventions: 18 sessions of transcranial LED therapy (3x/week for 6 weeks). LED therapy is non-invasive, painless, and non-thermal (500mW, FDA-cleared, non-significant risk device). Red/NIR photons increase ATP production and local rCBF in the areas of compromised cells. Main Outcome Measure(s): Standardized neuropsychological (executive function, memory), neuropsychiatric (depression, PTSD) and sleep measures (PSQI, actigraphy) were administered to participants pre- (T1), mid(T2), and one week (T3) post- LED treatment. Primary outcome measures: Stroop (executive function), CVLT-II (memory), BDI-II (depression), and actigraphy (sleep). Results: Both LED-treated cases showed marked improvement in sleep (actigraphy Total Sleep) 1 week post-LED treatment series (T3), as compared to pre-treatment (T1). P1 also improved in executive function, verbal memory, and Sleep Efficiency; while P2 significantly improved on measures of PTSD (PCL-M) and depression. No adverse events were reported. Conclusions: Our preliminary results showed that sleep and cognition can be improved by LED treatment in chronic moderate TBI. These findings

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e77 suggest that this novel noninvasive therapeutic approach (LED) has potential to reduce persistent cognitive symptoms in moderate TBI and associated neuropsychiatric symptoms (sleep disturbance, depression, and PTSD). Controlled studies are warranted. Key Words: Actigraphy, Low Level Light Therapy, Executive function, Sleep, Neurorehabilitation Disclosure(s): None Disclosed.

Poster 236 Psychiatric Comorbidities Among Individuals With Post Concussive Syndrome Yelena Goldin (JFK Johnson Rehabilitation Institute), Keith Ganci, Keith Cicerone Objective: To examine the frequency and nature of co-morbid psychiatric disorders among individuals with Post-Concussive Syndrome (PCS) seeking neuropsychological services and/or cognitive rehabilitation. Design: Observational cross-sectional. Setting: Clinical and research facility in a suburban medical center. Participants: 100 consecutive referrals for neuropsychological evaluation ofindividuals with presenting diagnosis of mild traumatic brain injury and/ or PCS (age 19-68, 40% male). Interventions: None. Main Outcome Measure(s): Three modules from the Patient Health Questionnaire (PHQ):1) PHQ-9, which assesses the presence and severity of depression; 2) PHQ-15, which assesses the presence and severity of somatization and somatoform disorder; and 3) GAD-7, which assesses the presence and severity of anxiety disorders.PTSD Checklist e Civilian Version (PCL-C) was used to screen for the presence of post-traumatic stress disorder (PTSD). All measures demonstrate good reliability and have been widely used in the assessment of individuals with chronic medical conditions. Neurobehavioral Symptom Inventory was used to assess the presence and severity of post-concussive symptoms. Results: The largest groups included individuals with PCS only who did not meet criteria for any of the four psychiatric disorders assessed (29%) and individuals who met criteria for three psychiatric conditions (27%).The remainder of the sample was comparably distributed among individuals who met criteria for one (14%), two (15%), and all four (15%) psychiatric conditions assessed.Among individuals who met criteria for one or more psychiatric disorder, somatization/somatoform disorder was the most prevalent conditions when occurring alone or in combination with other conditions, followed by depression, and anxiety.Post-traumatic stress disorder occurred in only 4 individuals (4% of the sample) and only when criteria for at least two other conditions were met.Patients with selective cognitive/cognitive-affective PCS symptoms were less likely to meet criteria for psychiatric co-morbidities, compared to patients with global PCS symptoms who were more likely to meet criteria for three psychiatric conditions (most prevalently somatization/somatoform disorder, depression, and anxiety). Conclusions: Approximately one third of the sample exhibited PCS without any psychiatric co-morbidities.Approximately two thirds of individuals with PCS met criteria for one or more psychiatric conditions, and approximately one third met criteria for three co-morbid psychiatric conditions. Contrary to the majority of the literature that suggests that depression and anxiety are the most common psychiatric conditions, our data indicate that somatization/somatoform disorder is most prevalent among individuals with PCS, followed by depression and anxiety.A diagnosis of PTSD was relatively uncommon in this sample and occurred in the context of global psychiatric dysfunction.Selective cognitive/ cognitive-affective PCS symptoms were less likely to be associated with psychiatric co-morbidities than global PCS symptomatology.Implications