ONF ABI program research project focuses on new thinking about brain injury recovery

Thinking outside the box may lead to a new route to improve memory function for those who experience moderate to severe traumatic brain injury (TBI). Dr. Robin Green, Senior Scientist at the Toronto Rehabilitation Institute and Canada Research Chair (tier II) in traumatic brain injury, has received a grant through the Ontario Neurotrauma Foundation (ONF) Acquired Brain Injury (ABI) program to further test and expand a unique behavioural intervention that may improve not just compensate for memory loss.

“We know it is hard to achieve improvements in memory with those who are in the chronic stage of brain injury. Traditional approaches address compensation options of memory functions,” says Dr. Green. “We are aiming to actually restore brain structure and function as well as to mitigate further declines. In this way we can help to promote healthier brain aging, and improve day-to-day memory functioning in a very flexible way. We are trying to promote greater participation in every day life.”

he memory restoration treatment protocol developed by Dr. Green and colleagues involves the application of what is called allocentric, or “bird’s eye view” spatial navigation. “Our intervention has patients navigating online maps of a different city every week, and patients are encouraged to create mental maps as if they were looking down from above on the routes,” says Dr. Green. “The intervention is designed to be fun, with different kinds of rewards along the way. Early research indicates that aging of the hippocampi (the memory structures of the brain) is slowed and memory improvement is observed in very similar kinds of intensive, allocentric spatial navigation exercises in healthy younger and older adults.”

Dr. Green’s lab has previously shown that people with even quite severe brain injury months and years post-injury can carry out such brain exercises in their own home with very minimal supervision.

Those participating in a pilot research project for the study were engaged in the intervention and experienced good outcomes individually without additional rewards or encouragement required to ensure their compliance. This new grant will explore the outcomes with additional rewards and offers encouragement to family members to help them support participants.

Another key outcome of the work to be completed through the grant (which is entitled “Addressing a gap in evidence and care: Development of a remotely delivered learning and memory intervention and province-wide delivery infrastructure”) is to evaluate the benefit of expanding this relatively easy-to-apply and low-cost treatment protocol provincially.

Access to treatment remotely could break down some of the barriers to treatment for those who do not live in major Ontario centres. Dr. Green is already communicating with partners across Ontario and in other provinces. If successful, the study could lead to significant improvements in the lives of people across the province.

“There are always complexities when applying new treatments and we hope to increase the understanding of what works for individuals and why,” says Dr. Green, who leads one of the largest and best-established ABI clinical programs in the province. “We are trying to build an approach based on hard science that also takes into consideration that each person participating in the study is an individual with unique needs. During and after the study, participants and family members will be asked questions about what facilitated and what impeded participation in the treatment.”

“Dr. Green’s research is intrinsically aligned to our goal of moving evidence to practice,” says Corinne Kagan, Senior Program Director ABI Program, ONF. “The simplicity but power of this approach gives us new hope that those who have been debilitated by TBI will see improvements in their daily lives and their ability to meaningfully participate in their communities.”