Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 5 , Pages 974-981, May 2008

Prediction of Memory Rehabilitation Outcomes in Traumatic Brain Injury by Using Functional Magnetic Resonance Imaging

  • Gary E. Strangman, PhD

      Affiliations

    • Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
    • Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
    • Corresponding Author InformationReprint requests to Gary E. Strangman, PhD, Neural Systems Group, 149 13th St, Psychiatry, Room 2651, Charlestown, MA 02129
    • ,
  • Therese M. O'Neil-Pirozzi, ScD

      Affiliations

    • Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
    • Department of Speech-Language Pathology and Audiology, Northeastern University, Boston, MA
    • ,
  • Richard Goldstein, PhD

      Affiliations

    • Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
    • ,
  • Kalika Kelkar, BA

      Affiliations

    • Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
    • ,
  • Douglas I. Katz, MD

      Affiliations

    • Department of Neurology, Boston University School of Medicine, Boston, MA
    • Braintree Rehabilitation Hospital, Braintree, MA
    • ,
  • David Burke, MD

      Affiliations

    • Department of Rehabilitation Medicine, Emory University, Atlanta, GA
    • ,
  • Scott L. Rauch, MD

      Affiliations

    • McLean Hospital, Harvard Medical School, Belmont, MA
    • ,
  • Cary R. Savage, PhD

      Affiliations

    • Hoglund Brain Imaging Center, Kansas University Medical Center, Kansas City, KS.
    • ,
  • Mel B. Glenn, MD

      Affiliations

    • Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA

Abstract 

Strangman GE, O'Neil-Pirozzi TM, Goldstein R, Kelkar K, Katz DI, Burke D, Rauch SL, Savage CR, Glenn MB. Prediction of memory rehabilitation outcomes in traumatic brain injury by using functional magnetic resonance imaging.

Objective

To evaluate the ability of functional magnetic resonance imaging (fMRI) measures collected from people with traumatic brain injury (TBI) to provide predictive value for rehabilitation outcomes over and above standard predictors.

Design

Prospective study.

Setting

Academic medical center.

Participants

Persons (N=54) with TBI greater than 1 year postinjury.

Intervention

A novel 12-session group rehabilitation program focusing on internal strategies to improve memory.

Main Outcome Measure

The Hopkins Verbal Learning Test−Revised (HVLT-R) delayed recall score.

Results

fMRI measures were collected while participants performed a strategically directed word memorization task. Prediction models were multiple linear regressions with the following primary predictors of outcome: age, education, injury severity, preintervention HVLT-R, and task-related fMRI activation of the left dorsolateral and left ventrolateral prefrontal cortex (VLPFC). Baseline HVLT-R was a significant predictor of outcome (P=.007), as was injury severity (for severe vs mild, P=.049). We also found a significant quadratic (inverted-U) effect of fMRI in the VLPFC (P=.007).

Conclusions

This study supports previous evidence that left prefrontal activity is related to strategic verbal learning, and the magnitude of this activation predicted success in response to cognitive memory rehabilitation strategies. Extreme under- or overactivation of VLPFC was associated with less successful learning after rehabilitation. Further study is necessary to clarify this relationship and to expand and optimize the possible uses of functional imaging to guide rehabilitation therapies.

Key Words: Magnetic resonance imaging, Rehabilitation

 

 Supported by National Institute on Disability and Rehabilitation Research (grant no. H133A020513) and the National Institute of Neurological Disorders and Stroke (grant no. K25-NS046554).No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

PII: S0003-9993(08)00124-X

doi:10.1016/j.apmr.2008.02.011

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 5 , Pages 974-981, May 2008

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