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| Name | Class |
|---|---|
| Biomedical Research Institute of New Mexico | OTHER |
| New Jersey Institute of Technology | OTHER |
| University of Miami | OTHER |
| The Mind Research Network |
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Aim 1: To use magnetoencephalography (MEG) and magnetic resonance imaging (MRI) in Veterans and civilians with mild traumatic brain injury (mTBI) and sensory postconcussive symptoms (PCS) to demonstrate the mechanism of therapeutic benefit of HD-tDCS for sensory symptoms, as shown by reliable changes in the activity of the cognitive control network (CCN) and sensory system network (SSN) following stimulation; Aim 2: this intervention will result in long-term improvements in measures of executive function, depression/anxiety, and quality of life.
Experimental Design and Methods Participants: 120 subjects will be recruited for this study from the NM VA Health Care System and community, 40 healthy controls subjects for an imaging-only group, and 80 mTBI subjects for the stimulation arm who have suffered injury at least 3 months prior to study enrollment, but not more than 15 years prior to enrollment. All participants will be 18-59 years of age.
Recruitment: Human participants (ages 18-59) will be invited to come to the University of New Mexico (UNM) to ask questions prior to providing consent. They will be provided with consent forms that describe the study procedures and potential risks.
Once informed consent is obtained and the appropriate forms signed, the participant will be assigned a unique research subject identifier (URSI) number, and from that point forward all research data will only be labeled with the URSI number. The key linking identifiers of participants to the URSI will be maintained on a separate database that will be stored behind locked doors, in a locked filing cabinet in a secure area. All participants may then undergo demographic data collection, neuropsychological assessments sensory evaluation, at UNM. They may also undergo MEG and MRI at the Mind Research Network (MRN), located in the same building.
Demographic Data: As part of the initial assessment, basic demographic data regarding the subject may be noted down, including age, gender, socioeconomic status, educational attainment, handedness, use of common stimulants such as caffeine, and brain injury severity. They may also be asked if they are willing to allow their medical record to be accessed, for the purposes of confirming details about any traumatic brain injury (TBI) as well as obtaining results of neuroimaging studies done at the time of injury or afterward. This will include medical, surgical, neurological and psychiatric history, results of lab tests, brain scans, electroencephalography tests, medication lists, information from doctor's visits and hospital visits.
Neuropsychological testing procedures: All neuropsychological testing will be administered in the Center for Brain Recovery and Repair Core by trained study personnel under direct supervision of core directors. The following domains and tests will be administered: Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research (Examiner); Digit Span; Delis-Kaplan Executive Function Systems (DKEFS) Trail-making Test Conditions 2 and 4; Hopkins Verbal Learning Test (HVLT); Frontal Systems Behavior Scale (FrSBe); Test of Memory Malingering (TOMM); Wechsler Test of Adult Reading (WTAR); Digit Symbol Coding; Handedness; Socioeconomic Status (SES); Patient's Global Impression of Change (PGIC); Glasgow Outcome Scale-Extended (GOSE).
Sensory Assessment: Hearing, balance, and vision will be assessed using Common Data Element (CDE) instruments, including the Hearing Handicap Assessment, the Test for Visual Discomfort, the modified Balance Error Scoring System. Oculomotor control will be assessed using virtual reality goggles (Oculus) with implanted eye trackers (iScan).
Magnetoencephalography: Magnetoencephalography (MEG) may be done after neuropsychological testing. The participant will sit in the MEG scanner to record brain magnetic fields. MEG setup takes between 10 and 30 minutes, and subsequent recording takes one hour. During MEG assessments participants will complete numerous tasks. Each task is designed to parse different cognitive mechanisms that contribute to sensory performance. In perceptual tasks, participants will discriminate tone pitches amongst novel distracting tones (Auditory Orienting Task; AOT). For eye movement tasks, participants are asked look either towards or away from a visual stimulus (Pro- and Anti-saccades).
Magnetic resonance imaging (MRI): MRI scan(s) will be obtained for integration with MEG, as needed for analyses. Total scan time, including participant setup and removal, is expected to take 1 hour. Participants may lie down on a table and be placed into a long donut-shaped magnet. During the scan, participants will be asked to rest quietly or to fixate on a dot on a screen in front of them, or to perform a memory task. No contrast will be used. Any female over 18 who thinks she may be pregnant will complete a urine pregnancy screen before the MRI scan.
Following initial testing, the participants in the stimulation arm of the study will receive 10 consecutive weekday sessions of high-definition transcranial direct current stimulation. 2 milliamperes active or sham anodal current will be delivered to the left dorsolateral prefrontal cortex for 30 minutes. During this time, participants will perform vision therapy tasks through a virtual reality headset, or a computer-based working memory task. Skin sensations will be assessed every 10 minutes.
Post stimulation testing: the next available weekday following completion of the study protocol, subjects will return to UNM to repeat the demographic, neuropsychological, sensory, and imaging assessments.
Long term followup: At 1 month, 3 months and 6 months after stimulation, subjects will be contacted via telephone or meet in person, and will be administered the Beck Depression Inventory (BDI-II), Posttraumatic Stress Disorder Checklist-Military (PCL-M), the Neurobehavioral Symptom Inventory (NSI), and Patient Global Impression of Change (PGIC) quality of life assessment tools utilized before and immediately after, after stimulation. Veterans will undergo these study followup visits at NMVAHCS, and civilians at UNM.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Active Stimulation | Active Comparator | Active HD-tDCS will be delivered while subjects perform sensory training tasks. |
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| Sham Stimulation | Sham Comparator | Sham HD-tDCS will be delivered while subjects perform sensory training tasks. |
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| Imaging Only | No Intervention | 40 subjects will undergo initial testing only as a healthy control group. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Active High-definition transcranial direct current stimulation (HD-tDCS) | Device | Active HD-tDCS delivers active current through 2-10 electrodes held against the scalp with a lycra cap at specified 10-20 electroencephalography (EEG) coordinates. |
| Measure | Description | Time Frame |
|---|---|---|
| Postconcussive Sensory Symptoms | The NSI is a validated scale of postconcussive symptoms; the Somatic Subscale score captures severity of physical symptoms such as tinnitus, blurry vision, loss of balance, and insomnia. (range 0-48; 0-12 mild; 13-24 moderate; 25-36 severe; 37-48 very severe) | 2 week visit |
| Measure | Description | Time Frame |
|---|---|---|
| Magnetoencephalography Peak Activation | Peak activation during the Auditory Orienting Task (AOT) performed during magnetoencephalography | 2 week visit |
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Inclusion Criteria:
Exclusion Criteria:
10) any significant blindness, to screen out peripheral sensory damage; 11) any significant deafness beyond mild hearing loss, to screen out peripheral sensory damage; 12) any ongoing litigation related to TBI, to prevent interference with legal proceedings; 13) any contraindication to MRI; 14) membership in an identified vulnerable population, including minors, pregnant women, and prisoners, so as to prevent coercion.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of New Mexico Health Sciences Center | Albuquerque | New Mexico | 87106 | United States |
De-identified participant data, including demographic, neuropsychological, and imaging data, will be uploaded to FITBIR for use by TBI researchers, as specified by the grant sponsor.
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Data will be uploaded to the Federal Interagency Traumatic Brain Injury Registry (FITBIR) at study termination.
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| ID | Title | Description |
|---|---|---|
| FG000 | Active Stimulation | Active HD-tDCS will be delivered while subjects perform sensory training tasks. Active High-definition transcranial direct current stimulation (HD-tDCS): Active HD-tDCS delivers active current through 2-10 electrodes held against the scalp with a lycra cap at specified 10-20 electroencephalography (EEG) coordinates. |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Nov 30, 2020 |
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| OTHER |
| The City College of New York | OTHER |
120 subjects will be recruited for this study: 40 healthy controls subjects for the imaging-only group, and 80 mTBI subjects for the stimulation arm who have suffered mild TBI at least 3 months prior to study enrollment, but not more than 15 years prior to enrollment. The 80 mTBI subjects will be randomized to either active stimulation (40) or sham stimulation (40).
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Active and sham HD-tDCS will be delivered with the same device, and participants and research technician are blinded to the condition.
| Sham High-definition transcranial direct current stimulation (HD-tDCS) | Device | Sham HD-tDCS delivers sham current through 2-10 electrodes held against the scalp with a lycra cap at specified 10-20 electroencephalography (EEG) coordinates |
|
| FG001 |
| Sham Stimulation |
Sham HD-tDCS will be delivered while subjects perform sensory training tasks. Sham High-definition transcranial direct current stimulation (HD-tDCS): Sham HD-tDCS delivers sham current through 2-10 electrodes held against the scalp with a lycra cap at specified 10-20 electroencephalography (EEG) coordinates |
| FG002 | Imaging Only | 40 subjects will undergo initial testing only as a healthy control group. |
| COMPLETED |
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| NOT COMPLETED |
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This is the population of patients with complete behavioral and magnetoencephalography data
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| ID | Title | Description |
|---|---|---|
| BG000 | Active Stimulation TBI Group | Subjects have experienced a mild TBI with ongoing symptoms. Active HD-tDCS will be delivered while subjects perform sensory training tasks. Active HD-tDCS delivers active current through 2-10 electrodes held against the scalp with a lycra cap at specified 10-20 electroencephalography (EEG) coordinates. Sham delivers a negligible amount of current that does not cause physiological changes. |
| BG001 | Sham Stimulation TBI Group | Subjects have experienced a mild TBI with ongoing symptoms. Sham HD-tDCS will be delivered while subjects perform sensory training tasks. Active HD-tDCS delivers active current through 2-10 electrodes held against the scalp with a lycra cap at specified 10-20 electroencephalography (EEG) coordinates. Sham delivers a negligible amount of current that does not cause physiological changes. |
| BG002 | Imaging Only Control Group | Subjects will undergo initial testing only as a healthy control group. |
| BG003 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean | Standard Deviation | years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Ethnicity (NIH/OMB) | Count of Participants | Participants |
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| Race (NIH/OMB) | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| Neurobehavioral Symptom Inventory Somatic Subscale Score | The NSI is a validated scale of postconcussive symptoms; the Somatic Subscale score captures severity of physical symptoms such as tinnitus, blurry vision, loss of balance, and insomnia. (range 0-48; 0-12 mild; 13-24 moderate; 25-36 severe; 37-48 very severe) | Mean | Standard Deviation | units on a scale |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Postconcussive Sensory Symptoms | The NSI is a validated scale of postconcussive symptoms; the Somatic Subscale score captures severity of physical symptoms such as tinnitus, blurry vision, loss of balance, and insomnia. (range 0-48; 0-12 mild; 13-24 moderate; 25-36 severe; 37-48 very severe) | For active and sham, analysis population includes all participants who completed intervention and all pre-intervention and post-intervention visit assessments. For imaging only group, analysis includes all participants who completed all pre-intervention visit assessments. | Posted | Mean | Standard Deviation | score on a scale | 2 week visit |
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| Secondary | Magnetoencephalography Peak Activation | Peak activation during the Auditory Orienting Task (AOT) performed during magnetoencephalography | For active and sham intervention groups, analysis population includes all participants who completed intervention | Posted | Mean | Standard Deviation | femtotesla | 2 week visit |
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adverse event data was collected for the "Active Stimulation" and "Sham Stimulation" Arms during the 2-week stimulation period between Visit 1 and Visit 2; adverse event data were collected over a single day at Baseline for participants in the "Imaging Only" Arm.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Active Stimulation | Active HD-tDCS will be delivered while subjects perform sensory training tasks. Active High-definition transcranial direct current stimulation (HD-tDCS): Active HD-tDCS delivers active current through 2-10 electrodes held against the scalp with a lycra cap at specified 10-20 electroencephalography (EEG) coordinates. | 0 | 21 | 0 | 21 | 3 | 21 |
| EG001 | Sham Stimulation | Sham HD-tDCS will be delivered while subjects perform sensory training tasks. Sham High-definition transcranial direct current stimulation (HD-tDCS): Sham HD-tDCS delivers sham current through 2-10 electrodes held against the scalp with a lycra cap at specified 10-20 electroencephalography (EEG) coordinates | 0 | 21 | 0 | 21 | 2 | 21 |
| EG002 | Imaging Only | 40 subjects will undergo initial testing only as a healthy control group. | 0 | 37 | 0 | 37 | 0 | 37 |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| syncope | Nervous system disorders | Non-systematic Assessment |
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| nausea | Gastrointestinal disorders | Non-systematic Assessment |
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| headache | Nervous system disorders | Non-systematic Assessment |
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| nightmares | Psychiatric disorders | Non-systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Davin Quinn | University of New Mexico Health Sciences Center | 505-272-2223 | dquinn@salud.unm.edu |
| Jan 2, 2025 |
| Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D001924 | Brain Concussion |
| ID | Term |
|---|---|
| D000070642 | Brain Injuries, Traumatic |
| D001930 | Brain Injuries |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D006259 | Craniocerebral Trauma |
| D020196 | Trauma, Nervous System |
| D016489 | Head Injuries, Closed |
| D014947 | Wounds and Injuries |
| D014949 | Wounds, Nonpenetrating |
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| Male |
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| Not Hispanic or Latino |
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| Unknown or Not Reported |
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| Asian |
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| Native Hawaiian or Other Pacific Islander |
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| Black or African American |
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| White |
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| More than one race |
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| Unknown or Not Reported |
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| Post-Intervention (2 week visit) |
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| Units | Counts |
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| Participants |
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