tDCS and Cognitive Training in Active Duty Service Members With Mild TBI: A Pilot Study

NCT04925453 | Completed

• 1 other identifier: NMCSD.2020.0016
• Study Type: interventional
• Target: 56
• Locations: 1 country
• Sites: 1

Brief Summary

The proposed study will evaluate a new approach to cognitive rehabilitation of mild traumatic brain injury (mTBI) using a brain stimulation technique called transcranial direct current stimulation (tDCS). Specifically, we will investigate how tDCS combined with cognitive training improves deficits to attention and working memory in Active Duty Service Members with a history of mild traumatic brain injury (TBI). Measures of attention-related brain activity, neurocognitive assessments, and self-reported clinical outcomes will be used to determine effects of tDCS vs. sham tDCS when paired with a cognitive training intervention. By doing this study, we hope to find a reliable, noninvasive, and efficient method of treating mild TBI cognitive symptoms.

Conditions

Brain Concussion; Brain Trauma; Attention Concentration Difficulty; Brain Injuries; Brain Injuries, Traumatic; Neurocognitive Dysfunction; Attention Impaired; Memory Impairment; Mild Traumatic Brain Injury; Mild Cognitive Impairment

Keywords

military health; brain stimulation; cognitive training; cognitive rehabilitation

Outcome Measures

Primary Outcomes (13)

• Symbol Digit Modalities Test (SDMT)

  Standardized neuropsychological assessment measure of visual attention and working memory

  Change from Baseline SDMT at 1 week after the intervention.

• Symbol Digit Modalities Test (SDMT)

  Standardized neuropsychological assessment measure of visual attention and working memory

  Change from Baseline SDMT at 6 weeks after the intervention.

• Symbol Digit Modalities Test (SDMT)

  Standardized neuropsychological assessment measure of visual attention and working memory

  Change from 1 week post-intervention SDMT at 6 weeks after the intervention.

• Neuropsychological Assessment Battery (NAB) Attention Module

  Standardized neuropsychological assessment consisting of 4 subtests to assess visual and auditory attention, working memory, and scanning.

  Change from Baseline NAB Attention Module at 1 week after the intervention.

• Neuropsychological Assessment Battery (NAB) Attention Module

  Standardized neuropsychological assessment consisting of 4 subtests to assess visual and auditory attention, working memory, and scanning.

  Change from Baseline NAB Attention Module at 6 weeks after the intervention.

• Neuropsychological Assessment Battery (NAB) Attention Module

  Standardized neuropsychological assessment consisting of 4 subtests to assess visual and auditory attention, working memory, and scanning.

  Change from 1 week post-intervention NAB Attention Module at 6 weeks after the intervention.

• Electroencephalogram (EEG)

  EEG will be collected to assess neural dynamics during rest and during performance of generalization tasks. The neural dynamics to be assessed include functional connectivity, mean ERP amplitude, and spectral power of delta, theta, alpha, beta, and gamma frequency bands.

  Change from Baseline EEG at 1 week after the intervention.

• Electroencephalogram (EEG)

  EEG will be collected to assess neural dynamics during rest and during performance of generalization tasks. The neural dynamics to be assessed include functional connectivity, mean ERP amplitude, and spectral power of delta, theta, alpha, beta, and gamma frequency bands.

  Change from Baseline EEG at 6 weeks after the intervention.

• Electroencephalogram (EEG)

  EEG will be collected to assess neural dynamics during rest and during performance of generalization tasks. The neural dynamics to be assessed include functional connectivity, mean ERP amplitude, and spectral power of delta, theta, alpha, beta, and gamma frequency bands.

  Change from 1 week post-intervention EEG at 6 weeks after the intervention.

• Neurobehavioral Symptom Inventory (NSI)

  A measure of common post-concussive symptoms rated on a 5-point Likert scale (0-4); with low scores corresponding to mild or no incidence of symptoms and high scores corresponding to more severe incidence of symptoms.

  Change from Baseline NSI at 1 week after the intervention.

• Neurobehavioral Symptom Inventory (NSI)

  A measure of common post-concussive symptoms rated on a 5-point Likert scale (0-4); with low scores corresponding to mild or no incidence of symptoms and high scores corresponding to more severe incidence of symptoms.

  Change from Baseline NSI at 6 weeks after the intervention.

• Neurobehavioral Symptom Inventory (NSI)

  A measure of common post-concussive symptoms rated on a 5-point Likert scale (0-4); with low scores corresponding to mild or no incidence of symptoms and high scores corresponding to more severe incidence of symptoms.

  Change from 1 week post-intervention NSI at 6 weeks after the intervention.

• Magnetic Resonance Imaging (MRI) w/out contrast (optional)

  Medical imaging technique that uses a magnetic field and computer-generated radio waves to create detailed images of the organs and tissues in your body. Mean white matter and CSF signals across time are calculated for each participant. Additionally, time courses for regions of interest are also extracted.

  Change from Baseline MRI at 1 week after the intervention.

Secondary Outcomes (11)

• NIH Toolbox Quality of Life Assessment (NeuroQoL)

  Change from Baseline NeuroQoL at 1 week after the intervention.

• NIH Toolbox Quality of Life Assessment (NeuroQoL)

  Change from Baseline NeuroQoL at 6 weeks after the intervention.

• NIH Toolbox Quality of Life Assessment (NeuroQoL)

  Change from 1 week post-intervention NeuroQoL at 6 weeks after the intervention.

• Insomnia Severity Index (ISI)

  Change from Baseline ISI at 1 week after the intervention.

• Insomnia Severity Index (ISI)

  Change from Baseline ISI at 6 weeks after the intervention.

Study Arms (2)

Active tDCS

EXPERIMENTAL

Based on previous studies targeting working memory, focality of current delivery, and comfort and tolerance levels, (Paulo S. Boggio et al., 2006; Hill et al., 2016; Hoy et al., 2013; Teo, Hoy, Daskalakis, \& Fitzgerald, 2011), we will use a 2 mA current administered via two circular carbon rubber core electrodes in saline-soaked surface sponges (25 cm2), placed in a neoprene headcap with marked locations based on the 10-10 EEG system. The anodal stimulating electrode will be at location F3, over left dorsolateral prefrontal cortex (DLPFC) and the cathodal electrode at location F4, over right DLPFC. Two reference electrodes, CMS and DRL, will be attached to the EarClip and applied to the earlobe with conductive gel. Before each training session, the impedance of the electrodes will be checked and verified to be ≤15 KOhm. Additionally, the stimulation will be terminated if the impedance of the electrodes is \> 20 KOhm. The current and impedance will be recorded for every session.

Combination Product: active tDCS and cognitive training intervention

Sham tDCS

SHAM COMPARATOR

For sham stimulation, the electrodes will be placed at the same positions as for active stimulation (F3 and F4). After an initial ramp-up period of 30 seconds, stimulation fades out over a period of 30 seconds. Additionally, at the end of the sham stimulation period, stimulation will fade in over a period of 30 seconds and then end with a final 30 second ramp-down period. Participants will feel the initial itching sensation associated with tDCS and experience the ramp-down period at the end of the sham stimulation period but will receive no active current during the rest of the sham stimulation period. This method of sham stimulation has been shown to be reliable (Gandiga et al., 2006). Before each training session, the impedance of the electrodes will be checked and verified to be ≤15 KOhm. Additionally, the stimulation will be terminated if the impedance of the electrodes is \> 20 KOhm. The current and impedance will be recorded for every session.

Combination Product: sham tDCS and cognitive training intervention

Interventions

active tDCS and cognitive training intervention COMBINATION_PRODUCT

Intervention sessions will occur during Visits 2-6. Cognitive training will occur concurrently with tDCS in both the active and sham tDCS groups. Over each 46-minute daily training period, 4 of 5 BrainHQ training tasks will be performed for approximately 11 minutes in a randomly selected order. Order of task presentation will be randomized each session. Stimulation sequences will occur in the first 13 minutes (shut off: Minute 13) of the session and the last 13 minutes of the session (turn on: Minute 33). The Symptom Rating Questionnaire (SRQ) will be asked before and after stimulation to assess for any side-effects. The BrainHQ Task Load Index (TLX) will be administered at the end of each intervention session. At the end of Intervention Session 3, subjects will be given a Blinding Questionnaire which asks whether they thought they received active or sham treatment.

Also known as: intervention group, active group

Active tDCS

sham tDCS and cognitive training intervention COMBINATION_PRODUCT

Intervention sessions will occur during Visits 2-6. Cognitive training will occur concurrently with tDCS in both the active and sham tDCS groups. Over each 46-minute daily training period, 4 of 5 BrainHQ training tasks will be performed for approximately 11 minutes in a randomly selected order. Order of task presentation will be randomized each session. Stimulation sequences will occur in the first and last 13 minutes of the session. For sham stimulation, the electrodes will be placed at the same positions as for active stimulation, but current will be ramped down immediately after the initial 30s ramp up period. The Symptom Rating Questionnaire (SRQ) will be asked before and after stimulation to assess for any side-effects. The BrainHQ Task Load Index (TLX) will be administered at the end of each intervention session. At the end of Intervention Session 3, subjects will be given a Blinding Questionnaire which asks whether they thought they received active or sham treatment.

Also known as: fake tDCS group, placebo group, sham group

Sham tDCS

Eligibility Criteria

• Age: 18 Years - 55 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• (1) Have a remote history mild traumatic brain injury as defined by the VA/DoD clinical practice guidelines(The Management of Concussion/mTBI Working Group, 2016) that is \>/= 6 months, and report moderate severity neurocognitive symptoms related to attention, concentration, working memory, or memory based on NSI scores and self-report.
• (2) Are between the ages of 18-55.
• (3) Are stable on any medications for at least 2 weeks at the baseline visit (Visit #1).

You may not qualify if:

• (1) Have a history of seizures or epilepsy.
• (2) Have a history of ECT or cortical energy exposure within the past 12 months, including participation in any other neuromodulation studies.
• (3) Have current stimulant dependence.
• (4) Have a diagnosis of intellectual disability or pervasive developmental disorder (i.e. premorbid IQ less than or equal to 70).
• (5) Have any medical condition or treatment other than mild TBI (e.g. stroke, tumor, HIV, moderate-severe TBI), with significant neurological disorder or insults that, based on the Principal Investigator's judgement, would impact risk.
• (6) Diagnosed with current active psychosis or mania.
• (7) Have metallic cranial plates/screws or implanted device,
• (8) Have eczema on scalp or other scalp lesions or skin disorders that may become irritated by stimulation.
• (9) Pregnant individuals and individuals with ferromagnetic metal in their body that would prohibit them from being safe in the MRI will not be excluded from the overall study, but will be excluded from the optional MRI.

Sponsors & Collaborators

• United States Naval Medical Center, San Diego: lead
• The Defense and Veterans Brain Injury Center: collaborator

Study Sites (1)

Naval Medical Center San Diego

San Diego, California, 92134, United States

Location

MeSH Terms

Conditions

Brain Concussion; Brain Injuries, Traumatic; Brain Injuries; Cognition Disorders; Memory Disorders; Cognitive Dysfunction

Condition Hierarchy (Ancestors)

Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Craniocerebral Trauma; Trauma, Nervous System; Head Injuries, Closed; Wounds and Injuries; Wounds, Nonpenetrating; Neurocognitive Disorders; Mental Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Lars D Hungerford, PhD

  United States Naval Medical Center, San Diego

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR
• Masking Details: The tDCS unit software has a double-blind selection, blinding all study members, care providers, and participants until blinds are broken.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: FED
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Senior Clinical Research Director

Model Details: This is a double-blind, randomized, placebo (sham) controlled pilot study.

Study Record Dates

• First Submitted: September 8, 2020
• First Posted: June 14, 2021
• Study Start: January 19, 2021
• Primary Completion: June 30, 2025
• Study Completion: July 30, 2025
• Last Updated: November 12, 2025

Record last verified: 2025-11

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)