Randomized control trial of computer-based rehabilitation of spatial neglect syndrome: the RESPONSE trial protocol

Background: Spatial neglect is a frequent and debilitating consequence of acquired brain injury and currently has no widely accepted standard of care. While previous interventions for spatial neglect have targeted patients’ overt spatial deficits (e.g., reduced contralesional visual scanning), far fewer have directly targeted patients’ non-spatial deficits (e.g., sustained attention deficits). Considering that non-spatial deficits have shown to be highly predictive of long-term disability, we developed a novel computer based training program that targets both sustained (tonic) and moment-to-moment (phasic) aspects of non-spatial attention (Tonic and Phasic Alertness Training, TAPAT). Preliminary studies demonstrate that TAPAT is safe and effective in improving both spatial and non-spatial attention deficits in the post-acute recovery phase in neglect patients. The purpose of the current trial (referred to as the REmediation of SPatial Neglect or RESPONSE trial) is to compare TAPAT to an active control training condition, include a larger sample of patients, and assess both cognitive and functional outcomes. Methods/Design We will employ a multi-site, longitudinal, blinded randomized controlled trial (RCT) design with a target sample of 114 patients with spatial neglect. Patients will either perform, at their home, the experimental TAPAT training program or an active control computer games condition for thirty minutes/day, five days a week, over three months. Patients will be assessed on a battery of cognitive and functional outcomes on three occasions: a) immediately before training, b) within forty-eight hours post completion of total training, and c) after a three-month no-contact period post completion of total training, to assess the longevity of potential training effects. Discussion The strengths of this protocol are that it tests an innovative, in-home administered treatment that targets a fundamental deficit in neglect, employs highly sensitive computer-based assessments of cognition as well as functional outcomes, and incorporates a large sample size (relative to other neglect treatment studies) in an RCT design. Trial registration ClinicalTrials.gov identifier, NCT0196595

West Hartford-Bloomfield Health District Community Needs Assessment: A Mixed Methods Study Identifying COVID-19 Knowledge, Perceptions, and Health Disparities

Background: The West Hartford-Bloomfield Health District (WHBHD) is a regional health department serving the towns of West Hartford and Bloomfield in Connecticut. From February to April of 2020, elderly and Black residents accounted for 59% and 38% of COVID-19 related deaths, respectively. Since the district has not assessed community health needs previously and is interested in becoming accredited, a community needs assessment will serve as the first step in implementing effective and timely interventions to address needs, disparities, and misperceptions about the pandemic. Methods: A comprehensive survey was adapted from existing NIH COVID-19 research instruments. 779 responses were collected on the topics of community health and COVID-19 knowledge, practices and perceptions. Five semi-structured key informant interviews were conducted with faith-based organizations and local government leaders to corroborate findings from the survey. Quantitative analyses were performed via SAS and R, and qualitative data was summarized. Results: Demographic distributions significantly differed between West Hartford and Bloomfield in age, income, race, marital status and household size. While there were differences in community health problems, social/environmental problems, and health care barriers, both towns shared individual health problems and perceived certain populations as most underserved. Both towns have adequate COVID-19 knowledge regarding symptoms and transmissions, low perceived risk of infection, and positive attitude towards preventative actions and measures. There were significant differences in COVID-19 testing accessibility between towns (p = 0.002), with nearly double the proportion of West Hartford residents reporting difficulty accessing testing. COVID-19 vaccination status is also different between towns, with both reporting lack of available vaccines as the primary reason preventing or delaying vaccination. Conclusions: The mixed methods approach to conducting this community needs assessment has provided consequential preliminary findings that will be useful in refining the health district’s current and future responses to COVID-19 and other public health issues.https://elischolar.library.yale.edu/ysph_pbchrr/1055/thumbnail.jp

Randomized control trial of computer-based training targeting alertness in older adults: the ALERT trial protocol

Background: Healthy aging is associated with a decline in multiple functional domains including perception, attention, short and long-term memory, reasoning, decision-making, as well as cognitive and motor control functions; all of which are significantly modulated by an individual’s level of alertness. The control of alertness also significantly declines with age and contributes to increased lapses of attention in everyday life, ranging from minor memory slips to a lack of vigilance and increased risk of falls or motor-vehicle accidents. Several experimental behavioral therapies designed to remediate age-related cognitive decline have been developed, but differ widely in content, method and dose. Preliminary studies demonstrate that Tonic and Phasic Alertness Training (TAPAT) can improve executive functions in older adults and may be a useful adjunct treatment to enhance benefits gained in other clinically validated treatments. The purpose of the current trial (referred to as the Attention training for Learning Enhancement and Resilience Trial or ALERT) is to compare TAPAT to an active control training condition, include a larger sample of patients, and assess both cognitive and functional outcomes. Methods/design We will employ a multi-site, longitudinal, blinded randomized controlled trial (RCT) design with a target sample of 120 patients with age-related cognitive decline. Patients will be asked to complete 36 training sessions remotely (30 min/day, 5 days a week, over 3 months) of either the experimental TAPAT training program or an active control computer games condition. Patients will be assessed on a battery of cognitive and functional outcomes at four time points, including: a) immediately before training, b) halfway through training, c) within forty-eight hours post completion of total training, and d) after a three-month no-contact period post completion of total training, to assess the longevity of potential training effects. Discussion The strengths of this protocol are that it tests an innovative, in-home administered treatment that targets a fundamental deficit in adults with age-related cognitive decline; employs highly sensitive computer-based assessments of cognition as well as functional abilities, and incorporates a large sample size in an RCT design. Trial registration ClinicalTrials.gov identifier: NCT02416401

Childhood trauma and clinical high risk for psychosis

As a risk factor for psychosis, childhood trauma rates are elevated in the clinical-high-risk (CHR) syndrome compared to the general population. However, it is unknown whether trauma is typically experienced in childhood or adolescence/young adulthood, whether it occurred prior to CHR syndrome onset, and how severe trauma relates to presenting symptoms. In this study, we examined the relationship of trauma history to symptoms and functioning in individuals diagnosed with the CHR syndrome on the Structured Interview for Psychosis-Risk Syndromes (N = 103). Trauma, defined as meeting the DSM-IV A1 criterion of actual or threatened death or injury, was assessed by semi-structured interview. A large proportion of CHR participants (61%) reported trauma exposure, including interpersonal trauma, trauma prior to CHR onset, and childhood trauma prior to age 12. Those with a trauma history (versus those without trauma) were rated as having more severe perceptual disturbances, general/affective symptoms and more impairment on the Global Assessment of Functioning Scale. The number of traumatic events correlated with more severe ratings in those three domains. Additionally, the number of interpersonal traumas was correlated with ratings of suspiciousness. Trauma was unrelated to specific measures of social and role functioning. A small proportion of CHR participants were diagnosed with formal PTSD (14%), which was unrelated to symptom severity or functioning. Thus, we demonstrate that trauma exposure is often early in life (before age 12), occurs prior to the onset of the CHR syndrome, and is related to both positive and affective symptoms