How can practitioners integrate emerging
neuroplasticity-based interventions with
existing standards of care?
Chaired by: Olivier Oullier,
Professor of Behavioral and Brain Sciences
at Aix-Marseille University
Bruce Wexler,
NIH Dire...
Bruce Wexler,
NIH Director’s Award Winner
and Professor of Psychiatry at
Yale University
Improving Executive Function and ...
The Potential: Harnessing
Neuroplasticity for Clinical Treatment
 Structure and function of brains of mammals
are shaped ...
Harnessing Neuroplasticity to Treat
Schizophrenia
 TRANSFER to non-trained cognitive functions
 DURABILITY of gains afte...
Harnessing Neuroplasticity to Treat
Schizophrenia – Normalizing Brain
Activation
6
Next Generation Programs
 New Functionalities
 Assessment and Intervention
 For Children – Time of greatest neuroplasti...
A Next Generation Program:
Activate by C8Sciences
 New Functionalities
 Online error diagnostics
 Individualized correc...
A Next Generation Program:
Activate by C8Sciences
 New Functionalities
 Integration with Physical Exercises (optional)
...
A Next Generation Program:
Activate by C8Sciences
 New Functionalities
 Integration with Physical Exercises (optional)
...
A Next Generation Program:
Activate by C8Sciences
 New Functionalities
 Integration with Physical Exercises (optional)
...
General Implementation Issues and
Strategies
 Integration and Synergies with Other
Treatments
 ADHD: is Cognitive traini...
Q&A
10 minutes
(Included in session
recording)
Kate Sullivan,
Director of the Brain Fitness
Center at Walter Reed National
Military Medical Center
Integrating brain-
training programs
with traditional
interventions for
Wounded Warrior
rehabilitation
Katherine W. Sulliv...
Disclaimers
The views expressed in this lecture are those of the
author and do not necessarily reflect the official
policy...
• More cognitive training as an adjunct to functional therapy
• Therapeutic “homework” that can be intensive and monitored...
22
 382 total patients at WRNMMC
 Diagnosis:
 254 TBI
 128 Other (CVA, PTSD, ADHD,
Aneurysm, Chemofog, etc.)
 Average...
A Multi-Discipline Resource
23
24%
16%
14%
14%
13%
7%
4%
3%
2% 2% 1%
TBI CM
SLP
Audiology
OT
Psychiatry
Neuropsych
Behavio...
Programs available
in the WRNMMC BFC
Dakim Brain Fitness
• Cross-Trainer
Posit Science - Classic
• Auditory Processing
Pos...
0
10
20
30
40
50
60
70
2008 2009 2010 2011 2012 2013
TBI
nonTBI
Unique Population
25
PTSD
Flashbacks
Avoidance
Hypervigila...
Unique Setting
Number of sessions completed and the duration of participation for
each research participant in Groups A an...
Benefits and Limitation of neuroplasticy-based
brain-training in a military treatment facility
 Limitations
• Less Monito...
Q&A
10 minutes
(Included in session
recording)
Sponsors
Partners
Thank You for
Joining Us!
To Learn More…
Summit
Recordings
Book Market
Report
sharpbrains.
com/book/
sharpbrains.
com/summit/
sharpbrains.com
/marke...
How can prac­ti­tion­ers inte­grate emerg­ing neuroplasticity-based inter­ven­tions with exist­ing stan­dards of care?
How can prac­ti­tion­ers inte­grate emerg­ing neuroplasticity-based inter­ven­tions with exist­ing stan­dards of care?
How can prac­ti­tion­ers inte­grate emerg­ing neuroplasticity-based inter­ven­tions with exist­ing stan­dards of care?
How can prac­ti­tion­ers inte­grate emerg­ing neuroplasticity-based inter­ven­tions with exist­ing stan­dards of care?
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How can prac­ti­tion­ers inte­grate emerg­ing neuroplasticity-based inter­ven­tions with exist­ing stan­dards of care?

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A promis­ing fron­tier of applied neu­ro­science lies in tech­nolo­gies that stim­u­late our brains in order to har­ness neu­ro­plas­tic­ity and achieve pos­i­tive out­comes. What are the prac­ti­cal Pros and Cons of dif­fer­ent method­olo­gies such as cog­ni­tive train­ing, EEG/ QEEG biofeed­back, vir­tual real­ity, and what are appro­pri­ate ways to inte­grate them with tra­di­tional interventions?

- Chair: Olivier Oul­lier, Pro­fes­sor of Behav­ioral and Brain Sci­ences at Aix-Marseille University
- Bruce Wexler, NIH Director’s Award Win­ner and Pro­fes­sor of Psy­chi­a­try at Yale University
- Kate Sul­li­van, Direc­tor of the Brain Fit­ness Cen­ter at Wal­ter Reed National Mil­i­tary Med­ical Center

This session took place at the 2013 SharpBrains Virtual Summit: http://sharpbrains.com/summit-2013/agenda/

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How can prac­ti­tion­ers inte­grate emerg­ing neuroplasticity-based inter­ven­tions with exist­ing stan­dards of care?

  1. 1. How can practitioners integrate emerging neuroplasticity-based interventions with existing standards of care?
  2. 2. Chaired by: Olivier Oullier, Professor of Behavioral and Brain Sciences at Aix-Marseille University Bruce Wexler, NIH Director’s Award Winner and Professor of Psychiatry at Yale University Kate Sullivan, Director of the Brain Fitness Center at Walter Reed National Military Medical Center How can practitioners integrate emerging neuroplasticity-based interventions with existing standards of care?
  3. 3. Bruce Wexler, NIH Director’s Award Winner and Professor of Psychiatry at Yale University Improving Executive Function and Treating ADHD with Computer-Presented Brain Training Programs
  4. 4. The Potential: Harnessing Neuroplasticity for Clinical Treatment  Structure and function of brains of mammals are shaped after birth by stimulation from the environment  Hubel and Wiesel received Nobel Prize  Sur et al convert auditory to visual cortex in ferrets  This post-natal shaping of the brain is greater in humans than any other animal  “Neurons that fire together wire together”  Deliberately harness this neuroplasticity to treat illness and improve cognition 4
  5. 5. Harnessing Neuroplasticity to Treat Schizophrenia  TRANSFER to non-trained cognitive functions  DURABILITY of gains after training ends  FUNCTIONAL IMPACT in real world activities  Meta-analysis shows significant but modest effects in 40 studies together including over 1,000 patients  Evidence-based adjunctive treatment for an aspect of illness that limits functionality and quality of life but does not respond to medication 5
  6. 6. Harnessing Neuroplasticity to Treat Schizophrenia – Normalizing Brain Activation 6
  7. 7. Next Generation Programs  New Functionalities  Assessment and Intervention  For Children – Time of greatest neuroplasticity  Enhance cognitive development  Especially to increase executive function  “School lunch” program for the brain  Treat neurodevelopmental disorders  ADHD  Autism 7
  8. 8. A Next Generation Program: Activate by C8Sciences  New Functionalities  Online error diagnostics  Individualized corrective strategy messages and temporary performance aids  Integrated multi-dimensional and multi- component program shapes to user  Anonymous expert review for the Director of the NIH: “easily the most sophisticated brain training program…”  Integration with Physical Exercises (optional)  Assessment and Intervention 8
  9. 9. A Next Generation Program: Activate by C8Sciences  New Functionalities  Integration with Physical Exercises (optional)  “Cognition Rich” physical exercises  Activate the same neurocognitive systems as do computer exercises but in context of whole body activity and social interaction  Assessment and Intervention  Hybrid home/office/school implementation  Effective 9
  10. 10. A Next Generation Program: Activate by C8Sciences  New Functionalities  Integration with Physical Exercises (optional)  Assessment and Intervention  Executive Function tests from NIH Toolbox built in and automatically administered  Compared to results from 1000’s of children  Analysis of 20,000 responses per child during training exercises to create individual profiles of cognitive strengths and weaknesses  Hybrid home/office/school implementation  Effective 10
  11. 11. A Next Generation Program: Activate by C8Sciences  New Functionalities  Integration with Physical Exercises (optional)  Assessment and Intervention  Hybrid home/office/school implementation  Web-based log in from anywhere  Immediate online access for Clinician/Coach/Teacher to all tests and indicators of participation  Physical exercises for groups, in gyms, in classrooms or parent/child at home  Effective 11
  12. 12. General Implementation Issues and Strategies  Integration and Synergies with Other Treatments  ADHD: is Cognitive training facilitated by stimulant meds or does it replace them?  Family therapy with practical focus on doing the computer and/or physical exercises  Sequencing Different Treatments  Cognitive training first to increase gains from other treatments  Hybrid home/office/school implementations  Leverage clinical impact 16
  13. 13. Q&A 10 minutes (Included in session recording)
  14. 14. Kate Sullivan, Director of the Brain Fitness Center at Walter Reed National Military Medical Center
  15. 15. Integrating brain- training programs with traditional interventions for Wounded Warrior rehabilitation Katherine W. Sullivan M.S., CCC-SLP, CBIS Walter Reed National Military Medical Center Center for Neuroscience and Regenerative Medicine Defense and Veterans Brain Injury Center 19
  16. 16. Disclaimers The views expressed in this lecture are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Army, or Air Force, the Department of Defense, nor the U.S. Government This presentation does not imply any Federal/DOD endorsement I have no relevant financial or nonfinancial relationships with the products described, reviewed, evaluated or compared in this presentation Unclassified
  17. 17. • More cognitive training as an adjunct to functional therapy • Therapeutic “homework” that can be intensive and monitored • Maintenance once discharged and transitioned home • Schedule filler or distraction; making MTF days more structured Clinical Education Research The Brain Fitness Center Started in 2009 at Walter Reed for any service member complaining of cognitive dysfunction
  18. 18. 22  382 total patients at WRNMMC  Diagnosis:  254 TBI  128 Other (CVA, PTSD, ADHD, Aneurysm, Chemofog, etc.)  Average age 34 ; 84% male  Majority United States Army, Active Duty  50% of pts seen >1 year TPO  Pt visits per month : 125  Average 23.4 sessions  Average stay 96.0 days 64% 17% 12% 7% TBI Severity mild moderate severe penetrating BFC Patient Population 0 20 40 60 80 100 120 BOTH SLP OT Concomitant Therapy
  19. 19. A Multi-Discipline Resource 23 24% 16% 14% 14% 13% 7% 4% 3% 2% 2% 1% TBI CM SLP Audiology OT Psychiatry Neuropsych Behavioral Health Warrior Clinic Neuropsch HS Neurology Oncology
  20. 20. Programs available in the WRNMMC BFC Dakim Brain Fitness • Cross-Trainer Posit Science - Classic • Auditory Processing Posit Science - Insight • Visual Processing Posit Science - BrainHQ • Auditory, Visual, and Executive Functioning Lumosity • Web-Based, Cross-Trainer Cogmed • Working Memory mPOD/OVEI Neuro and biofeedback •Nintendo DS • Brain Age, Brain Age II Mobile Applications • Training on the go
  21. 21. 0 10 20 30 40 50 60 70 2008 2009 2010 2011 2012 2013 TBI nonTBI Unique Population 25 PTSD Flashbacks Avoidance Hypervigilance Nightmares Re-experiencing phenomenon TBI Headache Sensitivity to noise or light Nausea Vomiting Vision Problems Dizziness Irritability Cognitive deficits Insomnia Depression Fatigue Anxiety
  22. 22. Unique Setting Number of sessions completed and the duration of participation for each research participant in Groups A and B (N=26). There are two data points at (0,0) and (30, 8). Study design intended 30 sessions in 6 weeks.
  23. 23. Benefits and Limitation of neuroplasticy-based brain-training in a military treatment facility  Limitations • Less Monitoring • Perception it is “enough” • Blanket approach? • Pts are not home • Pts are not stable • Physically • Psychologically • Socially • Low compliance  Benefits • Focus on drills • Mobile • Low-cost • Patient engagement • Independent • Novel patients, novel approach • Intro to healthy brain habits • Maintenance 27
  24. 24. Q&A 10 minutes (Included in session recording)
  25. 25. Sponsors Partners Thank You for Joining Us!
  26. 26. To Learn More… Summit Recordings Book Market Report sharpbrains. com/book/ sharpbrains. com/summit/ sharpbrains.com /market-report/

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