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3 Optimizing Cognitive Rehabilitation of the Injured Warfighter
- Jason M Bailie, Ida Babakhanyan, Paul Sargent, Juan J Lopez, Melissa Caswell, Angela Basham, Lori Barnard, Ana Siblesz, Erin Venza, Jennifer Zientz, Sandi Chapman
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 668-669
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- Article
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Objective:
Many individuals who experienced a mild traumatic brain injury (mTBI) have persistent cognitive complaints. Traditional cognitive rehabilitation (TCR) interventions were primarily developed for severe neurological injury which has limited effectiveness in rehabilitation of active duty military personnel who have the goal of returning to full military operational status. To remain on active duty, warfighters must have sufficient mental competency to safely and effectively function in complex environments such as combat. There is need for a cognitive rehabilitation approach that addresses demands of military personnel to expedite return to duty. The Strategic Memory Advanced Reasoning Training (SMART) program is novel alternative to TCR. SMART is an evidence-based advanced reasoning protocol that enhances cognitive domains essential to military readiness (e.g., mental agility, strategic learning, problem solving, and focus) and requires less than half of the treatment time. The objective of this study was to assess the efficacy of SMART compared to TCR in terms of overall recovery as well as change in specific cognitive domains.
Participants and Methods:Participants were recruited from a military treatment facility. All patients had at least one diagnosed mTBI as well as persistent cognitive complaints. Participants completed the Rey-15 to ensure performance validity. Final sample was SMART n = 28 and SCORE n = 19. Primary dependent measure was the Global Deficit Scale (GDS). GDS was calculated from: Hopkins Verbal Learning Test-Revised (HVLT-R); Delis Kaplan Executive Functioning System Color Word (CW) and Trail Making (TM), Paced Auditory Serial Addition Test (PASAT), and the Symbol Digit Modality Test (SDMT). Demographically corrected t-scores were converted to deficit scores as follows: >40 = 0, 35-39 = 1, 30-34 = 2, 25-29 = 3, 20-24 = 4, <20 = 5. Deficit scores were averaged to calculate GDS. For each measure, Hohen’s g was analyzed for effect size comparisons pre-post treatment.
Results:Average number of treatment hours was significantly lower in the SMART condition (SMART: M = 18.47 hours, SD = 2.17; TCR: M = 42.42 hours, SD = 3.79, p <.001). A repeated measures ANOVA showed a significant change on GDS post-treatment (F = 30.25, p < .001) with a large effect size (n2 = .402); however, the interventions did not differ on GDS change. Impact on cognitive domains was relatively equivalent for processing speed (SMART h = 0.67 vs TCR h = -.54) and executive function (SMART h = -0.92 vs TCR h = -.85); however, SMART had a larger impact on memory (SMART h = -0.81 vs TCR h = -.39). SMART resulted in large improvements in retention and recognition memory which were minimally impacted by TCR.
Conclusions:Both TCR and SMART had comparable effectiveness in improving cognitive impairment, though SMART was completed in less than half of the treatment time. Both interventions had large effect sizes on processing speed and executive functioning; however, SMART was more effective in improving long-term memory. Memory is an integral part of military readiness. Further investigation is required to determine the relative effectiveness of these two approaches to improving cognitive readiness of the warfighter.
32 - Flow cytometric analysis of platelet function
- from PART II - METHODOLOGY
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- By Alan D. Michelson, Center for Platelet Function Studies and Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, USA, Marc R. Barnard, Center for Platelet Function Studies and Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, USA, Lori A. Krueger, Center for Platelet Function Studies and Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, USA, A. L. Frelinger III, Center for Platelet Function Studies and Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, USA, Mark I. Furman, Center for Platelet Function Studies and Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, USA
- Edited by Paolo Gresele, Università degli Studi di Perugia, Italy, Clive P. Page, Valentin Fuster, Jos Vermylen, Universiteitsbibliotheek-K.U., Leuven
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- Book:
- Platelets in Thrombotic and Non-Thrombotic Disorders
- Published online:
- 10 May 2010
- Print publication:
- 30 May 2002, pp 485-498
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Summary
Introduction
This chapter will review the use of flow cytometry for the detection of circulating activated platelets and the analysis of many other aspects of platelet function. Flow cytometry rapidly measures the specific characteristics of a large number of individual cells. Before flow cytometric analysis, cells in suspension are fluorescently labelled, typically with a fluorescently conjugated monoclonal antibody. In the flow cytometer, the suspended cells pass through a flow chamber and, at a rate of 1000–10000 cells per minute, through the focused beam of a laser. After fluorescent activation of the fluorophore at the excitation wavelength, a detector processes the emitted fluorescence and light scattering properties of each cell. (Ref. provides a very readable overview of the principles of flow cytometry.)
In the absence of an added exogenous platelet agonist, whole blood flow cytometry can determine the activation state of circulating platelets, as judged by the binding of an activation-dependent monoclonal antibody. In addition to this assessment of platelet function in vivo, inclusion of an exogenous agonist in the assay enables analysis of the reactivity of circulating platelets in vitro. In the latter application, whole blood flow cytometry is a physiological assay of platelet function in that an agonist results in a specific functional response by the platelets: a change in the surface expression of a physiological receptor (or other antigen or bound ligand), as determined by a change in the binding of a monoclonal antibody.