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/

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

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. 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. 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. 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. Harnessing Neuroplasticity to Treat
Schizophrenia – Normalizing Brain
Activation
6

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. 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. 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. 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. 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

16. 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

17. Q&A
10 minutes
(Included in session
recording)

18. Kate Sullivan,
Director of the Brain Fitness
Center at Walter Reed National
Military Medical Center

19. 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

20. 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

21. • 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

22. 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

23. 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

24. 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

25. 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

26. 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.

27. 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

28. Q&A
10 minutes
(Included in session
recording)

29. Sponsors
Partners
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Joining Us!

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