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SMART Program May Reshape Brain, Extend TBI Recovery Potential

Strategic Memory and Reasoning Training (SMART) Has Shown Multiple Benefits in Recent Studies

When we first reported on the SMART program for TBI patients in 2011, the technique was a fairly new addition to the cognitive recovery toolkit. Now, 10 years later, research has continued to show the program’s efficacy. Scientists have found evidence for novel improvements and determined SMART can be successfully administered online.

SMART Can Increase Cortical Thickness

A pair of studies conducted by the Center for BrainHealth at the University of Texas at Dallas found physical evidence of the changes SMART prompted in TBI patients’ brains. TBI itself can change brain structure, disrupting communications and harming a victim’s cognitive capabilities.

In one study, an 8-week training regimen produced noticeable differences in cortical thickness and resting-state functional connectivity (rsFC) among TBI patients. Both markers have previously been proven effective bellwethers for improvement, and patients with the biggest physical changes experienced the largest performance increases.

The second Center for BrainHealth study found the structural changes induced by SMART reduced symptoms of depression and boosted patients’ performance in daily tasks. The prefrontal cortex, which we rely on for executive function and emotional control, increased in thickness throughout the 8-week program. Researchers believe the changes in this region alone could account for the improvements seen in subjects’ lives.

SMART is not the only training program that can increase patients’ brain structure, but in both studies, it outperformed a knowledge-based training course offered to the other half of the participants. The first study was also notable in that participants had an average symptom age of 8 years. While doctors have believed for years that TBI recovery functionally stalls after 2 years, SMART may help patients continue to improve their cognitive skills beyond that deadline.

SMART via Skype Works

In a study conducted by researchers from the University of Cincinnati College of Medicine, a small group of adolescents who had suffered TBI was led through the SMART program online, via Skype. The participants completed the program over a span of 4-6 weeks. Afterward, along with improved skills in abstraction, cognitive flexibility, and working memory, parents reported an increase in participants' executive function.

Conducted in 2019, this study was important at the time for evaluating the potential for helping TBI patients of lower means access SMART. In a post-pandemic world, it also shows effective treatment can be administered without any in-person meetings. While the researchers recommend replicating this study with randomization and a larger sample size, the initial findings are promising for TBI patients.

Kihwan Han, Rebecca A. Davis, Sandra B. Chapman, Daniel C. Krawczyk. Strategy-based reasoning training modulates cortical thickness and resting-state functional connectivity in adults with chronic traumatic brain injury. Brain and Behavior. (April 2017).

Kihwan Han, David Martinez, Sandra B. Chapman, Daniel C. Krawczyk. Neural correlates of reduced depressive symptoms following cognitive training for chronic traumatic brain injury. Human Brain Mapping. (March 2018).

Cook, Lori G., Nellie N. Caulkins, Sandra B. Chapman.A Strategic Memory Advanced Reasoning Training Approach for Enhancing Higher Order Cognitive Functioning Following Sports- and Recreation-Related Mild Traumatic Brain Injury in Youth Using Telepractice. Perspectives of the ASHA Special Interest Groups. (February 2020).

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