Off-the-Shelf Games Help Some Veterans With Brain Injuries

An online game program developed to help aging adults maintain brain fitness has been found to improve cognitive function in veterans with a history of concussion, according to a study published last month in the journal Brain.

BrainHQ -- software available online that uses puzzles to exercise the brain -- improved cognitive function in affected veterans at four times the rate of those in a control group who played video games.

The improvements also continued after the study was complete, with the BrainHQ group seeing five times the gains when tested 12 weeks later, according to the study.

"The findings are certainly encouraging about the impact of this kind of cognitive training, which is really different than doing crossword puzzles or Sudoku," said Dr. Morris Bell, a scientist with the Department of Veterans Affairs' Rehabilitation Research and Development Service, in an interview with Military.com. "This is a systematic, highly structured, hierarchically organized set of tasks that begin with … primary sensory processing."

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The study included 83 veterans with cognitive impairment associated with mild traumatic brain injury from concussion or blast exposure. Participants trained in their homes an hour a day, five days a week, over 12 weeks.

Melissa Degnan, 65, suffered multiple concussions while serving in the Army for 15 years, working in explosive ordnance disposal. The damage, she said, robbed her of the ability to do math equations in her head or even manage a household. She became homeless.

"I spent five years on the street. I wasn't able to think properly," Degnan said in an interview with Military.com. "I literally was lured into a program with a burrito; I hadn't had warm food in a long time."

A nonprofit that helped house Degnan also introduced her to BrainHQ. Now, she can manage her household, count change, "comprehend the basics," she said.

"I used to be really smart -- I could do entire equations in my head. I can't do that now, but I know I used to. I also have the memory of being really stupid, for lack of a better word. Now, I'm sort of in-between," Degnan said.

She does the program every day for 20 minutes and credits it for helping her maintain focus.

"Two weeks ago, I was diagnosed with malignant breast cancer. You can imagine, my brain went all over the place, so I did BrainHQ longer than I normally do and I was able to focus again and be less panic-stricken," Degnan said.

Traumatic brain injury has been called the signature wound of the wars in Afghanistan and Iraq, the result of service members' proximity to roadside bomb blasts and other close-contact concussive events, from tactical vehicle accidents to building clearing operations.

More than 434,000 service members have been diagnosed with a brain injury in the past 20

years, with 82% of those classified as mild, meaning the patient has experienced brain dysfunction and possibly structural damage as the result of a physical knock or pressure blast to the head.

While not everyone who experiences a mild traumatic brain injury develops lasting effects, post-concussion syndrome, with symptoms that include headache, dizziness, irritability, insomnia, tinnitus and problems with concentration and memory, can greatly affect quality of life, lasting for years after an injury.

"Traumatic brain injury is a diffuse injury -- it leaves you with what you could call a 'noisy brain,' .... There's fatigue, there's distraction, there's confusion," said Bell, one of the co-authors of the study and a professor emeritus at Yale School of Medicine. "In order to do higher-level tasks, you need to be able to process at the simplest levels first."

And that's where BrainHQ comes in.

The program uses training based on brain plasticity -- the brain's ability to adapt to stimulus or injury by modifying neurons or other structures -- to address attention, memory, speed, navigation and personal skills.

Unlike video games, BrainHQ adapts to the user's pace, getting easier if a player makes mistakes or becoming more challenging if the exercise is too easy.

The BrainHQ study group saw their cognitive performance scores improve by nearly twice the rate as those in the control group, as indicated by their percentile scores -- the score when compared with other BrainHQ users the same age -- which rose an average 24 points.

"The whole nature of video games is to be exciting and energizing, to grab your attention," Bell said. "That's not useful training. This program is effortful attention. You apply attention, and you are processing, systematically, what is going on."

Researchers have long debated the effectiveness of brain training, which has become a multibillion-dollar industry for companies such as Posit Science, developers of BrainHQ; WordSmart Corp., maker of Lumosity; LearningRx; and Cognifit charging for premium content.

Studies conducted in the early 2010s found that brain training improved participants' ability to perform the specific task for which they were challenged but didn't show overall improvement in cognitive function.

The Federal Trade Commission in 2015 sued Lumosity's parent company and LearningRx for false advertising, charging that their marketing made false claims about their products' effectiveness for conditions such as memory loss, dementia and attention deficit hyperactivity disorder.

The companies paid combined settlements of $2.2 million to the federal government in the cases.

A National Academies of Sciences, Engineering, and Medicine review in 2017 found that cognitive training over time could improve function and help adults maintain independence.

Combining the training with blood pressure management and physical activity showed "modest but inconclusive evidence that they can help prevent cognitive decline and dementia," according to the report.

More research is needed to affirm the BrainHQ study results and determine whether the program can ward off cognitive decline or improve the brain health of those with other conditions that cause memory loss. But Bell said he has used the program to study whether it can help people with cognitive decline tied to alcohol abuse.

"Alcohol is not good for the brain," he said. "[With] chronic alcohol use, there are really devastating effects on the brain. ... We've gotten favorable effects in the VA population."

A limited sampling of BrainHQ games are available online for free, while the complete program is subscription based. Active-duty military personnel and military family members can access it through the online base library system and Military OneSource.

The study was funded by Posit Science through a grant from the Congressionally Directed Medical Research Program. The researchers included Henry Mahncke, the program's developer.

-- Patricia Kime can be reached at Patricia.Kime@Monster.com. Follow her on Twitter @patriciakime.

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