June 27, 2018
Eric Wicklund

A Vanderbilt study has found that an mHealth platform on which ICU patients can ‘exercise’ their brain at home after discharge from the hospital can help those patients recover cognitive skills.

An mHealth platform that enables recent ICU patients to “exercise” their brain at home after discharge is helping to improve recovery and reduce cognitive issues.

Researchers at Vanderbilt University have reported that a post-discharge program in which patients worked with an mHealth tool for 42 minutes a day over 12 weeks showed “significant improvement” in directly trained assessments of four key cognitive functions: attention, processing speed, memory and executive function.

Roughly one third of patients discharged from the ICU report newly-acquired or accelerated cognitive impairment, experts say, and as many as half of them become unemployed within a year because of those health problems. The road to recovery for these patients is often long and expensive.

Healthcare providers are now using mHealth and telehealth platforms to help patients with cognitive and neurological issues rehabilitate faster and more effectively at home. These so-called “brain games” can be played as frequently and for as long as needed, and can be personalized to the user’s cognitive functions and previous game results.

In addition, the connected health platform enables care providers to monitor patients at home, alter care management plans as needed and communicate with patients at any time.

The Vanderbilt study focused on a particular population that hasn’t had much access to this type of treatment: Older patients who have spent several days in an ICU and are discharged with what is called post-intensive care syndrome (PICS).

The study, called Returning to Everyday Tasks Using Rehabilitation Networks (RETURN-CCR), followed 33 people, ages 52-70, who’d spent one to three weeks in the hospital and between three and 16 days in the ICU. They were assigned 42 minutes of computer cognitive rehabilitation (CCR) training five days a week for 12 weeks on the BrainHQ online and mobile platform developed by Posit Science. The platform gave them access to 18 brain exercises, adjusted daily to create a series of seven exercises conducted for six minutes each.

In the study, published in the Annals of the American Thoracic Society, lead researcher Jo Ellen Wilson, MD, MPH, of the Vanderbilt Psychiatric Hospital, says CCR exercises have been used to help people with brain injuries and stroke, but have been largely untested on those with post-intensive care syndrome, as well as patients with “chemo-fog”, or HIV-associated neurologic dysfunction.

According to Wilson, the study showed “significant improvement in important neuropsychological domains and that improvement in untrained cognitive abilities was positively correlated with the amount of levels played.”

“This investigation is the first to our knowledge to evaluate feasibility of a computer gaming approach of cognitive rehabilitation in survivors of non-neuro/non-trauma critical illness,” she and her colleagues reported. “Such an approach is appealing as it is more scalable than traditional cognitive rehabilitation interventions that require intensive face-to-face interaction between patients and clinical professionals.”

“When comparing scores on untrained neuropsychological assessments, researchers found significant improvement on one assessment of executive function, with non-significant improvements on the other assessments,” a press release accompanying the study noted. “In their report, the researchers note (as a reason for a larger study) that the pilot was not powered to show significance on these measures. The amount of improvement on untrained measures correlated to the amount of training, with a sub–group that trained the most (twice as much as the average participant) showing significantly more improvement than those training the normal amount.”

Wilson and Dr. Henry Mahncke, CEO of Posit Science, each said separately that the study is an important first step in developing home-based digital health treatments for patients coming out of the ICU with PICS. Such treatments, if proven as effective as in-person therapy, can reduce the length and cost of post-discharge care and improve outcomes.

“Any patient (or family member of a patient) who has experienced post-ICU cognitive impairment or delirium knows how frightening that experience can be, and that we currently lack interventional tools to address it,” Mahncke said in the press release. “This exploratory study provides a clear roadmap for changing that.”