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Standardization of quantitative-fMRI for neurocognitive assessment and rehabilitation of mTBI

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Addressing Limitations
Standardized, Valid, Reliable and Objective Protocols

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– Appropriate for the Scanning Environment

– Applicable at the Single-Subject Level

– Refined Pre-Testing for BOLD Signal Optimization

– High Test Reliability (0.75-0.95)

– Compliance Monitoring

Standardized Protocols
Functional NeuroCognitive Imaging

Concurrently validated testing battery of six conventional neuropsychological test adaptations appropriate for the fMRI-scanning environment.

 

Normative Atlas
Uniform protocol administered to 58 healthy reference subjects.

Functional anatomical regions (e.g. Right Middle Gyrus) were identified in which independent activation peaks consistently occurred for each subject.

 

Normative Atlas for concussion neromarkers

 

Activation values were extracted from each functional region, resulting in 3D standard distribution of activation across healthy references.

 

Hypo- and Hyper-Activation

 

Activation values for patients are statistically contextualized with respect to reference norms and expressed as z-scores.

Patient Data Extrapolation
Neuromarkers Confirm Prolonged Effects of mTBI

Neuromarkers example of neurocognitive assesment

 

Concussion Neuromarkers were identified from a sample of 69 mTBI patients, reassessed in a sample of 70 concussed patients, and reconfirmed in another population of 111 patients.

Diagnostic Neuromarkers
Understanding Measurement Reliability

neuromarkers reliability rate in neurocognitive assesment

Conclusions
EPIC Treatment Shows Clinical Relevance

We demonstrate a standardized quantitative-fMRI approach with validity at the individual patient level and proven reliability in mTBI assessment and rehabilitation. Protocol standardization, normative-based assessment, compliance monitoring, and objective interpretation meet clinical requirements for wider acceptance of clinical fMRI in neurocognitive assessment and treatment.

Authors

Benjamin H. Wing1,2, Keifer L. Weiland1, Lindsey R. Holbrook1, Daniel C. Sands1, Alina K. Fong1,3, Mark D. Allen1,2

1Cognitive FX Provo, UT; 2Notus Neuropsychological Imaging, Orem, UT; 3Utah Valley Regional Medical Center

References

Allen & Fong (2008). Clinical Application of Standardized Cognitive Assesment using fMRI. I. Matrix Reasoning. Behavioral Neurology, 20, 127-140.

Allen et. al. (2012). Assessment of Brian Activity During Memory Encoding in a Narcolepsy Patient on and off Modafinil Using Normative fMRI Data. Neurocase, 18, 13-215.

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