A holistic brain injury rehabilitation digital system of cognitive networks – SYNCHRO-TC

Our work program focuses on the two main aspects of our project, the development of a public health tool and the basic and applied research that will result from this development. This program consists of four main steps: 1) providing the platform functional specifications, 2) developing static and interactive models, 3) developing SYNCHRO-TC in three stages: prototype, BETA version and GOLD version, and 4) evaluating SYNCHRO-TC at the level of healthcare professionals as well as the TBI patients.
The assessment of the usability of the platform by health professionals will be carried out at the level of the computer programming of the rehabilitation path as well as at the level of the follow-up of the patient during the rehabilitation. The evaluation of the usability of the platform by the patients will make it possible to evaluate the effects of the training on the mental functioning and the brain activity. As such, an fMRI study will collect indicators of cognitive effectiveness that will be evidences of brain function restoration following reorganization and / or compensation phenomena.

To date, we have delineated the functional specifications of the cognitive skills modules, scenarios, and contexts of the rehabilitation platform related to patient activities. We have also defined the relationship between rehabilitation paths, modules, scenarios and context. Concerning the specifications related to the activities of healthcare professionals, we have set user profiles, levels of administration and communication tools. Subsequently, in view of the functional and technical specifications we have implemented a 3D application dedicated to the patients and the web site of management dedicated to the professionals of health. We realized the models, the graphic chart and declined the screens of the interface. In order to represent structured data that will be used by our system, conceptual data models have been made with the JMerise software for each proposed user profile.We are currently developing the beta version of SYNCHRO-TC.

At the scientific level, the highlighting of a better mental functioning of patients TC as well as better capabilities to accomplish an activity which is become difficult will allow the emergence of both fundamental and applied works which will participate in improving the care of these patients. This project will also gain a better understanding of the cognitive and brain mechanisms that are stimulated during a cognitive rehabilitation and that are involved in cerebral compensation. Our fMRI study, which will measure changes in brain connectivity as a result of a cognitive training will allow us to place our analysis of the phenomena of compensation in the context of the dynamics of the brain networks. Understanding these phenomena in the context of the complexity of the brain function is a real challenge. This work will be pioneer and we hope that they will initiate many other studies in the field.
From an economic point of view, improving management of TBI patients should reduce its cost. Indeed, it is hoped that greater efficiency of the management decreases its lifetime. This optimization of the TBI patient monitoring device should reduce the time health professionals spend in support. In addition, SYNCRO-TC will promote exchanges between patients and health professionals. This will improve the communication among TBI patients and will have a positive impact on its psychoaffective sphere. The impact on the latter, added to a better mental functioning, will facilitate their social reintegration.

Ferrer, M-H., Deshayes, C., Chambon, C., Paban,V., Canini,F., Alescio-Lautier, B.(Mai 2016) Cognitive rehabilitation for TBI patients: research of vulnerability indicators and optimization factors of brain repair mechanisms. 4th ICMM Pan European Congress of Military Medicine. Paris

The SYNCHRO-TC (a holistic brain injury rehabilitation digital system of cognitive net works project) arose in the context of Brain Taumatic Injury (TBI). Indeed, TBI represents in their numbers and their potential consequences a major public health problem called "silent epidemic." Mild TBI are the most frequent (80%) followed by moderate TBI (10-15%) and severe TBI (5-10%). TBI have to deal with a wide range of deficits. When failing, they develop depressive syndromes that in turn increase the initial troubles such as fatigability and cognitive deficits, thus delaying the socio-professional recovery. This constellation of difficulties often complex does not help care of these patients. In this framework, SYNCHRO-CT aims at facilitating and improving medical treatment of TBI by a personal cognitive training that will take into account symptom heterogeneity. This project addresses the TBI in phase of reeducation/rehabilitation whatever the severity of the trauma assessed. SYNCHRO-CT is a numerical training system networked around a rehabilitation management and diffusion software platform. Its intended deployment within hospitals and social and medico-social practises will make SYNCHRO-CT a true e-reeducation and communication interface between TBI patients and health care professionals. The training program comprises 4 modules: an attention training module, a memory training module, an executive function training module and finally a module to stimulate creation and adaptation in executive contexts such as problem solving. Cognitive mechanisms that participate to creative processes will be build into each of these modules to act as unifying factors in the training. In this framework, we will promote a specific rehabilitation of the patient in his history for a creative integration. It will then be up to the patient to reinvent his daily life. During the therapy, there will be systematic evaluation of the patient's fatigability and psychological state (mood, relationships...). These evaluation data, combined with training data will constitute a compensation assessment that could become a predictive index for social and professional rehabilitation. The keys for a successful therapy cannot lay only in the content of the therapy, but also in the whole environment that will support it. We searched for an optimal media for managing patients and their personal training program, while providing them with a space inductive to exchanges and to information and advice diffusion. We have chosen to rely on information and communication technologies used in the field of electronically based learning, also called e-learning. The therapy will take place online, with a thought-out structure, based on script. According to the patient's personal training program, the sequences of modules and training sessions will have a sequential, parallel or mixed organisation. Thus the training will be a personalised path within modules, with specifically parameterised exercises.