# Foundational Elements of an Alternate Scientific Approach to Developing Veteran-centric Precision Cognitive Restoration Interventions

> **NIH VA I21** · EDWARD HINES JR VA HOSPITAL · 2022 · —

## Abstract

The purpose of this SPiRE is to identify the supports and barriers to scalability of Veteran-tailored iTBS and
APT across neurologic conditions, with the longer-term goal of providing an empirical basis for the tailoring of a
broader range of cognitive rehabilitation strategies to optimize each Veteran’s cognitve function in daily life. After
Veterans receive standard cognitve rehabilitation, cognitive impairments often persist and if they do make gains
there is limited carry-over to daily function. The tenets of precision neurorehabilitation suggest that tailored
interventions will optimize gains and carry-over, but precision-tailoring of cognitive rehabilitation will only be
possible if researchers develop and test scalable approaches for identifying, organizing, and analyzing the
multitude of Veteran-specific variables driving and influencing treatment responsiveness. Aligned with this need,
this project addresses long-standing scientific barriers to understanding treatment responsiveness, particularly
study sample heterogeneity and individual variability. We address study sample heterogeneity by linking
Veterans, across TBI and ischemic stroke, according to levels of cognitve impairment. We create a cohort of
Veterans with a homogeneous level of cognitve impairment, thereby enabling explication of person-centric
factors influencing treatment responsiveness and carry-over to daily function. To further scale-up the science of
precision neurorehabilitation, we advance understanding of how to design within-subject cross-
over studies. Advancing understanding of the basic study design elements will be achieved by leveraging our
knowledge of intermittent Theta Burst Stimulation (iTBS) and iTBS paired with Attention Processing Training
exercises (iTBS + APT). iTBS is advantageous as it robustly improves working memory with just one treatment
session. These interventions, together, are advantageous as they can each be tailored to a Veteran’s unique
cognitve challenges and to target the neural site, unique to each Veteran’s neuropathology. These two
interventions also directly address cognitive deficits, while simultaneously inducing neuroplasticity in neural
regions hampered or impaired by neural injury. For this SPiRE project, we will study Veterans with moderately
impaired cognition who, after standard cognitve rehabilitation, continue to struggle with daily life requiring
assistance with complex instrumental activities of daily living (IADL). Veterans will participate in a series of two
within-subject treatment studies, conducted on two separate days, 2-weeks apart. Veterans will be randomly
assigned to first receive a single session of Active iTBS or Placebo iTBS and then they will receive APT paired
with their assigned iTBS (Active iTBS + APT vs Placebo iTBS + APT). We will test if diagnosis moderates the
effects of these interventions on both immediate and persisting change in cognition. For immediate effects,
we use a novel testing battery and...

## Key facts

- **NIH application ID:** 10368616
- **Project number:** 1I21RX003751-01A1
- **Recipient organization:** EDWARD HINES JR VA HOSPITAL
- **Principal Investigator:** Theresa L Bender Pape
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2022-01-01 → 2023-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10368616

## Citation

> US National Institutes of Health, RePORTER application 10368616, Foundational Elements of an Alternate Scientific Approach to Developing Veteran-centric Precision Cognitive Restoration Interventions (1I21RX003751-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10368616. Licensed CC0.

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