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Examining the Efficacy of the Modified Story Memory Technique (mSMT) in Persons With TBI Using Functional Magnetic Resonance Imaging (fMRI): The TBI-MEM Trial

Chiaravalloti, Nancy D. PhD; Dobryakova, Ekaterina PhD; Wylie, Glenn R. DPhil; DeLuca, John PhD, ABPP

Section Editor(s): Bushnik, Tamara PhD, FACRM

Journal of Head Trauma Rehabilitation: July/August 2015 - Volume 30 - Issue 4 - p 261–269
doi: 10.1097/HTR.0000000000000164
TBI Model Systems 2015

Background: New learning and memory deficits are common following traumatic brain injury (TBI). Yet few studies have examined the efficacy of memory retraining in TBI through the most methodologically vigorous randomized clinical trial. Our previous research has demonstrated that the modified Story Memory Technique (mSMT) significantly improves new learning and memory in multiple sclerosis.

Methodology: The present double-blind, placebo-controlled, randomized clinical trial examined changes in cerebral activation on functional magnetic resonance imaging following mSMT treatment in persons with TBI. Eighteen individuals with TBI were randomly assigned to treatment (n = 9) or placebo (n = 9) groups.

Results: Baseline and follow-up functional magnetic resonance imaging was collected during a list-learning task. Significant differences in cerebral activation from before to after treatment were noted in regions belonging to the default mode network and executive control network in the treatment group only. Results are interpreted in light of these networks.

Conclusions: Activation differences between the groups likely reflect increased use of strategies taught during treatment. This study demonstrates a significant change in cerebral activation resulting from the mSMT in a TBI sample. Findings are consistent with previous work in multiple sclerosis. Behavioral interventions can show significant changes in the brain, validating clinical utility.

Kessler Foundation, Neuropsychology and Neuroscience Laboratory, West Orange, New Jersey (Drs Chiaravalloti, Dobryakova, Wylie, and DeLuca); and Department of Physical Medicine and Rehabilitation (Drs Chiaravalloti, Dobryakova, Wylie, and DeLuca) and Department of Neurology (Dr DeLuca), Rutgers, New Jersey Medical School, Newark, New Jersey.

Corresponding Author: Nancy D. Chiaravalloti, PhD, Kessler Foundation, Neuropsychology & Neuroscience Lab, 300 Executive Dr, Ste 70, West Orange, NJ 07052 (

The authors thank grant support from the National Institute on Disability and Rehabilitation Research (NIDRR) to N.D. Chiaravalloti (H133A070037 and H133G090078) and Kessler Foundation. The contents of this article were developed under the NIDRR grant # H133A070037 and H133G090078 to N.D. Chiaravalloti. However, these contents do not necessarily represent the policy of the Department of Education, and endorsement by the Federal Government should not be assumed.

The authors declare no conflicts of interest.

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