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Abstract
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Traumatic brain injury (TBI) often causes persistent deficits in cognitive flexibility and information updating.
Cognitive flexibility refers to the brain's ability to adjust its thinking and behavior in response to changing
circumstances, whereas information updating is the process of incorporating new facts into current knowledge.
Both cognitive flexibility and information updating are critical components of executive function, and their
impairment can have a major influence on a person's capacity to operate independently and adjust to life's
problems following a TBI. Understanding and addressing these specific cognitive processes is therefore critical in
designing successful therapies for TBI patients. Previous studies have examined the effects of non-invasive brain
stimulation and cognitive training separately. This study investigated the effects of combining transcranial direct
current stimulation (tDCS) with computer-based cognitive training, comparing this combined intervention
against a control group with no treatment, to assess improvements in two executive functions in TBI patients:
cognitive flexibility and information updating. Thirty TBI patients, 2–12 weeks post-injury with impaired executive
dysfunction, were randomized to an experimental or control group. The experimental group received ten
30-minute sessions over 2 weeks of anodal (A-tDCS), 2.0 mA to the prefrontal cortex while performing cognitive
training tasks from the RehaCom software. The control group received no intervention during this period.
Cognitive flexibility and information updating were assessed before and after the intervention period using the nback
working memory task, Wisconsin Sorting Card Test, and quantitative electroencephalography (qEEG)
during eyes-closed state. Statistically significant differences in theta, alpha, beta, and gamma band power were
observed between groups (p < .05, 4 < f < 6). Secondary outcomes indicated significant improvements in
cognitive flexibility wit
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