Neuromodulation and Neurorehabilitation for mTBI

Eligibility Criteria

• * At least 18 years of age and no older than 80 years of age
• * 3 months post exposure to mTBI event
• * Have a history of mTBI with PTSD OR mTBI without PTSD as defined by formalized measures to classify mTBI based on the Symptom Attribution and Classification Algorithm (SACA) and the PTSD Module L of the SCID
• * Endorse at least moderate severity on at least one of the four cognitive complaints in the Neurobehavioral Symptom Inventory
• * Participating in another research study
• * Non-fluent in English (speaking and reading)
• * History of epilepsy pre-injury
• * Receiving antiepileptic treatment for documented active seizures in the past 6 months
• * Taking medications that lower seizure threshold including antipsychotics, trazodone and tramadol
• * History of surgery on blood vessels in brain and/or valves of the heart
• * History of brain hemorrhage, neurovascular conditions and neurodegenerative disorders
• * History or current diagnosis of psychotic spectrum disorders (i.e. bipolar, schizophrenia)
• * Significant heart disease as determined by physician review of medical chart
• * Pregnant at time of enrollment or any time during study participation
• * MRI or TMS/iTBS contraindications such as claustrophobia, metal in eyes/face or brain
• * Cardiac pacemakers/defibrillators, cochlear implants, nerve stimulators, intracranial metal clips
• * Diagnosis of moderate or severe TBI (loss of consciousness \> 30 minutes, alteration of consciousness \> 24 hours, post traumatic amnesia or neuropsychological testing results
• * Prescribed dosage of mental health medications have been altered within the month preceding study screening. Any participant whose mental health medication(s) has/have changed, within 30 days of study screening. The following are considered a medication change: the addition of or discontinuation of medication, a change in the dose or dosage (daily amount) of medication.
• * Taking prescribed CNS stimulants and choosing to not stop these medications during study participation
• * Taking prescribed CNS stimulants and choosing to not stop these medications during study participation
• * Testing positive for opiates and do not have a prescription for opiates. If on prescription opiates and taking more than the equivalent of 200 mg of morphine per day.
• * Questionably valid test performance as indicated by a score of ≤ 85% on the Immediate Recognition, Delayed Recognition or Consistency Scales of the Medical Symptom Validity Test (MSVT) and clinical determination of questionable performance validity by a neuropsychologist on the research team
• * Actively suicidal as evidenced by plan to harm or recent attempt communicated on the Structured Clinical Interview for DSM-V (SCID-5).
• * Increased Intracranial Pressure (ICP) as evidenced through a funduscopic evaluation or on the baseline MRI scan.
• * Moderate or severe cannabis use disorder defined by ≥ 4 symptoms on the SCID-5
• * Severe alcohol use disorder defined by ≥ 6 symptoms on the SCID-5
• * Baseline systolic BP greater or equal to 170