National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 2011. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/13220.
×

Cognitive Rehabilitation Therapy
for Traumatic Brain Injury

Evaluating the Evidence

Committee on Cognitive Rehabilitation Therapy for Traumatic Brain Injury

Rebecca Koehler, Erin E, Wilhelm, Ira Shoulson, Editors

Board on the Health of Select Populations

INSTITUTE OF MEDICINE

OF THE NATIONAL ACADEMES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2011. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/13220.
×

THE NATIONAL ACADEMIES PRESS     500 Fifth Street, N.W.     Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract No. HHSP23320042509XI between the National Academy of Sciences and the U.S. Department of Defense. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

International Standard Book Number 13: 978-0-309-21818-4
International Standard Book Number 10: 0-309-21818-7

Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu/.

Copyright 2011 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

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Cover credit: The middle image is a U.S. Air Force photo by Staff Sgt. Robert Barney/Released.

Suggested citation: IOM (Institute of Medicine). 2011. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2011. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/13220.
×

“Knowing is not enough; we must apply.
Willing is not enough; we must do.”

—Goethe

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INSTITUTE OF MEDICINE
      OF THE NATIONAL ACADEMES

Advising the Nation.Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2011. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/13220.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2011. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/13220.
×

COMMITTEE ON COGNITIVE REHABILITATION
THERAPY FOR TRAUMATIC BRAIN INJURY

IRA SHOULSON (Chair), Professor of Neurology, Pharmacology and Human Science, and Director, Program for Regulatory Science and Medicine, Georgetown University, Washington, DC

REBECCA A. BETENSKY, Professor of Biostatistics, Harvard School of Public Health, Harvard University, Boston, MA

PETER COMO, Lead Reviewer/Neuropsychologist, U.S. Food and Drug Administration, Silver Spring, MD

RAY DORSEY, Associate Professor of Neurology, The Johns Hopkins University, Baltimore, MD

CHARLES DREBING, Acting Mental Health Service Line Manager, Bedford VA Medical Center, Bedford, MA

ALAN I. FADEN, David S. Brown Professor, Departments of Anesthesiology, Anatomy and Neurobiology, Neurosurgery, and Neurology, Director, STAR Organized Research Center, University of Maryland School of Medicine

ROBERT T. FRASER, Professor of Rehabilitation Medicine, University of Washington/Harborview Medical Center, Seattle, WA

TAMAR HELLER, Professor and Department Head, Department of Disability and Human Development, University of Illinois at Chicago

RICHARD KEEFE, Professor of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC

MARY R. T. KENNEDY, Associate Professor, Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis

HARVEY LEVIN, Professor and Director of Research, Department of Physical Medicine & Rehabilitation, Baylor College of Medicine; Director of the Center of Excellence for Traumatic Brain Injury, Michael E. De Bakey Veterans Affairs Medical Center, Houston, TX

CYNTHIA D. MULROW, Professor of Medicine, University of Texas Health Science Center at San Antonio, TX

HILAIRE THOMPSON, Assistant Professor, School of Nursing, University of Washington, Seattle

JOHN WHYTE, Director, Moss Rehabilitation Research Institute, Elkins Park, PA

Consultants

JENNIFER J. VASTERLING, Chief of Psychology, VA Boston Healthcare System; Professor of Psychiatry, Boston University School of Medicine, MA

BARBARA G. VICKREY, Professor and Vice Chair, Department of Neurology, University of California, Los Angeles

Suggested Citation:"Front Matter." Institute of Medicine. 2011. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/13220.
×

IOM Study Staff

REBECCA N. KOEHLER, Study Director

ERIN E. WILHELM, Associate Program Officer

ALICIA JARAMILLO-UNDERWOOD, Program Assistant

JON Q. SANDERS, Program Associate

ANDREA COHEN, Financial Associate

FREDERICK (RICK) ERDTMANN, Director, Board on the Health of Select Populations

Suggested Citation:"Front Matter." Institute of Medicine. 2011. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/13220.
×

 

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Charles H. Bombardier, University of Washington School of Medicine

Diana D. Cardenas, University of Miami

Keith Cicerone, JFK-Johnson Rehabilitation Institute

Chris Giza, University of California, Los Angeles

Wayne Gordon, Mount Sinai School of Medicine

Tessa Hart, Moss Rehabilitation Research Institute

Bruce Miller, University of California, San Francisco

Mark Sherer, TIRR Memorial Hermann

McKay Moore Sohlberg, University of Oregon

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2011. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/13220.
×

or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Dan G. Blazer, Duke University Medical Center, and Nancy E. Adler, University of California, San Francisco. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2011. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/13220.
×

Preface

Traumatic brain injury (TBI) is a too common and disabling occurrence in civilian and military life, estimated to annually affect 10 million people worldwide. The Institute of Medicine (IOM) has a long-standing role of providing guidance to the Department of Defense (DoD) on the health and well-being of services members and their families. At the request of DoD, the current study represents a concentrated endeavor by the Committee on Cognitive Rehabilitation Therapy for Traumatic Brain Injury to comprehensively evaluate the value of cognitive rehabilitation therapy (CRT) as a therapeutic intervention for traumatic brain injury.

The United States military is currently engaged in ongoing operations in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom). Conflicts in these war zones have been characterized by more explosive weaponry and other aggressive tactics, placing members of the military at greater risk for TBI, the “signature wound” of these wars. Recovering and returning service members with TBI may face long-term challenges in rehabilitation and reintegration to everyday life. These challenges to injured individuals also affect their families and communities. Survivors of TBI require ongoing support systems to care for and cope with physical injuries, cognitive impairment and coexisting disabilities such as posttraumatic stress disorders. An effective and reliable health care infrastructure and evidence-based treatment and rehabilitation policies must be in place to achieve effective recovery and a return to optimal functioning and productivity. The public increasingly is confronted with and better recognizes the often enduring and serious consequences of TBI and the need for providing the most effective treatments for those who serve our country in harm’s way.

Suggested Citation:"Front Matter." Institute of Medicine. 2011. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/13220.
×

The committee sought to provide a scientific framework to evaluate current research and practices related to CRT. To evaluate the value of CRT for TBI, the committee iteratively developed criteria for inclusion of published scientific reports and reviewed and analyzed some 88 studies to inform our findings on specific domains such as attention, executive function, language and social communication, and memory, as well as multi-modal or comprehensive CRT programs.

We are honored to have been of service in providing DoD with a comprehensive evidence-based review of CRT for TBI. This was a timely review, both in terms of the relevance of the topic and relatively brief time allocated to complete the review and our report. I am deeply appreciative of the expert work of our dedicated committee members and their extraordinary commitment and contributions to the task at hand. Over a course of about 6 months, we convened six in-person committee meetings, two open meetings including scientific presentations, and an abundance of teleconferences and email exchanges. We trust that this report assists not only DoD in its efforts to care for recovering and returning service members, but also informs the broader research community about the value of cognitive rehabilitation therapy for TBI sustained in both military and civilian settings.

The committee extends its appreciation to the many people who presented information at its open meeting and to our dedicated IOM staff: Rebecca Koehler, Erin Wilhelm, Alicia Jaramillo-Underwood, and Jon Sanders. We also thank Mary Ferraro and Andy Packel at the Moss Rehabilitation Institute (Philadelphia), who expertly abstracted information from reviewed research reports. We also thank consultants to the committee, Jennifer Vasterling and Barbara Vickrey, for their contributions in the development of several chapters of the report. A special appreciation is due to the patients, their families, and clinicians who strive together to combat and recover from the disabling and often devastating consequences of TBI.

Ira Shoulson, Chair

Committee on Cognitive Rehabilitation Therapy for Traumatic Brain Injury

Suggested Citation:"Front Matter." Institute of Medicine. 2011. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/13220.
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Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2011. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/13220.
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Acronyms and Abbreviations

AAD

Assessment of awareness of disability

AANN

American Association of Neuroscience Nurses

ACBIS

Academy of Certified Brain Injury Specialists

ACFI

Assessment of Client Functioning Inventory

ACOTE

Accreditation Council for Occupational Therapy Education

ACRM

American Congress of Rehabilitation Medicine

ADHD

Attention deficit hyperactivity disorder

ADL

Activities of daily living

AIM

Assessment of Intentional Memory

AIP

Awareness Intervention Program

AMPS

Assessment of Motor and Process Skills

ApoE

Apolipoprotein E

APT

Attention Process Training

ARN

Association of Rehabilitation Nurses

ASHA

American Speech-Language-Hearing Association

BI-ISIG

Brain Injury Interdisciplinary Special Interest Group

BINT

Blast-induced neurotrauma

BRISS–R

Behaviorally Referenced Rating System of Intermediary Social Skills–Revised

bTBI

Blast-induced traumatic brain injury

BVRT

Benton Visual Retention Test

CAA

Council on Academic Accreditation

CACR

Computer-assisted cognitive rehabilitation

CAMG

Computer-Assisted Memory Training Group

Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2011. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/13220.
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CAPTE

Commission on Accreditation of Physical Therapy Education

CBIS

Certified Brain Injury Specialist

CBT

Cognitive behavioral therapy

CDC

Centers for Disease Control and Prevention

CDE

Common data element

CFT

Rey-Osterrieth Complex Figure Test

CG

Control group

CHART–R

Craig Handicap Assessment and Reporting Technique–Revised

CHART–SF

Craig Handicap Assessment and Reporting Technique– Short Form

CIQ

Community Integration Questionnaire

CNRN

Certified Neuroscience Registered Nurse

CO

Cognitive orthosis

COPM

Canadian Occupational Performance Measure

COWAT

Controlled Oral Word Association Test

CP

Clinical psychologist

CPT

Continuous Performance Test

CRBC

Cognitive Retraining Behavior Checklist

CRRN

Certified Rehabilitation Registered Nurse

CRT

Cognitive Rehabilitation Therapy

CS

Constraint seeking

CSG

Cognitive skills group

CT

Computed tomography

CVLT

California Verbal Learning Test

DARE

Database of Reviews of Effects

DASS

Depression, Anxiety and Stress Scale

DMDC

Defense Manpower Data Center

DO

Diary only

DoD

Department of Defense

DRS

Disability Rating Scale

DSIT

Diary and Self-Instructional Training

DTI

Diffusion Tensor Imaging

DVBIC

Defense and Veterans Brain Injury Center

ECRI

Emergency Care Research Institute

EEG

Electroencephalogram

EL

Errorless learning

EMF

Everyday memory failures

EMQ

Everyday Memory Questionnaire

ERIC

Education Resources Information Center

Suggested Citation:"Front Matter." Institute of Medicine. 2011. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/13220.
×
FAM

Functional assessment measure

FANCI

First Steps Acute Neurobehavioral and Cognitive Intervention

FCSUS

Frequency of Cognitive Strategy Usage Scale

FIM

Functional independence measure

FITBIR

Federal Interagency Traumatic Brain Injury Research

fMRI

Functional magnetic resonance imaging

FNM

Face-name method

FRsBe

Frontal Systems Behavior Scale

GAS

Goal Attainment Scaling

GCS

Glasgow Coma Scale

GMT

Goal Management Training

GOS

Glasgow Outcome Scale

GOS-E

Extended Glasgow Outcome Scale

GST

General Stimulation Training

HKLLT

Hong Kong List Learning Test

HRTB

Halstead-Reitan Neuropsychological Test Battery

HVLT–R

Hopkins Verbal Learning Test–Revised

IADL

Instrumental activities of daily living

ICF

International Classification of Functioning, Disability, and Health

ICIDH

International Classification of Impairments, Disabilities and Handicaps

IED

Improvised explosive device

IRB

Institutional review board

IOM

Institute of Medicine

ISMT

Interactive strategy modeling training

IT

Information Technology

IVA-CPT

Integrated Visual and Auditory Continuous Performance Test

KAS

Katz Adjustment Scale

KAS–R

Katz Adjustment Scale–Relative Report Form

KAS-R1

Katz Adjustment Scale, modified form R1

LAP

Learning activities packet

LCFS

Levels of Cognitive Functioning Scale

LCSW

Licensed Clinical Social Worker

LM

Logical memory

Suggested Citation:"Front Matter." Institute of Medicine. 2011. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/13220.
×
LOC

Loss of consciousness

LTM

Long-term memory

MAC–F

Memory Assessment Clinics ratings scales–Family

MAC–S

Memory Assessment Clinics ratings scales–Self

MANOVA

Multivariate analysis of variance

MCI

Mild cognitive impairment

MCQ

Memory Compensation Questionnaire

MEPSM

Means-Ends Problem-Solving Measure

MHS

Military Health System

MI

Metacomponential Interview

MOL

Method of loci

MPAI-3

Mayo-Portland Adaptability Inventory III

MRI

Magnetic resonance imaging

MTBI

Mild traumatic brain injury

MSW

Master of Social Work

NART

National Adult Reading Test

NCLEX-RN

National Council Licensure Examination for Registered Nurses

NCSE

Neurobehavioral Cognitive Status Examination

NFI

Neurobehavioral Functioning Inventory

NICHD

National Institute of Child Health and Human Development

NIDRR

National Institute on Disability and Rehabilitation Research

NIH

National Institutes of Health

NR

Neurorehabilitation program

OEF

Operation Enduring Freedom

OIF

Operation Iraqi Freedom

ORM

Orientation Remedial Module

OT

Occupational therapist

OTR

Occupational therapist registered

PASAT

Paced Auditory Serial Addition Test

PASAT–R

Paced Auditory Serial Addition Test–Revised

PCS

Post-concussion syndrome

PCSS

Personal Conversational Style Scale

PDA

Personal digital assistant

PDBS

Partner Directed Behavior Scale

PET

Positron emission tomography

PFIC

Profile of Functional Impairment in Communication

Suggested Citation:"Front Matter." Institute of Medicine. 2011. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/13220.
×
PQOL

Perceived Quality of Life

PQRST

Preview, Question, Repeat, State, and Test

PROM

Patient Reported Outcome Measures

PRPP

Perceive, Recall, Plan, and Perform

PSQ

Problem Solving Questionnaire

PTA

Posttraumatic amnesia

PTSD

Posttraumatic stress disorder

QCIQ

Quality of Community Integration Questionnaire

RAPS

Rapid Assessment of Problem Solving

RAVLT–M

Rey Auditory Verbal Learning Test–Modified

RBMT

Rivermead Behavioural Memory Test

RCT

Randomized controlled trial

RIS

Ridiculously imaged story

RITS

Rehabilitation Intensity of Therapy Scale

RLTLT

Ruff-Light Trail Learning Test

RN

Registered nurse

RPM

Raven’s Progressive Matrices

SADI

Self Awareness of Deficits Interview

SART

Sustained Attention to Response Test

SCL–90 R

Symptom Checklist–90 Revised

SCSQ–A

Social Communication Skills Questionnaire–Adapted

SES

Socioeconomic status

SIT

Self-instruction training

SLP

Speech-language pathologist

SPRS

Sydney Psychosocial Reintegration Scale

SPRS–Relative

Sydney Psychosocial Reintegration Scale–Relative Ratings

SPRS–Self

Sydney Psychosocial Reintegration Scale–Self Ratings

SPSS

Social Performance Survey Schedule

SPSVM

Social Problem-Solving Video Measure

SR

Spaced Retrieval

SRSI

Self-regulation skills interview

SS/MB

Single-subject, multiple baseline

SUD

Substance use disorders

SWLS

Satisfaction with Life Scale

TAI

Traumatic axonal injury

TAMG

Therapist Administered Memory Training Group

TAP

Test for Attentional Performance

TASIT

The Awareness of Social Interference Test

Page xxii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2011. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/13220.
×
TBI

Traumatic brain injury

TMS

Transcranial magnetic stimulation

TPM

Time Pressure Management

TOT

Temporal Orientation Test

UCSS

Usefulness of Cognitive Strategy Scale

USUHS

Uniformed Services University of the Health Sciences

VA

Department of Veterans Affairs

VAMC

Veterans Affairs’ Medical Center

VHA

Veterans Health Administration

VPA

Visual paired associates

WA

Working alliance

WAIS

Wechsler Adult Intelligence Scale

WAIS–R

Wechsler Adults Intelligence Scale–Revised

WCST

Wisconsin Card Sorting Test

WHO

World Health Organization

WHO-ICF

World Health Organization’s International Classification of Functioning, Disability, and Health

WMS–R

Wechsler Memory Scale–Revised

WMT

Working Memory Training

WRAMC

Walter Reed Army Medical Center

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Traumatic brain injury (TBI) may affect 10 million people worldwide. It is considered the "signature wound" of the conflicts in Iraq and Afghanistan. These injuries result from a bump or blow to the head, or from external forces that cause the brain to move within the head, such as whiplash or exposure to blasts. TBI can cause an array of physical and mental health concerns and is a growing problem, particularly among soldiers and veterans because of repeated exposure to violent environments. One form of treatment for TBI is cognitive rehabilitation therapy (CRT), a patient-specific, goal-oriented approach to help patients increase their ability to process and interpret information. The Department of Defense asked the IOM to conduct a study to determine the effectiveness of CRT for treatment of TBI.

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