Cognitive Rehabilitation Therapy for Traumatic Brain Injury Evaluating the Evidence (2011) / Chapter Skim
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1 Introduction
1 Introduction
Pages 21-36
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One form of treatment for TBI-related deficits is cognitive rehabilitation therapy (CRT) , a systematic approach to functional recovery of cognitive or behavioral deficits and participation in related activities; however, the ef fectiveness of this treatment remains uncertain.
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The Committee on Cognitive Rehabilitation Therapy for Traumatic Brain Injury (hereafter referred to as "the committee") comprised members with expertise in epidemiology and study design, disability and long-term care, neurology, neuropharmacology, neuropsychology, nursing, psychiatry, psychology, rehabilitation medicine, and speechlanguage pathology.
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whether require ments for training, education and experience for providers outside the MHS direct-care system to deliver the identified evidence-based interventions are sufficient to ensure reasonable, consistent quality of care across the United States; and 5. An independent assessment of the treatment of traumatic brain injury by cognitive rehabilitation therapy within the MHS if time or resources permit.
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While in-theater, service members are increasingly attacked with more explosive weaponry. In 1991, during Operation Desert Storm, commonly referred to as the "first Gulf War," approximately 20 BOX 1-2 Department of Defense Definition of Traumatic Brain Injury A traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force that is indicated by new onset or worsening of at least one of the following clinical signs immediately following the event: • Any period of loss of or a decreased level of consciousness • ny loss of memory for events immediately before or after the injury (i.e., A posttraumatic amnesia [PTA]
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Mild TBI, also called concussion, often goes underreported since recovery of consciousness is rapid and medical attention may not be sought. In addition, due to stigma associated with seeking medical treatment and appearing physically or psychologically vulnerable, or the desire to stay with their unit instead of leaving for treat FIGURE 1-1 Number of U.S.
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These effects may include disruptions to everyday life and work, changes in family and social functioning, and potentially burdensome financial costs. Recovering from TBI may be a slow, long, and painful process for individuals and their families, requiring unique medical, vocational, and rehabilitative therapy (Sayer et al.
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. Cognitive impairments resulting from TBI can affect multiple domains, including attention, language and communication, memory, visuospatial perception, and executive function.
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Nonpharmacologic treatments include, but are not limited to, physical therapy, occupational therapy, speech-language therapy, and psychotherapy. Often, pharmacologic therapies supplement the overall rehabilitation program and aim to reduce specific impairments or effects of the injury.
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, examined the role of rehabilitation on recovery and outcome following mild or moderate to severe TBI. Cognitive Rehabilitation Therapy The goal of CRT is to increase individuals' ability to process and interpret information, thereby enhancing their capacity to function in everyday life.
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The VA health care system, the Veterans Health Administration (VHA) , is separate from the MHS; however, these two organizations share many common goals and characteristics.1 TRICARE is the MHS health care program for active duty personnel, military retirees, and family members of the seven uniformed services: the Army, the Air Force, the Navy, the Marine Corps, the Coast Guard, the Commissioned Corps of the Public 1 Individuals who formerly served in the military are "veterans." Individuals who serve in the military for 20 years or more are "military retirees"; in some cases, those who are medically discharged from service prior to 20 years may qualify as military retirees.
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The rehabilitation therapy must be rendered by an authorized provider, necessary to the establishment of a safe and effective maintenance program in connection with a specific medical condition, provided at a skilled level and must not be custodial care or otherwise excluded from coverage (e.g., exercise or able to be provided at a non-skilled level)
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Under the supplemental health care program, active duty service members may receive care that is excluded under TRICARE's basic program if necessary to ensure adequate availability of health care services. DoD may also authorize reimbursements for CRT for service members or veterans under this supplemental program.
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. DVBIC (Defense and Veterans Brain Injury Center)
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2008. Intervention for executive functions after traumatic brain injury: A systematic review, meta-analysis and clinical recommendations.
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2009. VA/DoD Clinical Practice Guideline: Management of Concussion/Mild Traumatic Brain Injury.
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