Cognitive performance is a measure of how well our brain functions. After a traumatic brain injury, it's common for patients to report cognitive performance difficulties. These deficits can present as problems in everyday brain functions such as:
- Attention.
- Concentration.
- Speech.
- Language.
- Memory.
- Reasoning.
- Planning.
- Problem-solving.
Although it's stressful to endure cognitive performance issues in important tasks and roles, neuropsychological assessments and may not demonstrate significant impairments in any specific neuropsychological domain. Cognitive performance dysfunction may be relatively subtle and only occur in demanding situations. TBICoE provides resources for medical providers to support military and civilian health care providers in assessing and treating service members and veterans who have sustained a TBI.
Possible Indicators of Cognitive Dysfunction After a TBI
| Cognitive Functions |
Common Difficulties |
|
Attention and Information Processing
|
- Following conversations and maintaining one’s train of thought
- Recalling information that is read and the contents of conversations
|
|
Memory
|
- Remembering to take medications and show up for appointments
- Remembering instructions, especially multi-component
|
| Language |
- Easily accessing words when verbally expressing oneself
- Comprehending complex written and spoken information
|
|
Executive
|
- Managing time
- Organizing oneself to initiate and engage in productive use of time
|
Cognitive Rehabilitation
Restoring cognitive performance after a TBI requires cognitive rehabilitation. Some treatments provided by certain programs have not been fully proven as effective stand-alone therapy for TBI, so cognitive rehabilitation is administered in a comprehensive package of physical therapy, occupational therapy, and speech-language pathology. TRICARE covers medical treatments that are proven safe and effective.
| Type of Therapy |
Area of Cognitive Impairment |
Specific Examples |
|
Attention Process Training
|
|
Letter cancellation tasks with distracting noise in background
|
|
Error Management Training
|
- Attention
- Memory
- Executive functioning
- Social pragmatics
|
Individual and group self-awareness training
|
|
Emotional Regulation Training
|
- Attention
- Memory
- Executive functioning
- Social pragmatics
|
Anger Management Training
|
|
External Cuing
|
- Attention
- Memory
- Executive functioning
|
- Supervised living
- Smart Phone
- PDA
|
|
Integrated Use
|
- Attention
- Memory
- Executive functioning
- Social pragmatics
|
|
|
Memory Notebook
|
- Attention
- Memory
- Executive functioning
|
|
|
Problem-Solving Training
|
- Attention
- Memory
- Executive functioning
- Social pragmatics
|
- Internal problem-solving
- Internal dialogue
|
|
Social Communications Skills Training Groups
|
- Executive functioning
- Social pragmatics
|
Group cognitive therapy
|
|
Various Mneumonic Techniques
|
Memory
|
- Story method
- Acronyms
- Sentence/acrostics
- Method of loci
- Chunking
- Repetition
|
|
Visual Imagery Mneumonics
|
Memory
|
Imagery-based training
|
|
Working Memory Training
|
Attention
|
Completing two cognitive tasks simultaneously
|
Frequently Asked Questions
Cognitive Rehabilitation
The complexity of the brain and brain injuries has led to questions about the nature of cognitive rehabilitation and its availability to service members who have sustained TBIs.
View questions and answers about cognitive rehabilitation.
Q1:
Does DOD/TRICARE cover cognitive rehabilitation?
A:
On April 14, 2010, the Assistant Secretary of Defense (Health Affairs) directed the implementation of a broad-based DOD pilot program intended to conform to the proceedings, and resulting guidance document, of the Consensus Conference on Cognitive Rehabilitation for Mild Traumatic Brain Injury held in April 2009. This guidance document outlined a standardized and measurable process for the provision of cognitive rehabilitation services. This policy mandated the implementation of the guidance at 13 military treatment hospitals and clinics.
In 2010, DOD provided over 45,000 hours of care involving cognitive rehabilitation to service members and over 32,000 hours to family members of active duty members and retirees. These treatments were delivered by a wide array of health professionals, including psychologists; occupational, speech and physical therapists; and physicians.
Q2:
Who may benefit most from cognitive rehabilitation?
A:
Patients who have experienced moderate to severe TBI and who suffer from recurring symptoms such as attention and memory deficits, problems with executive functioning and social pragmatics deficits are most likely to benefit from cognitive rehabilitation. In cases of mild TBI, nearly 90 percent recover with no residual problems and only those with persistent symptoms need to be evaluated and treated.
Q3:
What is CBT?
A:
Cognitive behavioral therapy is a common type of mental health counseling consisting of a range of therapies designed to treat conditions like anxiety or depression. CBT is meant to help patients become aware of inaccurate or negative thinking and to view challenging situations more clearly and respond to them in a more effective way. CBT can be an effective tool to help anyone learn how to better manage stressful situation.
Q4:
What is the difference between cognitive rehabilitation and CBT?
A:
Cognitive rehabilitation is a collection of treatment strategies designed to address problems with memory, attention, perception, learning, planning and judgment brought about by brain injury, neurological disorders and other illnesses. Cognitive Behavioral Therapy is a common type of mental health counseling to help a patient become aware of inaccurate or negative thinking.
Q7:
Are there "specialists" in cognitive rehabilitation, or do most doctors understand their uses?
A:
Neuropsychologists specialize in neuropsychological cognitive testing that is used to determine if a patient will benefit from cognitive rehabilitation. They are also the primary providers who develop the individualized cognitive rehabilitation plan for patients. However, cognitive rehabilitation may be performed by an occupational therapist, physical therapist, speech/language pathologist, neuropsychologist, or a physician.
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FAQ
Feb 27, 2024
The complexity of the brain and brain injuries has led to questions about the nature of cognitive rehabilitation and its availability to service members who have sustained TBIs.