Back to Top Skip to main content

New clinical recommendations on cognitive rehabilitation for TBI released

Dr. Gregory Johnson (right), Tripler Concussion Clinic medical director, has Army Spc. Andrew Karamatic, Department of Medicine combat medic, follow his finger with his eyes during a neurologic exam at Tripler Army Medical Center, Honolulu. (U.S. Air Force photo by Staff Sgt. Christopher Hubenthal) Dr. Gregory Johnson (right), Tripler Concussion Clinic medical director, has Army Spc. Andrew Karamatic, Department of Medicine combat medic, follow his finger with his eyes during a neurologic exam at Tripler Army Medical Center, Honolulu. (U.S. Air Force photo by Staff Sgt. Christopher Hubenthal)

Recommended Content:

Mental Health Care | Traumatic Brain Injury | Mental Wellness

The Defense and Veterans Brain Injury Center, the Defense Health Agency’s traumatic brain injury center of excellence, recently released the “Cognitive Rehabilitation for Service Members and Veterans Following Mild to Moderate Traumatic Brain Injury Clinical Recommendations.”

These recommendations build on the 2016 VA/DoD Clinical Practice Guidelines on Concussion/Mild Traumatic Brain Injury. While there has been new research on cognitive rehabilitation over the past few years, clinical practice varies widely in the MHS and throughout the VA.

To diminish this variation, DVBIC established subject matter expert work groups from the DoD, VA, civilian health care, and academia; nearly 40 experts were involved. Many of these individuals had previously been involved in developing clinical guidelines in professional settings such as the National Academies of Sciences, Engineering, and Medicine.

Drawing on both published literature and their own expertise, the working group developed a consensus opinion in August 2017 that helped shape how the specific recommendations were developed. The new DVBIC recommendations provide resources to enable consistent care delivery across the Military Health System, Veterans Health Administration, and civilian providers.

Cognitive rehabilitation focuses on improving thinking and communication skills such as attention, problem solving, planning, and memory. More generally, it provides strategies to target cognitive difficulties in daily life. For example, an individual having difficulty keeping track of appointments would work with the cognitive rehabilitation provider to develop and rehearse specific strategies, like the use of a smartphone calendar app and reminder, to track and successfully attend appointments. These types of strategies can help improve the daily functioning and independence of TBI patients. The new recommendations offer providers detailed guidance for treating service members and veterans with mild to moderate TBI and cognitive dysfunction as they move through each phase of recovery.

"These clinical recommendations are a unique contribution to the field of cognitive rehabilitation,” said Navy Capt. Scott Pyne, DVBIC division chief. “They provide an integrated source for clinicians: detailed, evidence-informed clinical guidance and links to an array of DoD/VA cognitive rehabilitation resources and tools that support state-of-the-science clinical care."

Approximately 82 percent of brain injury cases are considered mild TBIs, otherwise known as concussions. Among those who experience chronic effects from TBIs, cognitive impairment is the most persistent and disabling because it can directly affect return to duty or employment and can have a broad impact on daily living and quality of life. To address these challenges, the new recommendations outline unique considerations, including modifications, specific interventions, strategies, and best practices when providing treatment to this target population.

When developing the recommendations, the working group sought to address the needs of the end-user clinicians by incorporating their feedback and perspectives. As explained by working group member Dr. Wayne Gordon, Chief of Rehabilitation and Neuropsychology Service at Mount Sinai Hospital in New York City, cognitive rehabilitation should not be a “canned intervention” but rather “providers need to be flexible in their approach,” given the nuanced nature of how a TBI patient presents. The new recommendations allow providers to tailor their approach to the specific recovery needs of service members and veterans, which are often different from those of the general population.

The recommendations are available to download and print now via dvbic.dcoe.mil. To further support the clinical recommendations, an interactive web tool has been published on the DVBIC website. The tool outlines the clinical content and provides links to resources for cognitive rehabilitation providers, such as occupational therapists, speech-language pathologists, neuropsychologists, and other rehabilitation providers.

You also may be interested in...

NICoE & ISC Network maintain TBI care during COVID-19

Article
11/19/2020
Image of United States map with locations noted

The Network leveraged their geographic distribution to help each other quickly adapt to changing times.

Recommended Content:

Coronavirus | Traumatic Brain Injury

TBI Champions Roxana Delgado & Victor Medina

Video
11/17/2020
TBI Champions Roxana Delgado & Victor Medina

While he was deployed, retired Army Sgt. 1st Class Victor Medina was in a vehicle that was hit by an explosive device. He sustained a traumatic brain injury (TBI) that severely impaired some of his physical functions and ability to speak. Medina’s wife, Roxana Delgado, continued her pursuit of a Ph.D. in health sciences and became his caregiver. As they adjusted to a life neither one of them had imagined, their marriage became a new kind of partnership.

Recommended Content:

Traumatic Brain Injury

TBI Champion Gary Moran

Video
11/17/2020
TBI Champion Gary Moran

SGM Gary D. Moran shares his TBI recovery story, and tips for talking to kids about TBI.

Recommended Content:

Traumatic Brain Injury

TBI Champion Micah Norgard

Video
11/16/2020
TBI Champion Micah Norgard

After 12 years as an infantryman, Norgard's biggest battle was recognizing the cumulative effects of multiple TBIs.

Recommended Content:

Traumatic Brain Injury

TBI Champion Beth King

Video
11/16/2020
TBI Champion Beth King

Army veteran Beth King was on a routine mission when her helicopter was struck by an RPG, ultimately resulting in a traumatic brain injury (TBI). In this video, Beth shares the impact of her TBI and how she discovered her new passion along the way — recumbent biking.

Recommended Content:

Traumatic Brain Injury

Find Your Story: TBI Champions

Video
11/16/2020
Find Your Story: TBI Champions

In this video, A Head for the Future’s TBI Champions share their experiences with traumatic brain injury and resources that helped them through recovery. They can help you too.

Recommended Content:

Traumatic Brain Injury

Talking TBI: Talking to Kids

Video
11/16/2020
Talking TBI: Talking to Kids

While on patrol in Iraq, former U.S. Marine Corps Sgt. Maj. Gary Moran was knocked unconscious by an improvised explosive device, resulting in a traumatic brain injury (TBI). Gary and his son discuss how TBI affected their relationship early on and ultimately brought them closer together.

Recommended Content:

Traumatic Brain Injury

Talking TBI: Going Back to School

Video
11/16/2020
Talking TBI: Going Back to School

Marine Corps veteran Chris shares his experience going back to school following his TBI.

Recommended Content:

Traumatic Brain Injury

TBI Champion Dalton Mask

Video
11/16/2020
TBI Champion Dalton Mask

Facing a long road to recovery following his TBI, Dalton remained positive and participated in the 2019 Warrior Games.

Recommended Content:

Traumatic Brain Injury

TBI Champion Derek Poor

Video
11/16/2020
TBI Champion Derek Poor

While instructing hand-to-hand combat training, U.S. Army Special Forces veteran Derek Poor slammed his head against a wall and sustained a traumatic brain injury (TBI). Seeing stars and unable to shake his persistent, daily headaches, Poor sought help.

Recommended Content:

Traumatic Brain Injury

Talking TBI: Connect with Others

Video
11/16/2020
Talking TBI: Connect with Others

Navy veteran Amanda Burrill and Army veteran Elana Duffy had a few things in common: They both lived in New York City, experienced traumatic brain injuries (TBI) while in service and were coping with the injuries alone. Until they met each other.

Recommended Content:

Traumatic Brain Injury

WRNMMC displays the “Art of Healing” through December

Article
11/13/2020
Woman wearing mask, standing in front of several paintings

[T]he main focus of the exhibit was the art on display, and the artists behind it.

Recommended Content:

Health Readiness | Mental Health Care

How to develop a new relationship path after a TBI

Article
11/12/2020
A pair of hands clasped together

TBI can change the dynamics of a romantic relationship.

Recommended Content:

Traumatic Brain Injury

Progressive Return to Activity Clinical Support Tool Rehabilitation Providers

Publication
11/12/2020

This clinical support tool for rehabilitation providers details the algorithmic approach for enabling service members to return to pre-injury activity after sustaining a concussion/mild TBI. The tool is designed as a pocket-sized reference card, and supports the Progressive Return to Activity Following Acute Concussion/Mild TBI Clinical Recommendation for Rehabilitation Providers

Recommended Content:

Traumatic Brain Injury

Progressive Return to Activity Following Concussion/Mild TBI: Rehabilitation Provider

Publication
11/12/2020

This clinical recommendation for rehabilitation providers details the importance of aiding service members to progressively return to pre-injury activity and promotes the standardization of care following a concussion/mild TBI.

Recommended Content:

Traumatic Brain Injury
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 18

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.