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...

Chronic Traumatic Encephalopathy (CTE) Frequently Asked Questions

Fact Sheet
7/30/2020

This fact sheet provides answers and information to commonly asked questions about chronic traumatic encephalopathy, or CTE.

Recommended Content:

Traumatic Brain Injury | TBI Resources

Concussion/Mild TBI Signs and Symptoms Fact Sheet

Fact Sheet
7/30/2020

This fact sheet identifies major physical, cognitive and emotional symptoms of concussion and provides coping and recovery tips.

Recommended Content:

Traumatic Brain Injury | TBI Prevention | TBI Screening | TBI Symptoms | TBI Resources

Cognitive Rehabilitation Following Mild to Moderate TBI - Referring Provider Resource

Publication
7/30/2020

This document answers common questions that referring providers may have, such as how to determine if a patient is having cognitive difficulties or whether the patient is a good candidate for cognitive rehabilitation.

Recommended Content:

Cognitive Rehabilitation Therapy | Traumatic Brain Injury | TBI Resources

Head Injury and Dizziness Fact Sheet

Fact Sheet
7/30/2020

This fact sheet can be used by health care providers to educate patients with concussion/mild TBI on how to manage dizziness related to their injury.

Recommended Content:

Traumatic Brain Injury | TBI Symptoms | TBI Resources

Cognitive Rehabilitation Following Mild to Moderate TBI Clinical Recommendation - Short

Publication
7/30/2020

This short version of the Cognitive Rehabilitation Following Mild to Moderate TBI Clinical Recommendation provides an at-a-glance overview of the full-length version for quick access and use on the job.

Recommended Content:

Cognitive Rehabilitation Therapy | Traumatic Brain Injury | TBI Resources

Recurrent Concussion Evaluation

Publication
7/30/2020

The Recurrent Concussion Evaluation card is designed to guide providers in the management of patients with a history of three or more documented concussions within a 12-month span.

Recommended Content:

Traumatic Brain Injury | TBI Screening | TBI Resources

Concussion/Mild TBI Signs and Symptoms Spanish Version Fact Sheet

Fact Sheet
7/30/2020

This fact sheet — in Spanish — identifies major physical, cognitive and emotional symptoms of concussion/mild TBI, and provides coping and recovery tips.

Recommended Content:

Traumatic Brain Injury | TBI Symptoms | TBI Resources | TBI Screening

Cognitive Rehabilitation for Following Mild to Moderate TBI Clinical Recommendation - Full

Publication
7/30/2020

This clinical recommendation is broken down into three primary categories: Modifications for Service Members and Veterans; Interventions and Strategies to Address Cognitive Dysfunction; and, Delivery of Rehabilitation for Patients with Cognitive Challenges. Each category contains clinical recommendations, the background and rationale behind them, evidence review references, and clinical resources.

Recommended Content:

Cognitive Rehabilitation Therapy | Traumatic Brain Injury | TBI Resources

Assessment and Management of Dizziness Associated with Mild TBI Clinical Recommendation

Publication
7/30/2020

The Assessment and Management of Dizziness Associated with Mild TBI Clinical Recommendation and Clinical Support Tool provide primary care providers with an approach to evaluate dizziness following mild TBI and offers guidance on referral for further vestibular evaluation and care.

Recommended Content:

Traumatic Brain Injury | TBI Resources

Concussion Management Tool

Publication
7/30/2020

The CMT revises and replaces the 2012 Concussion Management Algorithm and the 2014 Army Concussion Management in the Garrison Setting Algorithm. The CMT replaces the prior CMA to better align with the current MACE 2, Progressive Return to Activity, and DVBIC clinical recommendations.

Recommended Content:

Traumatic Brain Injury | TBI Screening | TBI Resources

Concussion/mTBI and PTSD Fact Sheet

Fact Sheet
7/30/2020

This fact sheet defines concussion/mild traumatic brain injury and posttraumatic stress disorder and explains how overlapping symptoms often occur. It also describes why it’s important to seek out treatment for both conditions and provides helpful advice on what to tell your family and friends to help in the recovery process.

Recommended Content:

Posttraumatic Stress Disorder | Mental Health Care | Traumatic Brain Injury | TBI Symptoms

Military Acute Concussion Evaluation 2 (MACE 2)

Publication
7/30/2020

The 2018 Military Acute Concussion Evaluation 2 (MACE 2) is an acute assessment tool for all medically trained personnel who treat service members involved in a potentially concussive event. The MACE 2 incorporates current state-of-the-science traumatic brain injury information, including vestibular-ocular-motor screening. The MACE 2 is an update to and replaces the original MACE.

Recommended Content:

Traumatic Brain Injury

About TBICoE Fact Sheet

Fact Sheet
7/30/2020

This fact sheet provides an overview of TBICoEs education tools, clinical resources, research and it's network.

Recommended Content:

TBI Resources | Traumatic Brain Injury

Changes in Behavior, Personality or Mood Following Concussion/mTBI Fact Sheet

Fact Sheet
7/30/2020

This fact sheet can be used by health care providers to educate patients with concussion/mild TBI on how to manage changes in mood related to their injury.

Recommended Content:

Traumatic Brain Injury | Mental Health Care

DVBIC eye-tracking tech may help service members with concussions

Article
7/28/2020
Soldier sitting in front of a laptop with headphones on

The Fusion technology is more objective, by assessing eye reaction time.

Recommended Content:

Traumatic Brain Injury
<< < ... 6 7 8 9 10  ... > >> 
Showing results 76 - 90 Page 6 of 16

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.