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...

DVBIC Publications 1992-2018

Publication
8/4/2020

DVBIC research publications from 1992-2018.

Recommended Content:

Research and Development (J-9) | Traumatic Brain Injury Center of Excellence | Provider Resources | Traumatic Brain Injury | TBI Resources | TBICoE Research

Help With Ongoing Symptoms After Concussion

Publication
8/3/2020

Although the majority of service members recover from concussion with little to no intervention, some experience symptoms beyond the first three months after their initial injury. This guide addresses why symptoms continue to persist in some patients and how they can cope or seek additional help

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Educators | DoD TBI Worldwide Numbers | Patient and Family Resources | Provider Resources | A Head for the Future | Traumatic Brain Injury | TBI Symptoms | TBI Resources

Taking Care of Yourself While Caring for Others

Publication
8/3/2020

This guide provides coping techniques and self-care advice to those caring for a service member or veteran with a TBI.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Patient and Family Resources | TBI Educators | Provider Resources | A Head for the Future | Traumatic Brain Injury | TBI Resources

Talking with Children about TBI

Publication
8/3/2020

This guide offers communication techniques to parents or guardians who are struggling to help their children understand the changes in a loved one who sustained a TBI. It features specific communication techniques based on the age and stage of development of the child.

Recommended Content:

Traumatic Brain Injury | TBI Resources | Children's Health | Traumatic Brain Injury Center of Excellence | TBI Educators | Patient and Family Resources | Provider Resources | A Head for the Future

A Parent's Guide to Returning Your Child to School After a Concussion

Publication
8/3/2020

Car crashes, playground falls and sports injuries cause thousands of concussions a year among children. This guide offers practical advice to parents on how to recognize the signs and symptoms of a concussion, information on treatment and recovery, and what a parent can do to support a child’s recovery and successful return to school.

Recommended Content:

TBI Resources | Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | TBI Educators | Patient and Family Resources | Provider Resources

Vision Problems After Concussion

Publication
8/3/2020

This guide helps concussed service members understand vision problems and provides insight into treatment options.

Recommended Content:

Traumatic Brain Injury | TBI Symptoms | TBI Resources | Vision Loss | Traumatic Brain Injury Center of Excellence | Patient and Family Resources | Provider Resources

Talking with Children about Moderate or Severe TBI

Publication
8/3/2020

This guide offers communication techniques to parents or guardians who are struggling to help their children understand the changes in a loved one who sustained a moderate or severe TBI.

Recommended Content:

Traumatic Brain Injury | TBI Resources | Traumatic Brain Injury Center of Excellence | Patient and Family Resources | TBI Educators | Provider Resources | A Head for the Future

Addressing Family Needs

Publication
8/3/2020

This booklet provides loved ones with the tools, techniques and guidance to understand the changes their service member or veteran may experience after a TBI.

Recommended Content:

Traumatic Brain Injury | TBI Resources | Traumatic Brain Injury Center of Excellence | TBI Educators | Patient and Family Resources | Provider Resources

2019 DVBIC Annual Report

Publication
8/3/2020

Recommended Content:

Traumatic Brain Injury | TBI Resources

Back to School Guide for Academic Success After TBI

Publication
8/3/2020

This booklet provides guidance to service members and veterans who have ongoing symptoms from a TBI and are going to college, university or vocational school. It gives answers to common questions about accommodation plans, financial aid and assistive technology.

Recommended Content:

Traumatic Brain Injury | TBI Resources | Traumatic Brain Injury Center of Excellence | TBI Educators | Patient and Family Resources | Provider Resources

Return to Activity Educational Guidance for Service Members with Symptoms Following a Concussion

Publication
8/3/2020

This guide is intended to help service members and veterans who have experienced a concussion recover as quickly and safely as possible. It outlines each stage of the recovery process, explains what affected individuals should expect throughout the recovery process, provides guidance on how to track progress and includes a table to track developments.

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence

Neuroimaging Following Mild TBI in the Non-Deployed Setting Clinical Recommendation

Publication
7/31/2020

The Neuroimaging Following Mild TBI in the Non-Deployed Setting clinical recommendation offers guidance for a standard approach for imaging from the acute through chronic stages following mild TBI in the non-deployed setting.

Recommended Content:

Traumatic Brain Injury | TBI Resources | TBI Screening

MACE 2 Provider Training

Publication
7/31/2020

Medical provider training material for the MACE 2.

Recommended Content:

Provider Resources | TBI Educators | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury

MACE 2 Provider Training: Instructor Guide

Publication
7/31/2020

The MACE 2 Instructor Guide provides the curriculum needed for medical providers to train peers on how to properly use the MACE 2.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Provider Resources | TBI Educators | Traumatic Brain Injury

MACE 2 Provider Training: Student Workbook

Publication
7/31/2020

The MACE 2 Student Workbook is for use with the MACE 2 training slides to learn how to properly use the MACE 2.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Educators | Provider Resources | Traumatic Brain Injury
<< < ... 6 7 8 9 10  ... > >> 
Showing results 76 - 90 Page 6 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.