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J Head Trauma Rehabil. 2017 May/Jun;32(3):E1-E15. doi: 10.1097/HTR.0000000000000254.

Cognitive Rehabilitation for Military Service Members With Mild Traumatic Brain Injury: A Randomized Clinical Trial.

Author information

1
Defense and Veteran's Brain Injury Center, Silver Spring, Maryland (Drs Cooper, Kennedy, Curtiss, French, and Vanderploeg); Departments of Neurology (Drs Cooper and Kennedy) and Rehabilitation Medicine (Dr Bowles), Brooke Army Medical Center, San Antonio, Texas; Department of Psychiatry, University of Texas Health Science Center at San Antonio (Dr Cooper); Department of Physical Medicine and Rehabilitation, Uniformed Services University of Health Sciences, Bethesda, Maryland (Dr Bowles); James A. Haley VA Medical Center, Tampa, Florida (Drs Curtiss and Vanderploeg); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida (Drs Curtiss and Vanderploeg); Walter Reed National Military Medical Center, Bethesda, Maryland (Dr French); and Missouri Institute of Mental Health, University of Missouri-St Louis, Berkeley, (Dr Tate).

Abstract

OBJECTIVE:

To compare cognitive rehabilitation (CR) interventions for mild traumatic brain injury (mTBI) with standard of care management, including psychoeducation and medical care for noncognitive symptoms.

SETTING:

Military medical center.

PARTICIPANTS:

A total of 126 service members who received mTBI from 3 to 24 months before baseline evaluation and reported ongoing cognitive difficulties.

INTERVENTIONS:

Randomized clinical trial with treatment outcomes assessed at baseline, 3-week, 6-week, 12-week, and 18-week follow-ups. Participants were randomly assigned to one of four 6-week treatment arms: (1) psychoeducation, (2) computer-based CR, (3) therapist-directed manualized CR, and (4) integrated therapist-directed CR combined with cognitive-behavioral psychotherapy (CBT). Treatment dosage was constant (10 h/wk) for intervention arms 2 to 4.

MEASURES:

Paced Auditory Serial Addition Test (PASAT); Symptom Checklist-90 Revised (SCL-90-R); Key Behaviors Change Inventory (KBCI).

RESULTS:

No differences were noted between treatment arms on demographics, injury-related characteristics, or psychiatric comorbidity apart from education, with participants assigned to the computer arm having less education. Using mixed-model analysis of variance, all 4 treatment groups showed a significant improvement over time on the 3 primary outcome measures. Treatment groups showed equivalent improvement on the PASAT. The therapist-directed CR and integrated CR treatment groups had better KBCI outcomes compared with the psychoeducation group. Improvements on primary outcome measures during treatment were maintained at follow-up with no differences among arms.

CONCLUSIONS:

Both therapist-directed CR and integrated CR with CBT reduced functional cognitive symptoms in service members after mTBI beyond psychoeducation and medical management alone.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01339806.

PMID:
27603763
DOI:
10.1097/HTR.0000000000000254
[Indexed for MEDLINE]

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