Treatment of persistent post-concussive symptoms after mild traumatic brain injury: a systematic review of cognitive rehabilitation and behavioral health interventions in military service members and veterans.
Increased prevalence of traumatic brain injury (TBI) has been associated with service members and veterans who completed combat deployments in support of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Management of persistent post-concussive symptoms (PCS) has been a challenge to healthcare providers throughout the Military and Veterans Healthcare Systems, as well as civilian healthcare providers, due in part to the chronic nature of symptoms, co-occurrence of behavioral health disorders such as depression, Posttraumatic Stress Disorder (PTSD), and substance use disorders, and fear of a potential stigma associated with psychiatric diagnoses and behavioral health treatment(s). This systematic review examined non-pharmacologic behavioral health interventions and cognitive rehabilitation interventions for PCS in military service members and veterans with a history of mild TBI (mTBI). Six electronic databases were searched with specific term limitations, identifying 121 citations. Ultimately, 19 articles met criteria for inclusion in this systematic review. Studies were broadly categorized into four subtypes: psychoeducational interventions, cognitive rehabilitation, psychotherapeutic approaches, and integrated behavioral health interventions for PCS and PTSD. The review provides an update of the empirical evidence for these four types of interventions for PCS in active duty service members and veterans. Recommendations for future research are discussed, including the need to expand and improve the limited evidence basis on how to manage persistent post-concussive symptoms in this population.
Defense and Veteran's Brain Injury Center, San Antonio Military Medical Center MCHE MDU (DVBIC), 3551 Roger Brooke Drive, Fort Sam Houston, TX, 78234-6200, USA. douglas.b.cooper.ctr@mail.mil.|Department of Neurology, San Antonio Military Medical Center, Fort Sam Houston, TX, USA. douglas.b.cooper.ctr@mail.mil.
Douglas B
DB
Cooper
Defense and Veterans Brain Injury Center, Bethesda, MD, USA.
Anne E
AE
Bunner
Defense and Veteran's Brain Injury Center, San Antonio Military Medical Center MCHE MDU (DVBIC), 3551 Roger Brooke Drive, Fort Sam Houston, TX, 78234-6200, USA.|Department of Neurology, San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
Jan E
JE
Kennedy
Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Valerie
V
Balldin
Missouri Institute of Mental Health, University of Missouri at St. Louis, St. Louis, MO, USA.
David F
DF
Tate
Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX, USA.
Blessen C
BC
Eapen
Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX, USA.
Carlos A
CA
Jaramillo
D001521:Behavior Therapy / Q000379:methods*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D006801:Humans; D008889:Military Personnel; D038223:Post-Concussion Syndrome / Q000628:therapy*; D014728:Veterans
Blast Injuries; Cognitive rehabilitation; Mild traumatic brain injury; OEF/OIF; Post-concussive syndrome; Post-deployment; Posttraumatic stress disorder; Psychoeducation; Psychotherapy