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



Military medical center.



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



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.



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



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.



Both therapist-directed CR and integrated CR with CBT reduced functional cognitive symptoms in service members after mTBI beyond psychoeducation and medical management alone.
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).
Douglas B
DB
Cooper
Amy O
AO
Bowles
Jan E
JE
Kennedy
Glenn
G
Curtiss
Louis M
LM
French
David F
DF
Tate
Rodney D
RD
Vanderploeg
D000328:Adult; D000704:Analysis of Variance; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis* / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D000066530:Neurological Rehabilitation / Q000379:methods*; D020127:Recovery of Function; D016896:Treatment Outcome; D055815:Young Adult