The other day, I met a young medical technician who told me, “I am what you call a wounded warrior.”
He had spent 18 months in two rehabilitation hospitals for traumatic brain injury, the veteran said, and explained to me how his therapists had worked with him to improve his memory and his physical functioning.
“It was a struggle, but it worked,” he said.
While some patients recovering from mild to moderate traumatic brain injury make progress through cognitive rehabilitation treatment, the National Academies of Science, Engineering and Medicine has found little proof the therapy is effective.
In 2011, the Department of Defense commissioned the National Academies’ Health and Medicine Division to research and report on the intervention. Researchers determined the problem with the treatment program is that there are too many variations — with no standardized method of administering the program — and no empirical evidence that it worked.
Clinical trials have failed to identify specific treatments that make a dependable and measurable difference in people with brain injury.
The “interventions are nearly as unique and varied as the individuals they are used to treat,” according to the report.
In 2017, two researchers again independently reviewed clinical trials and performed a meta‐analysis of studies in cognitive rehabilitation treatment rehabilitation.
They also found a lack of evidence to support the effectiveness of cognitive rehabilitation when the results are compared with patients who have had no intervention or conventional rehabilitation.
Still, the Defense Department has supported continuing the use of the cognitive treatment.
Traumatic brain injury is one of the invisible wounds of war and one of the signature injuries of troops wounded in Afghanistan and Iraq, according to the Department of Defense.
A special report by the department said worldwide military traumatic brain injury has affected nearly 384,000 service members from 2000 to 2018.
In April 2019, the Defense and Veterans Brain Injury Center released the online report, which included clinical recommendations to help providers treating service members and veterans after traumatic brain injury. The Department of Defense hopes its online information and tools available on the website will increase consistency in cognitive rehabilitation practices for service members and veterans with mild to moderate brain injury.
The clinical recommendations detailed in the online documents were accompanied by information on studies.
One study in 2013 recruited civilians from a regional hospital in Hong Kong that used a 12-session virtual reality problem-solving program for training clerical workers.
The cognitive rehabilitation intervention, according to the report, improved executive functioning, with significant differences in outcomes for the cognitive rehabilitation group compared to the control group. But another study found poor outcomes and high dropout rates in a self-administered, computerized cognitive rehabilitation program.
According to one recommendation, more intensive cognitive rehabilitation may be appropriate if cognitive dysfunction continues to affect daily functioning beyond the post-acute phase of the brain injury.
The Defense and Veterans Brain Injury website emphasizes that cognitive rehabilitation should be based on an assessment and understanding of a patient’s brain-behavior deficits, and therapeutic functional activities should be led by qualified neuropsychologists, occupational therapists and speech-language pathologists.
The website included a number of checklists and a symptom inventory to assist health providers with referrals for treatment.
Researchers have found cognitive symptoms attributed to traumatic brain injury, such as difficulty with memory and attention, overlap symptoms of post-traumatic stress disorder and depression, which can further complicate the evaluation of cognitive dysfunction.
For immediate help, military personnel and veterans can call a 24/7 crisis intervention line at 800-273-8255, ext. 1.
Andy Winnegar has spent his career in rehabilitation and is based in Santa Fe as a training associate for the Southwest ADA Center. He can be reached at email@example.com.