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...

Labyrinth: This path is made for mindful walking

Article
9/27/2018
Wounded warriors at the National Intrepid Center of Excellence are introduced to the indoor labyrinth during early days of their four-week intensive outpatient treatment program. (Photo courtesy of NICoE)

NICoE uses ancient symbol to promote healing

Recommended Content:

Warrior Care | Traumatic Brain Injury | Cognitive Rehabilitation Therapy

What to Expect at Your First Appointment

Video
9/20/2018
What to Expect at Your First Appointment

You’ve reached out for help, you’ve found the right provider, now Kristin Gwin from Walter Reed National Military Medical Center shares what to expect at your first appointment.

Recommended Content:

Mental Health Care

Kristin Gwin, Walter Reed Social Worker Talks About Getting Help

Video
9/12/2018
Kristin Gwin, Walter Reed Social Worker Talks About Getting Help

Kristin Gwin, a Social Worker at Walter Reed National Military Medical Center understands that getting help can be an intimidating process. She offers advice on how to get started by letting a professional know you want help.

Recommended Content:

Mental Health Care | Suicide Prevention

Air Force's first Invisible Wounds Center opens

Article
9/10/2018
Lt. Gen. Dorothy Hogg, Air Force Surgeon General, talks with a veteran during a tour of the Air Force’s first Invisible Wounds Center at the Eglin Air Force Base, Fla. The IWC will serve as a regional treatment center for post-traumatic stress, traumatic brain injury, associated pain conditions and psychological injuries. (U.S. Air Force photo)

The center will serve as a regional treatment center for post-traumatic stress, traumatic brain injury, associated pain conditions and psychological injuries

Recommended Content:

Posttraumatic Stress Disorder | Traumatic Brain Injury

Stopping bullying takes understanding, involvement

Article
9/7/2018
Children can experience social withdrawal, anxiety, and depression as a result of bullying. From the Stop Bullying campaign to Military OneSource, resources are available to help parents and their families identify and address bullying (U.S. Air Force graphic by Staff Sgt. Jamal D. Sutter)

Bullying can leave visible and invisible wounds and have lasting effects on children and teenagers. Signs of the behavior can vary, and bullying others and being bullied are not mutually exclusive, experts say.

Recommended Content:

Mental Wellness | Children's Health | Suicide Prevention

How sharing my PTSD struggles helped others—and me

Article
9/4/2018
Army Sgt. Jon Harmon lost both legs after stepping on an improvised explosive device while on a 2012 Afghanistan mission. Today he speaks to commands and veterans about his personal struggle with mental health and how he works to overcome it. (Photo by Kevin Fleming, U.S. Army Sustainment Command)

Army Sgt. Jon Harman 82nd Airborne Division, liaison officer at Walter Reed Military Medical Center

Recommended Content:

Mental Wellness | Mental Health Care | Suicide Prevention | Men's Health

Getting off tobacco road leads to renewed relief

Article
8/10/2018
Stopping smoking can be difficult, but healthy living is a daily effort. Take command of your health today. (U.S. Army graphic by Karin Martinez)

One service member’s struggle to become smoke-free

Recommended Content:

Preventive Health | Mental Wellness | Tobacco-Free Living

Healthy sleep for healing

Article
8/7/2018
Sleep is an important factor in health. In addition to aiding in the healing of the body after injury, studies suggest that sleep can help boost the immune system, prevent disease, and ease depression. (U.S. Army photo by Lt. Col. John Hall)

We know how to treat bad sleep

Recommended Content:

Traumatic Brain Injury

DHA PI 6490.01: BH Treatment and Outcomes Monitoring

Policy

This Defense Health Agency-Procedural Instruction (DHA-PI), based on the authority of References (a) and (b), and in accordance with the guidance of References (c) through (k): a. Establishes the Defense Health Agency’s (DHA) procedures for the collection and analysis of BH outcome data. b. Addresses how DoD will standardize BH outcome data collection to: assess variations in mental health and substance use care among in-garrison medical treatment facilities (MTFs) and clinics; assess the relationship of treatment protocols and practices to BH outcomes; and identify barriers to provider implementation of evidence-based clinical guidance approved by DoD. c. Designates the Army as the DoD lead Service for maintenance and sustainment of the Behavioral Health Data Portal (BHDP) in specialty care mental health and substance use clinics, referred to collectively as BH clinics, until BHDP functionality can be integrated with GENESIS or another electronic health record (EHR) system managed by DHA. d. Designates DHA Information Operations (J-6) as lead on transitioning BHDP functional requirements related to outcomes monitoring to future EHR data collection platforms and processes.

There is hope

Article
7/12/2018
Medically assisted treatment for opioid use can break the cycle of addiction.

More than 350,000 deaths are attributed to opioid overdoses nationwide since 1999

Recommended Content:

Mental Health Care | Substance Abuse | Addiction | Mental Wellness | Opioid Safety

Life without liquor

Article
6/29/2018
There are 2.5 million alcohol-related deaths worldwide each year, according to the National Council on Alcoholism and Drug Dependence. (Courtesy photo)

One service member’s story of how he overcame a drinking problem

Recommended Content:

Mental Wellness | Substance Abuse

Going the distance runs in the family

Article
6/14/2018
Elisa Zwanenburg (left) and Al Richmond (right) engage in their favorite father-daughter activity, marathon running. (Courtesy photo by James Frank)

For this father/daughter team, running, and the Marine Corps principles that carry them, are in their blood

Recommended Content:

Mental Wellness | Physical Activity | Men's Health

Breaking down anxiety one fear at a time

Article
6/5/2018
Marine Staff Sgt. Andrew Gales participates in ‘battlefield’ acupuncture, also known as ‘ear acupuncture,’ at Walter Reed National Military Medical Center, as a treatment for anxiety related to PTSD. (U.S. Navy photo courtesy Mass Communication Specialist 2nd Class Kevin Cunningham)

Generalized anxiety, panic disorder, and anxiety related to PTSD are common disorders. In fact, an estimated 31 percent of U.S. adults experience anxiety at some point in their lives; one marine discusses his journey.

Recommended Content:

Mental Health Care | Preventive Health | Men's Health | Mental Wellness | Posttraumatic Stress Disorder

Assess your mental wellness during Mental Health Awareness Month

Article
5/25/2018
Similar to physical health, mental health requires regular care. Mental health is as critical as physical health to mission readiness. Therefore, it’s just as important to invest in your mental health as it is your physical health. (U.S. Air Force photo)

TRICARE provides mental health services for you and your family at all times

Recommended Content:

Mental Health Care | Mental Wellness | Men's Health | TRICARE Health Program

TRICARE Mental Health

Video
5/24/2018
TRICARE Mental Health

Watch this video to learn more about the mental health care benefits TRICARE provides

Recommended Content:

Mental Health Care
<< < 1 2 3 4 5  ... > >> 
Showing results 31 - 45 Page 3 of 11

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.