Solid evidence is lacking thus far that specific goal-oriented treatments are effective for traumatic brain injury, or TBI, though results are promising, according to a government report.
Each year, it is estimated that 1.7 million people in the United States sustain a TBI. From 2000 to 2010, the number of military service members diagnosed with TBI nearly tripled from just under 11,000 to more than 30,700.
Traumatic brain injury results from a bump or blow to the head, or from external forces that cause the brain to move within the head, such as whiplash or exposure to blasts. It can cause cognitive, physical, and/or psychosocial problems.
One form of treatment for TBI is cognitive rehabilitation therapy (CRT), a goal-oriented approach to help patients increase their ability to process and interpret information. CRT involves a variety of treatments provided by health professionals in a wide range of fields. It also often involves the active participation of family or caregivers.
TBI is so prevalent in modern combat that it is considered the “signature wound” of the conflicts in Iraq and Afghanistan. The U.S. Department of Defense (DoD) thus asked the Institute of Medicine (IOM), the health division of the National Academy of Sciences, to conduct a study to determine the effectiveness of cognitive rehabilitation therapy for treatment of TBI.
“Survivors of traumatic brain injury may face long-term challenges in rehabilitation and reintegration to everyday life. They need an effective health care infrastructure and evidence-based treatment and rehabilitation policies to care for and cope with their impairments,” said Dr. Ira Shoulson, the head of the IOM committee that studied the problem and a neurologist at Georgetown University.
Understanding Cognitive Rehabilitation Therapy
The goal of cognitive rehabilitation therapy (CRT) is to help an individual with a brain injury enhance his or her ability to move through daily life by recovering or compensating for damaged cognitive functions. A restorative approach helps the patient reestablish cognitive function, while compensatory approaches help the individual to adapt to an ongoing impairment.
CRT interventions are nearly as unique and varied as the individuals they are used to treat. A comprehensive rehabilitation program may be used for individuals with multiple impairments, for example memory loss combined with difficulties in problem-solving, while approaches focused on a single cognitive function attempt to work on each impairment in isolation. In addition to the variation in treatment, an individual’s response to any one treatment may vary as well, depending on the injury, the individual’s prior state of health, and the individual’s social context. Treatment strategies evolve, as different treatments become necessary at different points in time.
CRT is practiced by a wide range of professionals in rehabilitation medicine, nursing, physical and occupational therapy, speech-language pathology, psychology, and neurology. Each profession determines the training requirements for its own practitioners, and U.S. states regulate professional licensing standards. Because no national brain injury rehabilitation license and credential exist, the standards vary among rehabilitation professionals.
Shortcomings in the CRT Research
According to the IOM report, current evidence provides limited support for the efficacy of cognitive rehabilitation therapy interventions. The evidence varies in both the quality and volume of studies, and therefore is not yet sufficient to develop definitive guidelines for health professionals on how to apply CRT in practice.
The variation among patient characteristics, severity of injuries, and CRT interventions has made it difficult for researchers to know with certainty how effective a specific CRT intervention is in the long-term recovery of a specific individual. A lack of standardized terms for the different forms of CRT also presents a challenge for researchers.
Despite the methodological shortcomings of the evidence, the IOM supports the ongoing use of CRT for people suffering from a TBI while improvements are made in the standardization, design, and conduct of studies.
CRT interventions are promising approaches, but further development and assessment of this therapy is required, concluded the report.
“It doesn’t mean beneficial therapies don’t exist. It just means that at this point in time it’s hard to ascertain them,” Shoulson told the Washington Post.
It is estimated that TBI affects nearly 10 million people in the world today, and that incidence of TBI is rapidly rising. The survival rate, however, is rising along with it, largely due to improved protective equipment and more effective life-saving measures, according to the IOM report.
Source: Institute of Medicine