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Evidence Lacking That Cognitive Rehab Therapy Helps Brain-Injured Vets

TUESDAY, Oct. 11 (HealthDay News) -- Studies on the effectiveness of cognitive rehabilitation therapy for traumatic brain injury are plagued by design problems, a new report issued by the U.S. Institute of Medicine (IOM) finds.

The upshot: While evidence exists that this kind of therapy helps such patients regain lost mental and physical skills, it's not strong enough to develop definitive guidelines for its use.

With traumatic brain injury (TBI) now a "signature wound" among veterans of the Iraq and Afghanistan wars, the U.S. Department of Defense initiated a review of studies on cognitive rehabilitation therapy (CRT) to determine how it should be used and covered in the military health system.

The Society for Cognitive Rehabilitation website describes the therapy as "the process of relearning cognitive skills that have been lost or altered as a result of damage to brain cells/chemistry."

"Survivors of traumatic brain injury may face long-term challenges in rehabilitation and reintegration to everyday life," report chair Ira Shoulson, director of Georgetown University Medical Center's program for regulatory science and medicine, said in an IOM news release.

"They need an effective health care infrastructure and evidence-based treatment and rehabilitation policies to care for and cope with their impairments," he added.

CRT can be given one-on-one or in a group, and for long or short periods of time. A typical program can involve a speech-language pathologist, a neuropsychologist, a physical therapist, and/or an occupational therapist depending on the issue at hand. All therapies are designed to help TBI patients recover their ability to communicate, think clearly, and/or perform basic daily functions such as cooking and dressing.

Dr. Summer Ott, a neuropsychologist and co-director of the Methodist Concussion Center in Houston, said measuring success of CRT is understandably difficult.

"There are a lot of different CRT programs out there," she said. "So, first of all it's important to gear any rehabilitation plan to those deficits that are clearly attributable to brain injury. And that could mean that if the problem is memory, word-finding, or language skills, then what you will need is a speech pathologist. But, in other cases the situation might call for a physical therapist instead."

The report committee avoided saying that these treatments are not worthwhile for treating the roughly 10 million patients who struggle with the emotional and physical impact of TBI worldwide.

But given that these interventions are in now in widespread use among the nation's nearly 31,000 military personnel currently diagnosed with TBI, the Department of Defense wanted to know exactly how effective such treatments can be.

Unfortunately, the review revealed that many studies suffer from a relatively small pool of participants, the absence of a standardized language for describing interventions and a poor accounting for a host of factors not directly attributable to brain injury that can affect treatment results.

The report said that post-traumatic stress disorder and the presence or lack of family support can affect how well patients recover from skull fractures or brain hemorrhages, and should be evaluated alongside any implementation of CRT.

The team acknowledged, however, that the therapy's effectiveness is difficult to measure given that the term serves as umbrella term for a wide range of interventions for a variety of TBI-related cognitive impairments.

The process of recovery from TBI is typically lengthy and often incomplete, the report noted, making treatment assessment tricky. Although most TBI cases are mild, others are quite severe, requiring a wholly different type of therapeutic approach and technique.

"Another problem that researchers might have come across in the past," Ott said, "is that in assessing any individual patient's situation we used to rely a great deal on self-report, on the patient's own recall of their past cognitive abilities, which is not very reliable. But recently, among athletes and military members, more and more it's become common protocol to get a snapshot of a person's strengths and weaknesses before exposure to brain injury risk... So, perhaps going forward it'll be easier to see what works and what doesn't."

More information

For more on traumatic brain injury, visit the U.S. National Institutes of Health.

-- Alan Mozes

SOURCES: Summer Ott, neuropsychologist and co-director, Methodist Concussion Center, Houston Institute of Medicine, Texas; Oct. 11, 2011, Institute of Medicine, news release

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