Validation of Cognitive Enhancement Techniques for Mild Traumatic Brain Injury (VoCET-mTBI)
Abstract
Objectives and Rationale: Traumatic brain injury (TBI) is a major health concern for the United States Military Health System. Cognitive symptoms associated with mild traumatic brain injury (mTBI) are complex to treat, given that many Service members have a history of multiple head injuries as well as psychological co-morbidities that negatively influence recovery. Current cognitive rehabilitation treatments are primarily modeled after methods designed to treat individuals with very severe brain injuries, with the focus of care on learning new skills or compensatory strategies for basic (e.g., dressing and feeding) and instrumental activities of daily living (e.g., management of finances, academic strategies). These interventions have shown effectiveness in the acute and sub-acute phase of recovery from TBI, but they are only modestly effective in helping the complaints of active duty military personnel with mild TBI (mTBI). Further, the treatments can be very time intensive (e.g., 10 hours per week). This study seeks to validate an alternative treatment that is well validated in civilians. The Strategic Memory Advanced Reasoning Training (SMART) treatment is a strategy-based program that focuses on enhancing advanced cognitive skills such as reasoning and problem-solving. By improving more high-level ways of thinking, this intervention improves performance of both brain injured patients and healthy people. The SMART protocol implements strategies to apply to a wide range of everyday tasks including strategic attention, reasoning, and innovative thinking. SMART has shown improvements in multiple measures of cognition including reasoning and problem-solving. These are essential cognitive attributes that active duty military need to perform in defense of our nation. The objective of this study is to evaluate the effectiveness of SMART, a novel and innovative treatment, compared to traditional cognitive rehabilitation of active duty Service members with chronic cognitive complaints following mTBI. The key question raised by this research is whether a cognitive-control, top-down training protocol can achieve better cognitive improvement and ecologically relevant outcomes (i.e., healthcare utilization, command performance evaluation) than traditional treatment. In the last several years, there have been many advances in treatment approaches for cognitive rehabilitation, and it is imperative for the military research community to establish evidence-based practices, ultimately providing the most effective treatment for our Service members. Applicability and Potential Impact: There are over 21,000 diagnosed brain injuries each year among military personnel and mTBI is the most common type of brain injury. This type of brain injury can result in long-term complaints about forgetfulness, attention, processing speed, and decision-making. Those with these persistent symptoms following mTBI may benefit from more effective treatments. The research in this area is scarce and gold standards are not established. Clinical implications are vast, including treatment planning, access to novel evidence-based intervention, as well as interventions targeting advancement of cognitive ability to improve the Warfighter performance in combat. This research will set new standards for the cognitive care of Service members with mTBI. Benefit to Military Service Members: This research will help the military to identify the best cognitive rehabilitation treatment program to address ongoing cognitive complaints following mTBI. Military Service members, Veterans, and those impacted by complex TBI will benefit from this study by increased accessibility to evidence-based treatment modalities. This study will ensure efforts are made to deliver the most effective treatment, challenging current practices, and ultimately improving quality of medical care. Improvements including reduced cognitive complaints, improved performance on cogn
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Nov 19, 2019
- Source ID
- W81XWH1910864
Entities
People
- Jason Bailie
Organizations
- General Dynamics
- United States Army