Cognitive rehabilitation therapy in traumatic brain injury

Abstract

On Oct 11, the US Institute of Medicine released Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. 10 million cases of traumatic brain injury are reported worldwide every year. In the USA, 1·7 million Americans endure traumatic brain injury and the number of active US military personnel with traumatic brain injury has increased from 11 000 to 31 000 in the past decade.The report, which reviews 90 studies published from 1991 to 2011, states that current evidence provides limited support for the efficacy of cognitive rehabilitation therapy for traumatic brain injury. Although the technique seems helpful, the evidence lacks scientific rigour owing to the variable quality and size of studies. When the individual-patient tailored approach, and lack of outcome standardisation are taken into account, evidence for the therapy's efficacy is weak. The report concludes that existing evidence cannot support a definitive guideline on how cognitive rehabilitation therapy should be applied in practice to treat traumatic brain injury.Complexities surround delivery of this treatment modality and its outcome measurement. Patient characteristics, severity of injuries, and presence of comorbid conditions (such as pain, fatigue, and depression) vary substantially. The use of an interdisciplinary health-care provider approach (that can involve neurologists, neurosurgeons, nurses, occupational, physical, and speech therapists, as well as family members) creates an additional lack of uniformity.The need to effectively treat the longlasting consequences of traumatic brain injury is enormous. Further evidence to guide treatment will need larger studies with improved definition, standardisation, and assessment of cognitive rehabilitation therapy and its outcomes. An evaluation of specific interventions for individual cognitive functions, together with a comprehensive registry of cognitive rehabilitation therapy interventions, should also be established. Importantly, information about potential harms should be gathered too. On Oct 11, the US Institute of Medicine released Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. 10 million cases of traumatic brain injury are reported worldwide every year. In the USA, 1·7 million Americans endure traumatic brain injury and the number of active US military personnel with traumatic brain injury has increased from 11 000 to 31 000 in the past decade. The report, which reviews 90 studies published from 1991 to 2011, states that current evidence provides limited support for the efficacy of cognitive rehabilitation therapy for traumatic brain injury. Although the technique seems helpful, the evidence lacks scientific rigour owing to the variable quality and size of studies. When the individual-patient tailored approach, and lack of outcome standardisation are taken into account, evidence for the therapy's efficacy is weak. The report concludes that existing evidence cannot support a definitive guideline on how cognitive rehabilitation therapy should be applied in practice to treat traumatic brain injury. Complexities surround delivery of this treatment modality and its outcome measurement. Patient characteristics, severity of injuries, and presence of comorbid conditions (such as pain, fatigue, and depression) vary substantially. The use of an interdisciplinary health-care provider approach (that can involve neurologists, neurosurgeons, nurses, occupational, physical, and speech therapists, as well as family members) creates an additional lack of uniformity. The need to effectively treat the longlasting consequences of traumatic brain injury is enormous. Further evidence to guide treatment will need larger studies with improved definition, standardisation, and assessment of cognitive rehabilitation therapy and its outcomes. An evaluation of specific interventions for individual cognitive functions, together with a comprehensive registry of cognitive rehabilitation therapy interventions, should also be established. Importantly, information about potential harms should be gathered too.