DVBIC releases new TBI clinical recommendations

The Defense and Veterans Brain Injury Center (DVBIC), theDefense Health Agency’s traumatic brain injury (TBI) center of excellence,recently released the “Cognitive Rehabilitation for Service Members andVeterans Following Mild to Moderate Traumatic Brain Injury ClinicalRecommendations.”

These recommendations build on the 2016 U.S. Department ofVeterans Affairs (VA)/ Department of Defense (DoD) Clinical Practice Guidelineson Concussion/Mild Traumatic Brain Injury. While there has been new research oncognitive rehabilitation over the past few years, clinical practice varieswidely in the Military Health System (MHS) and throughout the VA.

To diminish this variation, DVBIC established subject matterexpert work groups from the DoD, VA, civilian health care, and academia; nearly40 experts were involved. Many of these individuals had previously beeninvolved in developing clinical guidelines in professional settings such as theNational Academies of Sciences, Engineering, and Medicine.

Drawing on both published literature and its own expertise,the working group developed a consensus opinion in August 2017 that helpedshape how the specific recommendations were developed. The new DVBICrecommendations provide resources to enable consistent care delivery across theMHS, Veterans Health Administration, and civilian providers.

Cognitive rehabilitation focuses on improving thinking andcommunication skills such as attention, problem solving, planning and memory.More generally, it provides strategies to target cognitive difficulties indaily life. For example, an individual having difficulty keeping track ofappointments would work with the cognitive rehabilitation provider to developand rehearse specific strategies, like the use of a smartphone calendar app andreminder, to track and successfully attend appointments. These types ofstrategies can help improve the daily functioning and independence of TBIpatients. The new recommendations offer providers detailed guidance fortreating service members and veterans with mild to moderate TBI and cognitivedysfunction as they move through each phase of recovery.

"These clinical recommendations are a uniquecontribution to the field of cognitive rehabilitation,” said Navy Capt. ScottPyne, DVBIC division chief. “They provide an integrated source for clinicians:detailed, evidence-informed clinical guidance and links to an array of DoD/VAcognitive rehabilitation resources and tools that support state-of-the-scienceclinical care."

Approximately 82 percent of brain injury cases areconsidered mild TBIs, otherwise known as concussions. Among those whoexperience chronic effects from TBIs, cognitive impairment is the mostpersistent and disabling because it can directly affect return to duty oremployment and can have a broad impact on daily living and quality of life. Toaddress these challenges, the new recommendations outline uniqueconsiderations, including modifications, specific interventions, strategies,and best practices when providing treatment to this target population.

When developing the recommendations, the working groupsought to address the needs of the end-user clinicians by incorporating theirfeedback and perspectives. As explained by working group member Dr. WayneGordon, chief of Rehabilitation and Neuropsychology Service at Mount SinaiHospital in New York City, cognitive rehabilitation should not be a “cannedintervention” but rather “providers need to be flexible in their approach,”given the nuanced nature of how a TBI patient presents. The new recommendationsallow providers to tailor their approach to the specific recovery needs ofservice members and veterans, which are often different from those of thegeneral population.

The recommendations are available here to download and print. 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.

Source: Health.mil