Few Definitive Findings

While taking pains to note the limitations of their own study, IoM researchers identified 90 studies looking at CRT that met their criteria — studies looking at one or several forms of CRT to treat the effects of TBI. They evaluated the outcomes of these studies over the short-term and the long-term, as well as how it helped the patient function in the real world.

The studies showed that there was a benefit from some forms of CRT for TBI. For example, one study used speech pathology and social work professionals to conduct training sessions with TBI patients and their families. The researchers found that, after 12 weeks of the treatment, those receiving the intervention had better communication skills — improvements that were maintained through a six-month follow-up.

Another study looked at using visual imagery to improve memory. After 30 treatment sessions, those receiving treatment performed better on the immediate recall of stories, as well as other memory tests. The treatment effects were maintained three months after treatment.  

However, most findings were less definitive. Many studies had flaws in the design, and most had small sample sizes. The committee also found little evidence of CRT impact on executive function impairments — the cognitive processes that allow individuals to plan or develop goals, initiate behavior, solve problems and monitor their course of life.

The end result is a body of evidence that is inconclusive as to CRT’s effectiveness, the IoM report states. The researchers laid out a comprehensive set of recommendations directed at how DoD should proceed. They included convening a multiagency conference with VA, NIH and other stakeholders to decide what criteria should be used in studying CRT, and plan a strategy to adopt a common definition of the treatment.

DoD also should collaborate with other research agencies to foster all phases of research and development of CRT treatments. The IoM researchers noted in their report that, while there was insufficient evidence to conclusively prove effectiveness, this was a result of a lack of evidence, not evidence to the contrary. A research strategy that incorporates support for CRT treatments for TBI from pilot phase to early efficacy research to large-scale clinical trials and comparative effectiveness studies will help pave the way to more effectively judge the treatment’s worth.

Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence

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