Reconceptualizing rehabilitation of individuals with chronic symptoms following mild traumatic brain injury.

Abstract

Purpose/Objective: Effective treatment for postconcussive symptoms (PCS) immediately following mild traumatic brain injury (mTBI) includes reassurance, support, education about mTBI, and symptom management. However, effective treatments for chronic postconcussive-like symptoms, particularly with mental health comorbidities, remain unclear. Research Method/Design: We conduct a critical review of the treatment literature for chronic PCS, present exemplar studies of two alternative treatment approaches (i.e., cognitive rehabilitation (CR) and psychotherapy with various cognitive-behavioral therapy (CBT) approaches) and compare their relative effectiveness, and examine other literature to compare treatment benefits of one approach over another. Results: This review and comparisons found CBT approaches to be 5 to 6 times more potent in reducing chronic PCS than CR. Conclusions/Implications: Based on these findings we encourage rehabilitation professionals to "re-conceptualize" the factors that likely underlie chronic PCS and the most effective treatment for this condition. We propose that CBT interventions focusing on comorbid and underlying mental health issues should be an essential, not adjunctive, treatment approach for chronic PCS. Impact and ImplicationsEffective treatments for chronic symptoms following a distal mild traumatic brain injury (mTBI), particularly with mental health comorbidities have been unclear. Both cognitive rehabilitation (CR) and psychotherapeutic cognitive-behavioral approaches (CBT) have demonstrated some efficacy. CBT approaches appear to be 5 to 6 times more potent in reducing chronic symptoms which many patients attribute to TBI than CR approaches, and also are far more effective in treating common comorbidities

Resilience facilitates adjustment through greater psychological flexibility among Iraq/Afghanistan war veterans with and without mild traumatic brain injury.

“…Brenner et al (2009) recommended the use of evidence-based interventions to treat veteran distress regardless of etiology, and recent work suggests that cognitive–behavioral interventions may be more effective in alleviating postconcussive symptoms associated with mTBI than cognitive rehabilitation strategies (Vanderploeg, Belanger, Curtiss, Bowles, & Cooper, 2019). Our results suggest that there are pathways common to both personality prototypes and warzone-related mTBIs that impact symptom reports of PTSD, depression, and functional impairment.…”

Neuropsychiatric Treatment for Mild Traumatic Brain Injury: Nonpharmacological Approaches

“…116 Interestingly, some have argued that CBT approaches to postconcussion symptom management may be more potent in reducing symptoms than traditional cognitive rehabilitation. 15…”

“…6 11 Thus, addressing these symptoms first can lead to improvement in other domains. 15 16 Nonpharmacological approaches are a mainstay of managing PCS from mTBI, and optimal care should involve individualized symptom-specific treatments. 13 In this article, we review current nonpharmacological approaches for PCS including psychoeducation; psychotherapy; vestibular, visual, and physical therapies; and cognitive rehabilitation (see Table 1 ).…”

Medico‐Legal Aspects of Concussion

“…A literature review conducted by Vanderploeg and colleagues 81 concerning the effectiveness of cognitive rehabilitation and CBT methods on mTBI symptoms revealed a dearth of standardization in established and studied cognitive rehabilitation procedures. Interventions focused solely on cognitive rehabilitation spanned in general over 12‐15 weeks and hours were protocol dependent with varying distribution across days.…”

“…Cognitive rehabilitation in combination with cognitive behavioral therapy (CBT) programs revealed generally longer intervention periods and this combination intervention proved most efficacious in alleviating PCS when compared to cognitive rehabilitation only. Authors encourage providers to focus on the comorbid and underlying the mental health symptoms rather than cognitive complaints, especially for those who reported PCS 81 …”