According to the Defense Medical Surveillance System, mild traumatic brain injury (TBI), also known as concussion, accounts for more than 82 percent of TBI cases throughout the Defense Department worldwide.

“Service members and veterans who have sustained a concussion may experience cognitive symptoms that keep them from normal activity,” said Linda M. Picon, the Department of Veterans Affairs liaison for TBI at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE).

“These symptoms may be related to a history of mild TBI and to deployment-related complaints such as chronic pain, headaches, post-traumatic stress disorder, depression, anxiety, sleep difficulties, substance use disorders and life stressors following return from deployment,” said Picon during a recent webinar hosted by DCoE.

Six Guiding Principles of Cognitive Rehabilitation

Douglas B. Cooper, research director for the Defense and Veterans Brain Injury Center (DVBIC), and Micaela Cornis-Pop, national program manager of the Veterans Affairs Polytrauma System of Care, outlined best practices for providers who treat concussed patients.

In order to create an evidence-based practice, providers need to combine research evidence, clinical experience, and knowledge of patients’ values and preferences, said Cooper. He explained how health care professionals can apply six guiding principles when working with service members and veterans:

• Recruit resilience. Help patients develop ways to bounce back from difficult experiences and adapt to overcome adversity.
• Cultivate therapeutic alliances. Build a foundation for the therapeutic process by developing strong relationships with patients.
• Acknowledge complexities. Help patients identify factors that may have contributed to their challenges and affect their ability to overcome them.  
• Build a team. Interdisciplinary teams of specialists can reduce the risk of missing problems that might affect treatment.
• Focus on function. Aim to help patients reduce limitations on daily activities and participate more fully in life.
• Promote realistic expectations for recovery. Promoting realistic expectations will help individuals develop self-confidence and take charge of their lives, improving treatment outcomes.

Making Cognitive Rehab Work

“Right at the beginning of the clinical interaction with the patient, it is important to build the trust and the collaborative relationship that will lead to this establishment of the therapeutic alliance between the clinician and the service member or veteran,” said Cornis-Pop.

She shared four stages of therapy health care professionals should follow to ensure that cognitive rehabilitation treatment works for their patients:

1. Get started. Establish a therapeutic alliance that acknowledges the many factors that may affect a patient’s situation and ongoing symptoms.  
2. Set the stage for functional changes. Identify and explore problems to set functional goals early in the process.
3. Help the patient implement changes. Guide patients in a collaborative process as they incorporate the techniques into their daily activities.
4. Move toward self-management. Help patients reach the point where they are able to implement these techniques on their own and effectively solve their problems.

Providers should motivate patients to change rather than telling them why they should change, Cornis-Pop emphasized. It’s also important to respect patients’ autonomy by letting them decide for themselves what changes they want to make.

Visit the DCoE webinar archives to download a PDF PowerPoint presentation for the webinar, “Cognitive Rehabilitation in Mild Traumatic Brain Injury: Applications in Military Members and Veterans,” along with an PDF overview of TBI resources for providers, PDF webinar transcript and webinar podcast.