Cognitive rehabilitation therapy in traumatic brain injury.

Traumatic brain injury (TBI)—affecting an estimated 10 million people worldwide—results from a bump or blow to the head, or from external forces that cause the brain to move within the head, such as whiplash or exposure to blasts. TBI is a serious and growing problem, particularly among soldiers and veterans because of repeated exposure to violent environments. It can cause cognitive, physical, or psychosocial problems. One form of treatment for TBI is cognitive rehabilitation therapy (CRT), a patient-specific, goal-oriented approach to help patients increase their ability to process and interpret information. CRT involves a variety of treatments provided by health professionals in a wide range of fields and often involves the participation of family or caregivers. Given that TBI is considered the “signature wound” of the conflicts in Iraq and Afghanistan, the Department of Defense (DoD) asked the Institute of Medicine (IOM) to conduct a study to determine the effectiveness of CRT for treatment of TBI. Specifically, the DoD asked the IOM to consider whether existing research on CRT provides a conclusive evidence base to support using specific CRT interventions and to guide the use of CRT for members of the military and veterans. The IOM appointed a committee of experts to answer the following questions: