Statement of Task

A consensus committee shall design and perform a methodology to review, synthesize, and assess the salient literature and determine if there exists sufficient evidence for effective treatment using cognitive rehabilitation therapy (CRT) for three categories of traumatic brain injury (TBI) severity—mild, moderate, and severe—and will also consider the evidence across three phases of recovery— acute, subacute, and chronic. In assessing CRT treatment efficacy, the committee will consider comparison groups such as no treatment, sham treatment, or other non-pharmacological treatment. The committee will determine the effects of specific CRT treatment on improving (1) attention, (2) language and communication, (3) memory, (4) visuospatial perception, and (5) executive function (e.g., problem solving and awareness). The committee will also evaluate the use of multi-modal CRT in improving cognitive function as well as the available scientific evidence on the safety and efficacy of CRT when applied using telehealth technology devices. The committee will further evaluate evidence relating CRT’s effectiveness on the family and family training. The goal of this evaluation is to identify specific CRT interventions with sufficient evidence base to support their widespread use in the MHS, including coverage through the TRICARE benefit.

The committee shall gather and analyze data and information that addresses

1. A comprehensive literature review of studies conducted, including but not limited to studies conducted on MHS or VA wounded warriors;

2. An assessment of current evidence supporting the effectiveness of specific CRT interventions in specific deficits associated with moderate and severe TBI;

3. An assessment of current evidence supporting the effectiveness of specific CRT interventions in specific deficits associated with mild TBI;

4. An assessment of (1) the state of practice of CRT and (2) whether requirements for training, education and experience for providers outside the MHS direct-care system to deliver the identified evidence-based interventions are sufficient to ensure reasonable, consistent quality of care across the United States; and

5. An independent assessment of the treatment of traumatic brain injury by cognitive rehabilitation therapy within the MHS if time or resources permit.

including neurology, psychology, psychiatry, rehabilitation medicine, neuropsychology, neuropharmacology, nursing, speech-language pathology, epidemiology and neurocognitive study design, and disability and long-term care. The committee developed a strategy for reviewing the evidence, including a comprehensive review of the literature on CRT for TBI. After reviewing the statement of task and meeting with a representative from the Department of Defense to clarify intent, the committee interpreted its charge as assessing the state of the evidence. The committee acknowledges the goal of evidence assessments is to inform policy, upon which clinical

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