saw the need to ensure personnel have adequate treatment for wounds sustained in relation to military service. Therefore, DoD asked the Institute of Medicine (IOM) to evaluate the efficacy and effectiveness of CRT for TBI to guide its use and coverage in the Military Health System (MHS).


To complete its task, the IOM formed an ad hoc committee of experts from a range of disciplines to conduct a 15-month study aimed at evaluating the efficacy of CRT for TBI. The Committee on Cognitive Rehabilitation Therapy for Traumatic Brain Injury (hereafter referred to as “the committee”) comprised members with expertise in epidemiology and study design, disability and long-term care, neurology, neuropharmacology, neuropsychology, nursing, psychiatry, psychology, rehabilitation medicine, and speech-language pathology. To address its Statement of Task (see Box 1-1), the committee developed a workplan and strategy for reviewing the evidence, including a comprehensive review of the literature on CRT for TBI. In addition to reviewing the literature, the committee conducted an assessment of recently completed or ongoing clinical trials; invited input from experts in the fields of cognitive rehabilitation research and practice, investigators of major research studies in both military- and civilian-related TBI, and advocates for the role of families and communities in providing ongoing support to injured members of the military and veterans; and received statements from stakeholders from various organizations and members of the public.

After reviewing the Statement of Task and meeting with a representative from the Department of Defense to clarify its 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 practice guidelines are developed. Those at the Department of Defense are the only ones in position to make policy judgments for the Military Health System. After extensive deliberation, the committee determined it was beyond its charge to interpret its assessment of the evidence with respect to policy recommendations or clinical practice guidelines.

Over the course of the study, the committee met six times, engaged the public through two public workshops and participated in a number of ongoing activities organized by working groups. The committee did not complete an independent assessment of the treatment of TBI by cognitive rehabilitation within the MHS (subtask 5 of the Statement of Task). To accomplish this subtask, the committee determined it would need a substantial amount of data and submitted relevant questions as well as a request for data to the Department of Defense. The committee did not receive answers or data in response to the specific request. Due to constrained resources, including a lack of available data and time constraints, the committee was

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