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Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×

Cognitive Rehabilitation Therapy
for Traumatic Brain Injury

Model Study Protocols and Frameworks to
Advance the State of the Science

Workshop Summary

Karin Matchett, Rapporteur

Board on the Health of Select Populations

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

This activity was supported by Contract No. HHSP23320042509XI/HHSP23337029T/0002 between the National Academy of Sciences and the U.S. Department of Health and Human Services. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity.

International Standard Book Number-13: 978-0-309-26786-1

International Standard Book Number-10: 0-309-26786-2

Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2013 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested citation: IOM (Institute of Medicine). 2013. Cognitive rehabilitation therapy for traumatic brain injury: Model study protocols and frameworks to advance the state of the science: Workshop summary. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×

Knowing is not enough; we must apply.
Willing is not enough; we must do.

—Goethe

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INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×

PLANNING COMMITTEE ON COGNITIVE REHABILITATION
THERAPY FOR TRAUMATIC BRAIN INJURY:
MODEL STUDY PROTOCOLS AND FRAMEWORKS
TO ADVANCE THE STATE OF THE SCIENCE1

IRA SHOULSON (Chair), Professor of Neurology, Pharmacology and Human Science, and Director of the Program for Regulatory Science and Medicine, Georgetown University, Washington, DC

RICHARD KEEFE, Professor of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC

MARY R. T. KENNEDY, Associate Professor, Department of Speech-Language-Hearing Science, University of Minnesota, Minneapolis

HILAIRE THOMPSON, Assistant Professor in the School of Nursing, University of Washington, Seattle

JOHN WHYTE, Director, Moss Rehabilitation Research Institute, Elkins Park, PA

Consultant

BARBARA G. VICKREY, Professor and Vice Chair, Department of Neurology, University of California, Los Angeles

IOM Staff

REBECCA KOEHLER, Program Officer

MARYJO M. OSTER, Program Officer

JON Q. SANDERS, Program Associate

ANDREA COHEN, Financial Associate

FREDERICK (RICK) ERDTMANN, Director, Board on the Health of Select Populations

_____________________

1Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×

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Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×

Reviewers

This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:

Alison Cernich, Defense Centers of Excellence

Wayne A. Gordon, Mount Sinai School of Medicine

Mary V. Radomski, Sister Kenny Research Center

Rodney Vanderploeg, James A. Haley VA Hospital

Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Jack C. Ebeler, Health Policy Alternatives, Inc. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteur and the institution.

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
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Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×

Acknowledgments

Many individuals were responsible for the planning of the workshop and the production of this summary. We wish to additionally thank Charles Drebing for his assistance and expertise.

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×

This page is blank

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×
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Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
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Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2013. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18257.
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In October 2011, the Institute of Medicine (IOM) released the report Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence, assessing the published evidence for the effectiveness of using cognitive rehabilitation therapy (CRT) to treat people with traumatic brain injury (TBI). TBI has gained increasing attention in the past 15 years because of its status as the signature wound of American military conflicts in Iraq and Afghanistan. Growing numbers of U.S. service members are suffering traumatic brain injuries and are surviving them, given that (a) the majority of traumatic brain injuries are mild and (b) lifesaving measures for more severe injuries have significantly improved. People with any level of injury can require ongoing health care in their recovery, helping them to regain (or compensate for) their losses of function and supporting their full integration into their social structure and an improved quality of life.

One form of treatment for TBI is CRT, a systematic, goal-oriented approach to helping patients overcome cognitive impairments. The Department of Defense (DoD) asked the IOM to evaluate CRT for traumatic brain injury in order to guide the DoD's use and coverage in the Military Health System. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence was the IOM's resulting study of the evidence. The report's conclusions revolved around the fact that there is little continuity among research studies of the effectiveness of different types of CRT, and there exist only small amounts of evidence (or, in many cases, none) demonstrating the effectiveness of using CRT to treat TBI—although the evidence that does exist generally indicates that CRT interventions have some effectiveness.

The workshop brought together experts in health services administration, research, and clinical practice from the civilian and military arenas in order to discuss the barriers for evaluating the effectiveness of CRT care and for identifying suggested taxonomy, terminology, timing, and ways forward for CRT researchers. The workshop consisted of individuals and was not intended to constitute a comprehensive group. Select decision makers in the Military Health System and Veterans Affairs (VA) and researchers were invited to participate. The workshop was designed to spur thinking about (1) the types of research necessary to move the field forward toward evidence-based clinical guidelines, (2) what the translational pipeline looks like and what its current deficiencies are, and (3) considerations that decision makers may choose to use as they decide what research they will support and decide how they will balance the urgency of the need with the level of evidence for CRT interventions. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science summarizes the happenings of the workshop.

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