Cognitive Rehabilitation Therapy for Traumatic Brain Injury Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary (2013) / Chapter Skim
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2 Overview of the Institute of Medicine Report (October 2011)
2 Overview of the Institute of Medicine Report (October 2011)
Pages 5-12
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From page 5... ...
Vickrey described the committee's efforts to survey the various definitions of CRT as used by professional societies and health care organizations, citing one definition used by the Brain Injury Interdisciplinary Special Interest Group (BI-ISIG) : Cognitive rehabilitation is a systematic, functionally oriented service of therapeutic cognitive activities, based on an assessment and understand ing of the person's brain-behavior deficits.
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From page 6... ...
The committee focused its work around the following question: Do cognitive rehabilitation interventions improve function and reduce cognitive deficits in adults with mild or moderate-severe TBI? The committee was charged with investigating the literature on interventions addressing each major cognitive domain -- attention, executive function, language and social communication, visuospatial perception, and memory -- as well as multi-modal interventions (CRT that comprehensively targets more than one domain)
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From page 7... ...
important § Role in the communication AND/OR daily activities home § Memory Environment: in the person's § Educational § Visuospatial Compensatory: § Social support physical and attainment perception Lessening of § Disability supports/ social § Community § Executive function disabling impact of service status environment participation impaired cognitive § Transportation access § Quality of life domain, through § Family/ specific Adequacy/Quality of caregiver compensatory Delivery of the CRT health strategies or Intervention: technologies § Appropriately trained providers § Standardized manuals and equipment/ facilities FIGURE 2-1 Model for modular CRT intervening between postacute TBI cognitive impairment in a domain, and outcomes.
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From page 8... ...
No evidence because the intervention has not been studied or uninformative evidence because of null results from flawed or otherwise limited studies Limited (+) Interpretable result from a single study or mixed results from two or more studies Modest (++)
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From page 9... ...
The committee graded the evidence for each study regarding immediate or long-term outcomes and regarding patient-centered outcomes, that is, improved social communication, integration into the community or social functioning in the community, or quality of life more globally. The committee found a range of levels of evidence of the effectiveness and efficacy of CRT interventions for the various domains.
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From page 10... ...
The committee found very little evidence of adverse effects or harm associated with CRT, but it recommended that future studies assess such risks. And, the overall evidence is insufficient to clearly establish whether telehealth technology delivery modes are more or less effective or more or less safe than other means of delivering CRT.
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From page 11... ...
The committee supported the ongoing application of CRT for TBI. Crucially, it recommended building on the literature base and considering how to design studies that build on the existing signal and strengthen the evidence to the point that it becomes useful for health services decision makers.
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