Original articleA Trial of Neuropsychologic Rehabilitation in Mild-Spectrum Traumatic Brain Injury
Section snippets
Objectives and Hypotheses
The primary objective of our investigation was to test the efficacy of a comprehensive outpatient neuropsychologic rehabilitation program in the treatment of persistent neuropsychologic dysfunction, emotional distress, and accompanying functional disability after mild and moderate TBI. The program was comprised of individual cognitive-behavioral psychotherapy (CBT) and individual cognitive remediation. By including a well-defined client population, using a randomized no-treatment control group,
Methods
This clinical trial used a randomized, individual baseline design by using repeated measures with 2 groups.49 The experimental group received both individual CBT and individual cognitive remediation. The no-treatment control group was wait-listed for treatment.
Results
Participant demographics and injury characteristics are described in table 2. On average, the sample was middle aged (range, 19–62y), well-educated, white, and female. There were no significant group differences on the demographic variables (all P≤.05). Most subjects suffered from mild brain injuries. The groups did not differ by injury severity (ie, percentage of mild or moderate subjects, P≤.189). As table 3 illustrates, the majority of subjects in both groups sustained their injuries because
Discussion
Results provide preliminary evidence that intensive outpatient treatment consisting of both CBT and cognitive remediation is beneficial in the treatment of persistent emotional distress and perhaps even cognitive dysfunction after mild and moderate TBI. In this randomized controlled trial (RCT), subjects in the treatment group showed less emotional distress and more improved cognitive functioning at follow-up compared with subjects who did not receive treatment. Moreover, improvement was most
Conclusions
RCTs are possible in community-living persons with TBI, and even small RCTs can provide important information. Although there are limits to the generalizability of the findings, this study shows that a readily available model for care can be implemented by trained clinicians. The treatment was well tolerated despite its intensity. No subject dropped out because of the intensity of the treatment. No clinical emergencies, such as psychiatric hospitalizations, were observed. Overall, control
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Supported by the National Institute on Disability and Rehabilitation Research (grant no. H133A980030) and the Henry Kessler Foundation (grant no. 20.1).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.