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Cognitive Rehabilitation Therapy

When people talk about Cognitive Rehabilitation Therapy (CRT), they’re actually not talking about one therapy - they’re talking about a constellation of techniques that are used to try to improve an individual’s ability to function after injury. In other words, CRT is not a single therapy, but a collection of individual treatment strategies designed to improve problems with memory, attention, perception, learning, planning and judgment brought about by brain injury, neurological disorders or other illnesses.

Examples of cognitive rehabilitation therapies include writing tasks and interaction with computer-assisted programs. The goal of many of these therapies is to improve functions of memory, attention processing, social communications, problem-solving and the regulation of emotions.

So far, evidence supporting cognitive rehabilitation is encouraging, and efforts by the Department of Defense continue to study and test the effectiveness of several forms of CRT.

It should be noted that in cases of mild traumatic brain injury (mTBI), nearly 90 percent of patients recover with no residual problems and only those with persistent symptoms need to be evaluated and treated. Diagnostic tools for mTBI are not precise and neuropsychological assessments can be difficult to interpret. Therefore, medical evidence for effectiveness of cognitive rehabilitation therapies has been difficult to measure.

Frequently Asked Questions

The complexity of the brain and brain injuries has led to questions about the nature of cognitive rehabilitation therapy and its availability to service members who have sustained TBIs.

View questions and answers about cognitive rehabilitation therapy.

Q1:

Does DoD/TRICARE cover CRT?

A:

On April 14th, 2010, the Assistant Secretary of Defense (Health Affairs) directed the implementation of a broad-based DoD pilot program intended to conform to the proceedings, and resulting guidance document, of the Consensus Conference on Cognitive Rehabilitation for Mild Traumatic Brain Injury held in April 2009. This guidance document outlined a standardized and measureable process for the provision of CRT services. This policy mandated the implementation of the guidance at 13 military treatment facilities (MTF’s).

In 2010, DoD provided over 45,000 hours of care involving CRT to service members and over 32,000 hours to family members of active duty members and retirees. These treatments were delivered by a wide array of health professionals, including psychologists; occupational, speech and physical therapists; and physicians.

Q2:

Who may benefit most from CRT?

A:

Patients who have experienced moderate to severe TBI and who suffer from recurring symptoms such as attention and memory deficits, problems with executive functioning and social pragmatics deficits are most likely to benefit from CRT. In cases of mild TBI, nearly 90 percent recover with no residual problems and only those with persistent symptoms need to be evaluated and treated.

Q3:

What is CBT?

A:

Cognitive behavioral therapy is a common type of mental health counseling consisting of a range of therapies designed to treat conditions like anxiety or depression. CBT is meant to help patients become aware of inaccurate or negative thinking and to view challenging situations more clearly and respond to them in a more effective way. CBT can be an effective tool to help anyone learn how to better manage stressful situation.

For more information about CBT visit Brainline.org.

Q4:

What is the difference between CRT and CBT?

A:

Cognitive Rehabilitation Therapy is a collection of treatment strategies designed to address problems with memory, attention, perception, learning, planning and judgment brought about by brain injury, neurological disorders and other illnesses. Cognitive Behavioral Therapy is a common type of mental health counseling to help a patient become aware of inaccurate or negative thinking.

Q5:

Why is it difficult to determine how effective CRTs can be; there seems to be great disparity of opinion on the subject?

A:

Limited data on the effectiveness of cognitive rehabilitation programs are available, and this is in part due to the heterogeneity of the subjects, interventions and outcomes studied. Lack of rigorous methodology (i.e., randomized controlled trials) in efficacy studies has also contributed to the disparity in opinion on the effectiveness of CRT.

Q6:

Are CRTs effective or ever used for injuries that did not involve head injuries? For example, is CRT effective for psychological disorders?

A:

The benefit of CRT is not limited to patients with head injuries. Patients with psychological disorders that have impairments in attention, memory, socialization, and reasoning and processing skills can also benefit from CRT.

Q7:

Are there "specialists" in CRTs, or do most doctors understand their uses?

A:

Neuropsychologists specialize in neuropsychological cognitive testing that is used to determine if a patient will benefit from cognitive rehabilitation. They are also the primary providers who develop the individualized cognitive rehabilitation plan for patients. However, cognitive rehabilitation may be performed by an occupational therapist, physical therapist, speech/language pathologist, neuropsychologist, or a physician.

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