Impact of baseline neurocognitive functioning on outcomes following rehabilitation of executive function training for veterans with history of traumatic brain injury

Abstract

Traumatic brain injury (TBI) is common among Veterans, and sequelae frequently include deficits in attention and executive function and problems with emotional regulation. Although rehabilitation has been shown to be effective, it is not clear how patient characteristics such as baseline cognitive status may impact response to rehabilitation in this sample. Explore the relationship between baseline neuropsychological status and postintervention functional outcomes in Veterans with chronic TBI. Thirty-three Veterans with chronic mild–severe TBI completed a neuropsychological evaluation, a functional assessment of executive function (EF), and measures of emotional and everyday functioning pre- and post-EF training or control training. Performance on baseline neuropsychological measures was used to cluster participants. Participants’ performance at baseline and postintervention assessments was compared by cluster using multivariate analyses of variance (MANOVAs). Cognitive Difficulty (CD; n = 19) and Cognitively Normal (CN; n = 14) clusters were identified. CD was characterized by z ≤ −.75 on neuropsychological measures of overall attention/EF, working memory, and memory. CD participants performed worse on functional EF assessment and endorsed more PTSD symptoms and community integration problems, at baseline. CD participants improved post-EF training, but not control training, on neuropsychological and functional measures. CN participants did not show statistically significant improvement. For Veterans with chronic TBI, cognitive assessment can aid in identifying functional impairment and assist treatment planning. Cognitive rehabilitation training appears to be a beneficial treatment option for TBI patients with cognitive, emotional, and daily living difficulties.

Keywords:

• Executive function
• rehabilitation
• traumatic brain injury

Acknowledgments

We wish to thank participating Veterans and a number of individuals who made this study possible, in particular: Deborah Binder, MS, for helping with development of Brain Health Education training protocol; Gerald Carlin, OTR/L; Fred Loya, PhD; Michelle Madore, PhD; Jim Muir, PhD; Michelle Murphy, PhD; Annemarie Rossi, OTR/L; and Nick Rodriguez for their exceptional work with participant training and evaluations.

Declaration of Interest

The authors report no conflict of interest exists.

Additional information

Funding

This material is based upon work supported by the Department of Veterans Affairs Rehabilitation Research & Development Service Merit Review Awards (VANCHCS Project # B7467I and VA 1IO1RX001111-01A1) and the VA Office of Academic Affiliation Interprofessional TBI/Polytrauma Rehabilitation Research Fellowship.