Long-Term Effect of Cognitive Rehabilitation Regardless of Prerehabilitation Cognitive Status for Veterans with TBI

Abstract

Persisting difficulties in executive functioning (EF) are common after traumatic brain injury (TBI). Cognitive rehabilitation can be effective, but the impact of pretreatment neurocognitive functioning on long term effects of rehabilitation is unknown. Because this information can impact treatment planning, we examined the relationship between prerehabilitation neurocognitive status and long-term effects of EF training. Archival data were drawn from a trial of Goal-Oriented Attentional Self-Regulation group-format EF training for Veterans with TBI [mild-severe; 11 years postinjury; 96% male, 32% nonwhite, 14.21 years education (SD 1.72), 41.13 years old (SD 11.39)]. Using prerehabilitation neurocognitive performance, participants were clustered into cognitive difficulty (CD) and cognitively normal (CN) groups. Six-plus months after EF rehabilitation training, participants completed a structured telephone interview and/or in-person cognitive/functional/emotional assessment using standardized measures of cognitive, daily, and emotional functioning frequently employed in TBI research. At 6+ months post-EF training compared to prerehabilitation, CD and CN improved in multiple cognitive (Overall Attention/EF: F(1,18) = 26.17, partial η² = .59; Total Memory: F(1,18) = 6.82, partial η² = .28) and functional domains (Goal Processing Scale [GPS] total score: F(1,15) = 6.71, partial η² = .31). CD improved more than CN on Learning and Memory functional domain [F(1,15) = 6.10, partial η² = .29]. Results of our small archival analysis raise the possibility that Veterans with chronic TBI may demonstrate long-term effects of EF training.

Keywords:

• Cognitive rehabilitation
• traumatic brain injury
• Veterans

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.

Disclosure statement

No conflict of interest exists.

Instrument availability

The long-term follow-up telephone interview questionnaire may be made available to interested researchers by contacting [email protected].

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 VA Office of Academic Affiliation Interprofessional TBI/Polytrauma Rehabilitation Research Fellowship.