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Cognitive rehabilitation for mTBI (Turkstra et al., 2025)

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posted on 2025-01-24, 14:08 authored by Lyn S. Turkstra, Melissa R. Ray, M. Marina LeBlanc, Lisa H. Lu, Glenn Curtiss, Amy O. Bowles, Blessen C. Eapen, Douglas B. Cooper

Purpose: The aim of this study was to describe the development of and pilot feasibility outcomes for a strategy-based, brief, intensive cognitive rehabilitation intervention delivered to U.S. service members and veterans with mild traumatic brain injury in a recently completed 3-year pragmatic clinical trial: Symptom-Targeted Approach to Rehabilitation for Concussion (STAR-C).

Method: To develop STAR-C, we used the Rehabilitation Treatment Specification System to identify core elements and principles from a previous randomized clinical trial of cognitive rehabilitation, and incorporated principles of neuroplasticity (e.g., high-dose spaced practice of personally meaningful tasks), best clinical practices (e.g., client-centered goal setting), health psychology (e.g., a focus on self-efficacy and motivation), and community-based participation research (e.g., the protocol was co-designed by clinicians and researchers). Treatment was based on a resource-allocation theory of everyday cognitive challenges, which predicted that automatic strategy use would reduce cognitive demands of everyday activities and therefore reduce cognitive symptoms. Treatment was delivered by speech-language pathologists (SLPs) and occupational therapists (OTs), using a protocol that included a problem-focused intake questionnaire, manualized treatment, and clinician resources. Therapy was delivered individually in six to 10 virtual or in-person sessions over 3–4 weeks. Therapy focused on desired changes in function, scaled using Goal Attainment Scaling.

Results: Trained SLPs and OTs delivered STAR-C to 53 U.S. service members and veterans, with treatment fidelity > 95%. Participants and clinicians rated STAR-C as acceptable, feasible, and appropriate, and most participants attained and maintained targets.

Conclusion: STAR-C appears to be a feasible method for improving everyday cognitive performance and efficacy should be tested in a controlled study.

Supplemental Material S1. Symptom-Targeted Approach to Rehabilitation for Concussion (DoD/VA STAR-C): Clinician Instruction Manual.

Supplemental Material S2. Symptom-Targeted Approach to Rehabilitation for Concussion (DoD/VA STAR-C): Clinician Resource Manual.

Turkstra, L. S., Ray, M. R., LeBlanc, M. M., Lu, L. H., Curtiss, G., Bowles, A. L., Eapen, B. C., & Cooper, D. B. (2025). Development and pilot implementation of a theory-based cognitive rehabilitation protocol for adults with chronic cognitive complaints after mild traumatic brain injury. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2024_AJSLP-24-00306

Publisher Note: This article is part of the Special Issue: Select Papers From the Fourth International Cognitive-Communication Disorders Conference.

Funding

This work was funded by a Congressionally Directed Medical Research Program grant under Contract W18XWH18-2-0070.

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