Reconceptualizing Rehabilitation of Individuals With Chronic Symptoms Following Mild Traumatic Brain Injury

Purpose/Objective: Effective treatment for postconcussive symptoms (PCS) immediately following mild traumatic brain injury (mTBI) includes reassurance, support, education about mTBI, and symptom management. However, effective treatments for chronic postconcussive-like symptoms, particularly with mental health comorbidities, remain unclear. Research Method/Design: We conduct a critical review of the treatment literature for chronic PCS, present exemplar studies of two alternative treatment approaches (i.e., cognitive rehabilitation (CR) and psychotherapy with various cognitive-behavioral therapy (CBT) approaches) and compare their relative effectiveness, and examine other literature to compare treatment benefits of one approach over another. Results: This review and comparisons found CBT approaches to be 5 to 6 times more potent in reducing chronic PCS than CR. Conclusions/Implications: Based on these findings we encourage rehabilitation professionals to "re-conceptualize" the factors that likely underlie chronic PCS and the most effective treatment for this condition. We propose that CBT interventions focusing on comorbid and underlying mental health issues should be an essential, not adjunctive, treatment approach for chronic PCS. Impact and Implications Effective treatments for chronic symptoms following a distal mild traumatic brain injury (mTBI), particularly with mental health comorbidities have been unclear. Both cognitive rehabilitation (CR) and psychotherapeutic cognitive-behavioral approaches (CBT) have demonstrated some efficacy. CBT approaches appear to be 5 to 6 times more potent in reducing chronic symptoms which many patients attribute to TBI than CR approaches, and also are far more effective in treating common comorbidities