Study aims to aid troops with mild brain injury

A team of experts at San Antonio Military Medical Center has launched a military study aimed at improving outcomes for service members suffering from a signature wound of today's wars: traumatic brain injury (TBI).

The Study of Cognitive Rehabilitation Effectiveness, dubbed the SCORE trial, is examining cognitive rehabilitation therapy's value as a treatment for service members with mild TBI.

The Defense and Veterans Affairs departments teamed up on this study to determine the best treatment for combat troops who are experiencing mild TBI symptoms — such as difficulties with attention, concentration, memory and judgment — three to 24 months post-injury, explained Douglas B. Cooper, the study's lead and a clinical neuropsychologist for the center's Traumatic Brain Injury Service.

“We have a lot of great interventions to help … in the first few days after concussion,” he said. However, “we don't have as many good interventions later on — six months, 12 months or two years post-injury,” added Cooper, who also serves as the director of the Military Brain Injury Rehabilitation Research Consortium.

The trial's aim is to determine if cognitive rehabilitation therapy improves chronic mild TBI symptoms and, if so, which interventions work best, on whom and why.

Cognitive rehabilitation, Cooper explained, involves a variety of interventions that help patients with brain injuries reduce, manage or cope with cognitive deficits. It's commonly used to treat patients with brain injuries, whether from concussions, penetrating brain injuries or strokes.

With vast experience in the field, Cooper said, he and his colleagues knew anecdotally that the therapy helps to improve memory and focus in patients. However, he added, experts have cited a lack of evidence-based research tying cognitive rehabilitation to successful treatment of brain injuries.

With a lack of in-hand research, insurance companies began to balk on covering it as a stand-alone treatment.

Rather than step away from the therapy, Congress directed a series of studies to explore cognitive rehabilitation and its effectiveness among troops, Cooper said.

The Defense and Veterans Brain Injury Center took on the challenge and soon enlisted the help of DOD and VA experts. They took a year to write manuals to serve as a trial guide and began enrolling patients in SCORE in July.

They had no shortage of available participants. A TBI database shows that more than 202,000 service members suffered a TBI between 2000 and 2010, with the majority experiencing a mild TBI or concussion, according to the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. The center cited blasts, fragments, bullets, motor vehicle accidents and falls as the leading TBI causes within the military.

The team plans to treat 160 participants in six-week cycles over the course of two to three years, Cooper said. While in the trial, patients participate two times a day, five days a week, and are entered into one of four treatment paths, or “arms,” he explained.

These treatment paths involve a variety of interventions, and may include individual appointments, group sessions, computer treatments and behavioral health — or a combination of several intervention types.

For the computer exercises, Cooper explained, service members complete a series of commercially available computer programs touted to improve “brain fitness.” These sessions take place in hospital and are proctored by clinic staff.

The programs are presented in a game-like format, he added. As they progress, troops earn “brain bucks” that can be used to outfit a virtual apartment with big-screen TVs and stereos. This suits technology-savvy service members, he noted, who often fall into the under-25 age range.

Elaine Sanchez is a writer with the American Forces Press Service.

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Study aims to aid troops with mild brain injury