Volume 51 Number 1, 2014
Pages 59 — 70
Abstract — Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) for Veterans with traumatic brain injury: Pilot randomized controlled trial
Elizabeth W. Twamley, PhD;1–2* Amy J. Jak, PhD;1–3 Dean C. Delis, PhD;1 Mark W. Bondi, PhD;2–3 James B. Lohr, MD1–2
1Center of Excellence for Stress and Mental Health, Department of Veterans Affairs (VA) San Diego Healthcare System, San Diego, CA; 2Department of Psychiatry, University of California, San Diego, San Diego, CA; 3Psychology Service, VA San Diego Healthcare System, San Diego, CA
Abstract — Traumatic brain injury (TBI) can result in cognitive impairments and persistent postconcussive symptoms that limit functional recovery, including return to work. We evaluated a 12 wk compensatory cognitive training intervention (Cognitive Symptom Management and Rehabilitation Therapy [CogSMART]) in the context of supported employment for Veterans with mild to moderate TBI. Participants were randomly assigned to receive 12 wk of supported employment plus CogSMART or enhanced supported employment that controlled for therapist attention (control). CogSMART sessions were delivered by the employment specialist and included psychoeducation regarding TBI; strategies to improve sleep, fatigue, headaches, and tension; and compensatory cognitive strategies in the domains of prospective memory, attention, learning and memory, and executive functioning. Compared with controls, those assigned to supported employment plus CogSMART demonstrated significant reductions in postconcussive symptoms (Cohen d = 0.97) and improvements in prospective memory functioning (Cohen d = 0.72). Effect sizes favoring CogSMART for posttraumatic stress disorder symptom severity, depressive symptom severity, and attainment of competitive work within 14 wk were in the small to medium range (Cohen d = 0.35–0.49). Those who received CogSMART rated the intervention highly. Results suggest that adding CogSMART to supported employment may improve postconcussive symptoms and prospective memory. These effects, as well as smaller effects on psychiatric symptoms and ability to return to work, warrant replication in a larger trial.
Key words: attention, brain injury, cognitive rehabilitation, cognitive training, depression, employment, executive functioning, memory, postconcussive symptoms, posttraumatic stress disorder, rehabilitation, unemployment.
View HTML ¦ View PDF ¦ Contents Vol. 51, No.1
This article and any supplementary material should be cited as follows:
Twamley EW, Jak AJ, Delis DC, Bondi MW, Lohr JB. Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) for Veterans with traumatic brain injury: Pilot randomized controlled trial. J Rehabil Res Dev. 2014;51(1):59–70.
http://dx.doi.org/10.1682/JRRD.2013.01.0020
Twamley EW, Jak AJ, Delis DC, Bondi MW, Lohr JB. Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) for Veterans with traumatic brain injury: Pilot randomized controlled trial. J Rehabil Res Dev. 2014;51(1):59–70.
http://dx.doi.org/10.1682/JRRD.2013.01.0020
Go to TOP
Last Reviewed or Updated Thursday, April 10, 2014 8:29 AM
