INTERVENTIONS and STRATEGIES to ADDRESS COGNITIVE DYSFUNCTION

Attentional Difficulties

Recommendation: Attentional challenges are best addressed within the context of integrated treatment focused on compensatory strategies and the executive functioning domain. Integrative and holistic approaches considering specific patient complaints and therapist-directed attentional training are recommended.

Clinical Resources

·       mTBI Rehabilitation Toolkit. Chapter 7.  http://www.cs.amedd.army.mil/FileDownloadpublic.aspx?docid=e454f2ce-00ae-4a2d-887d-26d5474c8d1a

o   Improving Attention and Speed of processing (pp. 230-233).

o   Clinician Tip Sheets

§  Inventory of Attention/Speed of processing Difficulties (p.231)

§  Experiencing Attention levels (p. 231)

§  Overview of Strategies to Cope with Attention and Speed-of-Processing Difficulties (p. 232)

§  Strategies to Improve Attention – Identifying High and Low Demands Tasks (p.233)

§  Menu of Strategies Based on Attention Hierarchy (p. 233)

§  Practice Tasks for Attention Strategy Rehearsal and Transfer (p. 233)

o   Table 7-2: Possible Strategies Based on Patients’ Vulnerabilities Associated with Specific Levels of Attention (p. 234).

o   Table 7-3: Examples of Attention-Related Practice Tasks (pp. 235-236)

Return to Duty, Employment, School and Life

Recommendation:  Cognitive rehabilitation with the goal of return to duty emphasizes dual tasking, incorporates aspects of the SM’s actual duty responsibilities into treatment, and teaches strategies to conserve cognitive reserve. Collaboration with the SM’s command is essential for successful return to duty.    Rehabilitation towards return to employment and school emphasize executive functions, prospective memory, and the specific skills necessary for success in the setting as well as accommodation plans. A therapeutic focus on return to life should emphasize cognitive aspects of the resumption of the roles as a family member and friend, and includes coordination with the behavioral health care provider.

Clinical Resources:

·       mTBI Rehabilitation Toolkit. Chapter 9: Performance and Self-management, Work, Social, and School Roles http://www.cs.amedd.army.mil/FileDownloadpublic.aspx?docid=7b8e559d-eb34-47eb-b4e8-1528ec56f6a2

o   Section 2: Social Roles

§  Sections on reengaging with spouses, children and friends (p. 356); assessment of communication and interaction skills (pp. 356-362) including assessments and scales therapists can use

§  Intervention: Reengaging with spouses, children and friends including Clinician Tip Sheets on:  Resumption of parent roles (p.364), household roles (p.365); and student role (p. 366)

o   Section 3: Return to School with Clinician Tip Sheets on returning to school (pp. 366-367). 

§  Clinician Tip Sheet: Return to School Needs Assessment (p. 368)

§  Patient Handout: Return to School Needs Assessment – Essential Skills for College Success (pp. 429-430); Study-Reading Systems (p. 431); Note-taking Strategies (p. 432-434)

o   Section 4: Return to Duty with sections on Intervention – performing work roles and return to duty (p.375) and a description of the Return-to-Duty Performance Validation Program adopted at Ft. Campbell that describes the 10 tasks and grading system.

o   Clinician Tip Sheets available: Topographical symbols on a military map (p. 382); Determining grid coordinates of a point on a military map (p. 383); Performing first aid for a bleeding extremity (p. 384); tactical specific visual scanning activity (p. 384); target detection visual scanning activity (p. 385); duty roster and training schedule activity (p. 386); dress uniform error detection (p. 387).

·       CogSMART http://www.cogsmart.com/ 

o   A compensatory cognitive training intervention program in the context of supported employment for veterans with mild to moderate TBI. The manual for clinicians includes 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.