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Updated: Jun 2, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Meta-analysis of Cognitive Rehabilitation Interventions in Veterans and Service Members With Traumatic Brain Injuries
Tara A Austin1, Cooper B Hodges, Michael L Thomas
1Center of Excellence for Stress and Mental Health (Drs Austin and Twamley) and Research Service (Drs Austin and Twamley), VA San Diego Healthcare System, San Diego, California; The VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas (Drs Austin, Szabo, and Lantrip); School of Social and Behavioral Sciences, Andrews University, Berrien Springs, Michigan (Dr Hodges); Department of Psychology, Colorado State University, Fort Collins (Dr Thomas); Department of Psychology, California State University, Los Angeles (Dr Szabo); Department of Psychology and Neuroscience, Baylor University, Waco, Texas (Ms Parr and Dr Lantrip); Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX (Dr Eschler); Department of Psychiatry, University of California San Diego (Dr Twamley). Dr Szabo is now at California State University, Los Angeles.
Main Objective:
Cognitive difficulties are some of the most frequently experienced symptoms following mild-to-moderate traumatic brain injuries (TBIs). There is meta-analytic evidence that cognitive rehabilitation improves cognitive functioning after TBI in nonveteran populations but not specifically within the veteran and service member (V/SM) population. The purpose of the current meta-analysis was to examine the effect of cognitive rehabilitation interventions for V/SMs with a history of mild-to-moderate TBI.
Design And Main Measures:
This meta-analysis was preregistered with PROSPERO (CRD42021262902) and used the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist for reporting guidelines. Inclusion criteria required studies to have (1) randomized controlled trials; (2) used adult participants (aged 18 years or older) who were US veterans or active-duty service members who had a history of mild-to-moderate TBI; (3) cognitive rehabilitation treatments designed to improve cognition and/or everyday functioning; (4) used objective neuropsychological testing as a primary outcome measure; and (5) been published in English. At least 2 reviewers independently screened all identified abstracts and full-text articles and coded demographic and effect size data. The final search was run on February 24, 2023, using 4 databases (PubMed, PsycINFO, Web of Science, and Google Scholar). Study quality and bias were examined using the revised Cochrane Risk-of-Bias Tool for Randomized Trials.
Results:
We identified 8 articles meeting full criteria (total participants = 564; 97% of whom had a history of mild TBI). Compared with control groups, participants showed a small, but significant, improvement in overall objective neuropsychological functioning after cognitive rehabilitation interventions. Interventions focusing on teaching strategies had a larger effect size than did those focusing on drill-and-practice approaches for both objective neuropsychological test performance and performance-based measures of functional capacity.
Conclusion:
There is evidence of cognitive improvement in V/SMs with TBI histories after participation in cognitive rehabilitation. Clinician-administered interventions focusing on teaching strategies may yield the greatest cognitive improvement in this population.
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