Cognitive rehabilitation for mTBI (Turkstra et al., 2025)
Creators: name: Turkstra, Lyn S.
name: Ray, Melissa R.
name: LeBlanc, M. Marina
name: Lu, Lisa H.
name: Curtiss, Glenn
name: Bowles, Amy O.
name: Eapen, Blessen C.
name: Cooper, Douglas B.
Publisher: name: ASHA journals
Year: 2025
Subjects: classificationCode: 420110
subject: Speech pathology
classificationCode: 420109
subject: Rehabilitation
classificationCode: 520203
subject: Cognitive neuroscience

description: <b>Purpose: </b>The aim of this study was to describe the development of and pilot feasibility outcomes for a strategy-based, brief, intensive cognitive rehabilitation intervention delivered to U.S. service members and veterans with mild traumatic brain injury in a recently completed 3-year pragmatic clinical trial: Symptom-Targeted Approach to Rehabilitation for Concussion (STAR-C).<b>Method: </b>To develop STAR-C, we used the Rehabilitation Treatment Specification System to identify core elements and principles from a previous randomized clinical trial of cognitive rehabilitation, and incorporated principles of neuroplasticity (e.g., high-dose spaced practice of personally meaningful tasks), best clinical practices (e.g., client-centered goal setting), health psychology (e.g., a focus on self-efficacy and motivation), and community-based participation research (e.g., the protocol was co-designed by clinicians and researchers). Treatment was based on a resource-allocation theory of everyday cognitive challenges, which predicted that automatic strategy use would reduce cognitive demands of everyday activities and therefore reduce cognitive symptoms. Treatment was delivered by speech-language pathologists (SLPs) and occupational therapists (OTs), using a protocol that included a problem-focused intake questionnaire, manualized treatment, and clinician resources. Therapy was delivered individually in six to 10 virtual or in-person sessions over 3–4 weeks. Therapy focused on desired changes in function, scaled using Goal Attainment Scaling.<b>Results: </b>Trained SLPs and OTs delivered STAR-C to 53 U.S. service members and veterans, with treatment fidelity &gt; 95%. Participants and clinicians rated STAR-C as acceptable, feasible, and appropriate, and most participants attained and maintained targets.<b>Conclusion:</b> STAR-C appears to be a feasible method for improving everyday cognitive performance and efficacy should be tested in a controlled study.<b>Supplemental Material S1.</b> Symptom-Targeted Approach to Rehabilitation for Concussion (DoD/VA STAR-C): Clinician Instruction Manual.<b>Supplemental Material S2.</b> Symptom-Targeted Approach to Rehabilitation for Concussion (DoD/VA STAR-C): Clinician Resource Manual.Turkstra, L. S., Ray, M. R., LeBlanc, M. M., Lu, L. H., Curtiss, G., Bowles, A. L., Eapen, B. C., &amp; Cooper, D. B. (2025). Development and pilot implementation of a theory-based cognitive rehabilitation protocol for adults with chronic cognitive complaints after mild traumatic brain injury. <i>American Journal of Speech-Language Pathology</i>. Advance online publication. https://doi.org/10.1044/2024_AJSLP-24-00306<b>Publisher Note:</b> This article is part of the Special Issue: Select Papers From the Fourth International Cognitive-Communication Disorders Conference.