Institute of Medicine (IOM) Report on Cognitive Rehabilitation Therapy
Talking Points for Speech-Language Pathologists
The Institute of Medicine (IOM) issued a report in October 2011 titled Cognitive Rehabilitation Therapy for Traumatic Brain Injury. The IOM study supports the continued use of cognitive rehabilitation therapy (CRT) for individuals with traumatic brain injury (TBI). However, the findings of the IOM report have been misrepresented to some degree in the media.
The talking points below will assist speech-language pathologists in responding to questions that may be raised by other professionals, insurers, and the public.
What prompted the IOM report?
The U.S. Department of Defense (DoD) is seeking effective ways to address the rising incidence of TBI among military service members. The DoD commissioned the IOM to conduct a comprehensive evaluation of the effectiveness of CRT for adults with TBI.
A committee of 14 professionals reviewed 90 studies that met IOM criteria. The committee included ASHA member Mary Kennedy, a speech-language pathologist from the University of Minnesota. Speech-language pathologist McKay Moore Sohlberg was an invited expert reviewer.
Media stories have reported that the IOM report shows "insufficient evidence" for CRT. Does that mean CRT has been shown to be ineffective?
No. The report emphasizes that "...the committee supports the ongoing application of CRT interventions for individuals with cognitive and behavioral deficits due to TBI" (p. S–9).
Evidence from studies demonstrated effectiveness of CRT in the following three areas:
- Restorative strategies for language and social communication
- Internal compensatory strategies for memory
- External compensatory strategies for memory
Immediate treatment benefits were found in these areas in adults with moderate–severe TBI in the chronic recovery phase.
What does "insufficient evidence" mean?
Insufficient or limited evidence may mean that 1) studies have not been conducted, 2) studies are not high enough quality to draw conclusions about outcomes, or 3) studies have not addressed specific areas of CRT.
We know that CRT currently is not covered by TRICARE, the health insurance program for all service members and their families. How can the IOM report be used to support reimbursement to speech-language pathologists for CRT?
As noted above, the committee explicitly emphasized its support for the ongoing use of CRT.
Where can I get further information related to cognitive rehabilitation for TBI?
The Executive Summary of the report provides the background, methodology, and findings of the review.
Go to ASHA's clinical disorders webpages on Traumatic Brain Injury and Cognitive-Communication for more information about TBI and cognitive communication assessment and intervention.
Information for the public about TBI is also available on the ASHA website.
For more information, see the December 20, 2011, article in The ASHA Leader.