'Cognitive Rehabilitation Therapy' for Wounded Politicians, But Not Injured Troops?

Though top brain specialists have endorsed cognitive rehabilitation as an effective treatment for brain injury, Tricare officials have said that scientific evidence does not justify providing it comprehensively to troops.

When discussing its use for troops, this treatment has been called “deeply flawed,” “unacceptable” and “dismaying.” Yet the facility is described as “one of very few hospitals in the country designated as a model system for traumatic brain injury.”

(WASHINGTON D.C.) - As Congresswoman Gabrielle Giffords begins rehabilitative therapy in Houston after being shot in the head in Tucson earlier this month, she was transferred today [1] to TIRR Memorial Hermann, a premier rehabilitation hospital renowned for its treatment of traumatic brain injuries [2].

On its website, the hospital calls itself [3] “one of very few hospitals in the country designated as a model system for traumatic brain injury.” Among the techniques it relies on is cognitive rehabilitation [4] therapy, a tailored type of medical treatment designed to retrain the brain to do basic tasks.<

It’s a treatment that Rep. Giffords will likely end up receiving, if doctors’ general descriptions of her care plan are any indication. Dr. John Holcomb, a retired Army colonel and trauma surgeon at Memorial Hermann, has described Giffords’ treatment as a “tailored and comprehensive [5] rehab plan” that includes “speech, cognitive, physical rehabilitation [6].”

If Giffords does end up receiving it, she’ll be getting a treatment that many troops don’t. As we’ve reported [7], the Pentagon’s health program, Tricare, has refused to cover [8] cognitive rehabilitation therapy for the tens of thousands of service members who have suffered brain injuries in the line of duty. Tricare, which provides insurance-style coverage to troops and many veterans, does cover speech and occupational therapy, which are often part of cognitive rehabilitation.

We’ve called the hospital to get further details about Giffords’ treatment plan but have not yet received that information. News reports have described her treatment as using “high-tech tools to push the brain to rewire itself [9],” with a focus on [10] her physical abilities, speech, vision, cognitive skills and behavior.

Traumatic brain injuries have different types [11] and levels of severity, according to the Office of the Surgeon General. They can include penetrating injuries [12]—like Giffords’—or mild brain trauma [13] like the kind often sustained by troops in an explosion. The latter, as we’ve reported, has been called one of the signature wounds of the Iraq and Afghanistan wars, and tens of thousands of cases [14] have been left undiagnosed by the military’s medical system.

Though top brain specialists have endorsed cognitive rehabilitation as an effective treatment for brain injury, Tricare officials have said that scientific evidence does not justify [15] providing it comprehensively to troops.

To support that position, officials cite a 2009 Tricare-funded assessment of cognitive rehabilitation therapy—an assessment that internal and external reviewers have called “deeply flawed,” “unacceptable” and “dismaying,” as we reported last month with our partners at NPR.

Last week, Sen. Claire McCaskill, chairman of the subcommittee on contracting oversight, cited our findings [16] while announcing an investigation [17] into the Pentagon’s decision to deny treatment of traumatic brain injuries to troops. In 2008, McCaskill was one of 10 senators—including then-Senator Barack Obama—who signed a letter [18] to Defense Secretary Robert Gates urging the military to provide Tricare coverage of cognitive rehabilitation “so that all returning service personnel can benefit from the best brain injury care this country has to offer.”

This article was originally published by: propublica.org