Military service members (SMs) with history of mild traumatic brain injury (mTBI, or concussion) frequently report cognitive and behavioral difficulties. While most individuals with mTBI fully recover within 3 months, some experience lingering symptoms that can become chronic. At present, military clinical guidelines recommend clinician-run, manualized cognitive rehabilitation (CR) to treat these chronic symptoms; however, it is unclear whether this approach adequately addresses the unique needs of warfighters. Research suggests computerized cognitive training (CCT) programs have potential for treating chronic mTBI symptoms; however, there remains some ambiguity in the literature as to whether these programs constitute an effective approach to rehabilitation. The objective of the current study was to compare the effectiveness of CCT programs to clinician-run, manualized CR for the rehabilitation of SMs with a history of mTBI.

A total of 65 SMs with history of at least one diagnosed mTBI were recruited from a military hospital.  Participants received one of two interventions: clinician-run, manualized cognitive rehabilitation (CR; n = 37), consisting of 60 total hours of intervention over a 6-week period, or computerized cognitive training (CCT; n = 28), consisting of 20 total hours of intervention over a 4-week period. Participants were assessed pre- and post- intervention using a combination of self-report and objective outcome measures: Key Behaviors Change Inventory (KBCI), a self-report, measure of functional difficulties; Symbol Digit Modalities Test (SDMT), an objective, cognitive assessment that measures information processing speed; and Paced Auditory Serial Addition Test (PASAT), an objective cognitive assessment that measures both information processing speed, as well as sustained and divided attention.

A mixed ANOVA was used to compare changes in cognitive and functional impairment over time between conditions. The two intervention arms were the between groups factor and the time of assessment (pre and post) was the within groups factor. There were significant main within group effects for all three outcome measures: the PASAT (p<.001, η_p² = .54), SDMT (p<.001, η_p² = .25), and KBCI (p=.001, η_p² = .15). On average, participants showed improvement over baseline on the PASAT (CR delta= 6.98, SD= 7.25, p<.001; CCT delta=7.79, SD= 6.45, p<.001) and SDMT (CR delta= 4.62 , SD= 8.82, p= .003; CCT delta= 6.58, SD= 10.81, p= .003), as well as a reduction in perceived functional difficulties (CR delta= -3.22, SD= 7.09, p=.009; CCT delta=-2.00, SD= 4.72, p=.033). No significant main between group effect was detected for either the SDMT (p=.394, η_p² = .01) or KBCI (p=.462, η_p² = .01); however, there was a significant main between group effect for the PASAT (p=.014, η_p² = .09).

These findings suggest CCT programs have similar efficacy to clinician-run, manualized CR for treating chronic symptoms associated with mTBI; however, exploratory analyses suggest each approach may have distinct advantages for treating specific symptoms (e.g., information processing; specific areas of functioning). Together, our findings suggest that CCT may be a useful, beneficial tool when incorporated into an existing, evidence-based rehabilitative strategy for chronic cognitive dysfunction associated with mTBI.