rTMS/iTBS and Cognitive Rehabilitation to Remediate Deficits Associated with TBI and PTSD: A Theoretical Framework

Research Objectives: Rehabilitation of cognitive and psychosocial deficits resulting from traumatic brain injury (TBI) continues to be an area of concern in healthcare. Commonly co-occurring psychiatric disorders such as posttraumatic stress disorder (PTSD) create additional hurdles when attempting to remediate cognitive sequelae. Thus, there is a need for procedures that will yield consistent gains indicative of recovery of function in these patients. Intermittent theta burst stimulation (iTBS), a form of repetitive transcranial magnetic stimulation (rTMS), has potential as an instrument that can be tailored to aid cognitive processes and support functional gains. This theoretical review sought to summarize the existing literature regarding the pairing of rTMS/iTBS with cognitive interventions in patients with co-occurring TBI and PTSD.

Design: Theoretical review.

Setting: N/A

Participants: N/A

Interventions: N/A

Main Outcome Measures: N/A

Results: While there is evidence that rTMS/iTBS alone results in reduction of both physiological and psychosocial sequalae of injury, minimal gains have been noted for remediation of cognitive deficits. Pairing rTMS/iTBS with cognitive interventions may increase cognitive performance and support functional gains in patients with co-occurring TBI and PTSD because it enables direct targeting of damaged processes in a neural environment made more responsive to change by neurostimulation. There is emerging support in the literature for neurostimulation paired with attention process training, memory training, Prolonged Exposure Therapy, and Cognitive Processing Therapy.

Conclusions: The evidentiary framework we summarized supports the pairing of rTMS/iTBS with cognitive rehabilitation interventions. This framework is intended to be a steppingstone for future research as strategic parings have the potential to augment long-term gains and better ensure translation of rehabilitated and trained skills to everyday life in people living with co-occurring TBI and PTSD.

Author(s) Disclosures: None.