SONOMA-Cognition mTBI: A Multimodal Functional Rehabilitation Framework for Mild Traumatic Brain Injury

Mild traumatic brain injury (mTBI) is one of the most common neurological injuries, yet patients and families often lack clear, functional guidance on recovery. This paper introduces a structured rehabilitation framework based on SONOMA-Cognition™, a validated model that integrates subjective and objective outcomes into a single percent-change metric. The framework combines high-dosage Class IV laser therapy (photobiomodulation), strength/balance/coordination training, cognitive retraining, and humor/positive affect integration, each contributing to neuroplastic recovery. Importantly, exercise-based interventions are identified as the most potent drivers of brain-derived neurotrophic factor (BDNF), while laser therapy provides an adjunctive cellular environment for repair. For Veterans Affairs Community Care (VACC) referrals, treatment frequency is designed to remain flexible—minimum 1–2 sessions per week, with 3 sessions per week as the optimal schedule. The goal of care is often stabilization rather than dramatic reversal, with progress tracked objectively at regular intervals. This model emphasizes transparency, realistic expectation management, and ethical discontinuation when regression occurs, offering patients, families, and clinicians a clear roadmap for functional rehabilitation in mTBI.