American Speech-Language-Hearing Association Clinical Practice Guideline: Cognitive Rehabilitation for the Management of Cognitive Dysfunction Associated With Acquired Brain Injury

Abstract

Background: Cognitive-communication impairments following acquired brain injury (ABI) can have devastating effects on a person's ability to participate in community, social, vocational, and academic preinjury roles and responsibilities. Guidelines for evidence-based practices are needed to assist speech-language pathologists (SLPs) and other rehabilitation specialists in the delivery of cognitive rehabilitation for the adult population. Purpose: The American Speech-Language-Hearing Association, in conjunction with a multidisciplinary panel of subject matter experts, developed this guideline to identify best practice recommendations for the delivery of cognitive rehabilitation to adults with cognitive dysfunction associated with ABI. Method: A multidisciplinary panel identified 19 critical questions to be addressed in the guideline. Literature published between 1980 and 2020 was identified based on a set of a priori inclusion/exclusion criteria, and main findings were pooled and organized into summary of findings tables. Following the principles of the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision Framework, the panel drafted recommendations, when appropriate, based on the findings, overall quality of the evidence, balance of benefits and harms, patient preferences, resource implications, and the feasibility and acceptability of cognitive rehabilitation. Recommendations: This guideline includes one overarching evidence-based recommendation that addresses the management of cognitive dysfunction following ABI and 11 subsequent recommendations focusing on cognitive rehabilitation treatment approaches, methods, and manner of delivery. In addition, this guideline includes an overarching consensus-based recommendation and seven additional consensus recommendations highlighting the role of the SLP in the screening, assessment, and treatment of adults with cognitive dysfunction associated with ABI. Future research considerations are also discussed.

A Case of Functional Cognitive Disorder: Psychotherapy and Speech and Language Therapy Insights

“…It is often used alongside counseling principles, including behavioral activation and distress-tolerance skills. 16 In discussing goals, Ms. C expressed a desire to increase her general independence and return to some type of "meaningful work," whether paid or volunteer. Throughout treatment, she was encouraged to examine perceived barriers she would need to overcome to reach these goals.…”

Cognitive Rehabilitation Approaches to Traumatic Brain Injury: A Review of Efficacy and Outcomes

“…Restorative approaches, also called direct approaches, aim to target neuroplasticity through therapeutic learning tasks and relevant neurological correlates. Restorative approaches aim at directly targeting the cognitive disturbances following a TBI, focusing on reinforcing, strengthening, or re-establishing previously learned patterns of behavior with the goal of recruiting surrounding neural structures to take over damaged functions 12,22,23 . Inherent to this process is neural reorganization and relearning of specific functions that were affected by TBI 31,32 .…”

“…For example, to target memory, intervention techniques may include activities such as word lists and paragraph listening 34 . Overall, it may be beneficial to pair restorative approaches of treatments targeting specific skills to improve performance/function in a small subset of areas 23 . Unfortunately, evidence continues to emerge that improvements in a singular trained task, such as word lists, are confined to this task and demonstrate poor generalizability to functional outcomes 35,36 .…”

“…Within these cognitive domains, rehabilitation tasks may specifically be related to sustained attention training, errorless learning tasks, pragmatic language skills, meta-cognitive strategies, and problem solving skills 22 . Effective cognitive rehabilitation programs often include repeated stimulation, cognitive strategy instruction, external cognitive aids, and assistive technologies 23 .…”

“…The greatest improvements in cognitive function have been reported to occur when a combination of these areas are targeted [23][24][25] . This multifaceted approach to cognitive rehabilitation is most effectively carried out by an interdisciplinary team 22 .…”