INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part I: Posttraumatic Amnesia

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Introduction: Moderate to severe traumatic brain injury (TBI) results in complex cognitive sequelae. Despite hundreds of clinical trials in cognitive rehabilitation, the translation of these findings into clinical practice remains a challenge. Clinical practice guidelines are one solution. The objective of this initiative was to reconvene the international group of cognitive researchers and clinicians (known as INCOG) to develop INCOG 2.0: Guidelines for Cognitive Rehabilitation Following TBI. Methods: The guidelines adaptation and development cycle was used to update the recommendations and derive new ones. The team met virtually and reviewed the literature published since the original INCOG (2014) to update the recommendations and decision algorithms. The team then prioritized the recommendations for implementation and modified the audit tool accordingly to allow for the evaluation of adherence to best practices. Results: In total, the INCOG update contains 80 recommendations (25 level A, 15 level B, and 40 level C) of which 27 are new. Recommendations developed for posttraumatic amnesia, attention, memory, executive function and cognitive-communication are outlined in other articles, whereas this article focuses

Section: Resultsmentioning

confidence: 99%

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confidence: 99%

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: Methods, Overview, and Principles

Bayley¹,

Janzen²,

Harnett³

et al. 2023

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“…The next article, concerning management of posttraumatic amnesia (PTA), has been revised to reflect new and emerging evidence regarding assessment and therapy during this phase, with a recent randomized controlled trial showing the value of a structured error-controlled and procedural learning approach to training ADL during PTA (INCOG 2.0, Part I: Posttraumatic Amnesia). 22 The fourth article concerns rehabilitation of attention and processing speed. This article probably contains the least changes, given the ongoing limitations in the evidence for behavioral interventions in this domain, but does provide stronger evidence underpinning pharmacological interventions for attention (INCOG 2.0, Part II: Attention and Information Processing Speed).…”

Section: What's New In the Incog 20 Guidelines?mentioning

confidence: 99%

“…This article has been enhanced and updated with a new section on telerehabilitation. The next article, concerning management of posttraumatic amnesia (PTA), has been revised to reflect new and emerging evidence regarding assessment and therapy during this phase, with a recent randomized controlled trial showing the value of a structured error-controlled and procedural learning approach to training ADL during PTA (INCOG 2.0, Part I: Posttraumatic Amnesia) 22. The fourth article concerns rehabilitation of attention and processing speed.…”

Section: What's New In the Incog 20 Guidelines?mentioning

confidence: 99%

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: What's Changed From 2014 to Now?

Bayley

Janzen²,

Harnett³

et al. 2023

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“…INCOG 2.0 refers to cognitive-communication recommendations after the person has emerged from PTA. For further information regarding management during PTA, please refer to Ponsford et al 21 in this issue (INCOG 2.0, Part I: posttraumatic amnesia).…”

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confidence: 99%

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part IV: Cognitive-Communication and Social Cognition Disorders

Togher

Douglas²,

Turkstra³

et al. 2023

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Introduction: Moderate to severe traumatic brain injury causes significant cognitive impairments, including impairments in social cognition, the ability to recognize others' emotions, and infer others' thoughts. These cognitive impairments can have profound negative effects on communication functions, resulting in a cognitive-communication disorder. Cognitive-communication disorders can significantly limit a person's ability to socialize, work, and study, and thus are critical targets for intervention. This article presents the updated INCOG 2.0 recommendations for management of cognitive-communication disorders. As social cognition is central to cognitive-communication disorders, this update includes interventions for social cognition. Methods: An expert panel of clinicians/researchers reviewed evidence published since 2014 and developed updated recommendations for interventions for cognitive-communication and social cognition disorders, a decision-making algorithm tool, and an audit tool for review of clinical practice. Results: Since INCOG 2014, there has been significant growth in cognitive-communication interventions and emergence of social cognition rehabilitation research. INCOG 2.0 has 9 recommendations, including 5 updated INCOG 2014 recommendations, and 4 new recommendations addressing cultural competence training, group interventions, telerehabilitation, and management of social cognition disorders. Cognitive-communication disorders should be individualized, goal- and outcome-oriented, and appropriate to the context in which the person lives and incorporate social communication and communication partner training. Group therapy and telerehabilitation are recommended to improve social communication. Augmentative and alternative communication (AAC) should be offered to the person with severe communication disability and their communication partners should also be trained to interact using AAC. Social cognition should be assessed and treated, with a focus on personally relevant contexts and outcomes. Conclusions: The INCOG 2.0 recommendations reflect new evidence for treatment of cognitive-communication disorders, particularly social interactions, communication partner training, group treatments to improve social communication, and telehealth delivery. Evidence is emerging for the rehabilitation of social cognition; however, the impact on participation outcomes needs further research.