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

Bayley, Mark; Janzen, Shannon; Harnett, Amber; Teasell, Robert; Patsakos, Eleni; Bragge, Peter; Velikonja, Diana; Kua, Ailene; Douglas, Jacinta; Togher, Leanne; Ponsford, Jennie Louise; McIntyre, Amanda

doi:10.1097/htr.0000000000000838

Cited by 25 publications

(26 citation statements)

References 51 publications

(66 reference statements)

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“…Furthermore, in the situation of a very heterogenous disease, there is great difficulty in designing and performing prospective randomized trials that would provide conclusive answers regarding the optimal dosage and time of administration for Cerebrolysin or any other intervention. Under such circumstances, it is worth paying attention to algorithms created on the basis of the consensus of expert panels, such as the SIBICC or Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, 2023, where Cerebrolysin is mentioned as a compound worth considering in the treatment of TBI [ 5 , 37 ]. The INCOG guidelines represent the consensus made by a panel of experts based on the publications searched from 2014.…”

Section: Discussionmentioning

confidence: 99%

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Cerebrolysin in Patients with TBI: Systematic Review and Meta-Analysis

et al. 2023

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TBI (traumatic brain injury) is one of the most common causes of deaths and failure to return to society according to the latest statistics. Cerebrolysin is a drug approved for use in patients diagnosed with TBI. It is a mixture of neuropeptides derived from purified porcine brain proteins and multiple experimental studies have proven its neuroprotective and neurorestorative properties both in vitro and in vivo. In our meta-analysis, we analyze the latest clinical study reports on the use of Cerebrolysin in patients with TBI. The authors searched the databases: Pub Med, Cinahl, Web Of Science, and Embase from database inception until 11th July 2022. Ten clinical studies were eligible and included in the final analysis, including both retrospective and prospective studies of 8749 patients. Treatment with Cerebrolysin was associated with a statistically significant change in GCS and GOS. Mortality of any cause and the length of stay was not affected by the treatment. Our findings support and confirm the beneficial effects of Cerebrolysin treatment on the clinical outcome of patients after TBI. Further multi-center studies to optimize dosing and time of administration should be conducted.

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Section: Discussionmentioning

confidence: 99%

“…According to the authors, Cerebrolysin is one of the drugs that can be used with potential benefit in this group of patients. The authors point out, however, that there is a lack of broader evidence from the studies at present [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Cerebrolysin in Patients with TBI: Systematic Review and Meta-Analysis

et al. 2023

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“…The reader is referred to the methods article of this series (INCOG 2.0: Methods, Overview, and Principles) 54 for a review of the strategies used for the updated literature review (from 2014) and development of the recommendations and other tools. In brief, the Updated INCOG (with INCOG being an acronym standing for "International Cognitive") Guideline follows a thorough search, review, and critical evaluation of currently published studies for each domain including principles of assessment, PTA, attention, memory, executive function, and cognitive communication.…”

Section: Methodsmentioning

confidence: 99%

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

Ponsford

Trevena-Peters²,

Janzen³

et al. 2023

Journal of Head Trauma Rehabilitation

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Introduction: Posttraumatic amnesia (PTA) is a common occurrence following moderate to severe traumatic brain injury (TBI) and emergence from coma. It is characterized by confusion, disorientation, retrograde and anterograde amnesia, poor attention and frequently, agitation. Clinicians and family need guidelines to support management practices during this phase. Methods: An international team of researchers and clinicians (known as INCOG) met to update the INCOG guidelines for assessment and management of PTA. Previous recommendations and audit criteria were updated on the basis of review of the literature from 2014. Results: Six management recommendations were made: 1 based on level A evidence, 2 on level B, and 3 on level C evidence. Since the first version of INCOG (2014), 3 recommendations were added: the remainder were modified. INCOG 2022 recommends that individuals should be assessed daily for PTA, using a validated tool (Westmead PTA Scale), until PTA resolution. To date, no cognitive or pharmacological treatments are known to reduce PTA duration. Agitation and confusion may be minimized by a variety of environmental adaptations including maintaining a quiet, safe, and consistent environment. The use of neuroleptic medications and benzodiazepines for agitation should be minimized and their impact on agitation and cognition monitored using standardized tools. Physical therapy and standardized activities of daily living training using procedural and errorless learning principles can be effective, but delivery should be tailored to concurrent levels of cognition, agitation, and fatigue. Conclusions: Stronger recommendations regarding assessment of PTA duration

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“…The reader is referred to the methods paper of this series (INCOG 2.0: Methods, Overview, and Principles) 18 for a complete review of the strategies used in the updated literature review and development of the recommendations and other tools. In brief, the updated INCOG (with INCOG being an acronym for "International Cognitive") guideline follows a thorough search, review, and critical evaluation of currently published studies.…”

Section: Methodsmentioning

confidence: 99%

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part V: Memory

Velikonja¹,

Ponsford

Janzen³

et al. 2023

Journal of Head Trauma Rehabilitation

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Introduction: Memory impairments affecting encoding, acquisition, and retrieval of information after moderate-to-severe traumatic brain injury (TBI) have debilitating and enduring functional consequences. The interventional research reviewed primarily focused on mild to severe memory impairments in episodic and prospective memory. As memory is a common focus of cognitive rehabilitation, clinicians should understand and use the latest evidence. Therefore, the INCOG (“International Cognitive”) 2014 clinical practice guidelines were updated. Methods: An expert panel of clinicians/researchers reviewed evidence published since 2014 and developed updated recommendations for intervention for memory impairments post-TBI, a decision-making algorithm, and an audit tool for review of clinical practice. Results: The interventional research approaches for episodic and prospective memory from 2014 are synthesized into 8 recommendations (6 updated and 2 new). Six recommendations are based on level A evidence and 2 on level B. In summary, they include the efficacy of choosing individual or multiple internal compensatory strategies, which can be delivered in a structured or individualized program. Of the external compensatory strategies, which should be the primary strategy for severe memory impairment, electronic reminder systems such as smartphone technology are preferred, with technological advances increasing their viability over traditional systems. Furthermore, microprompting personal digital assistant technology is recommended to cue completion of complex tasks. Memory strategies should be taught using instruction that considers the individual's functional and contextual needs while constraining errors. Memory rehabilitation programs can be delivered in an individualized or mixed format using group instruction. Computer cognitive training should be conducted with therapist guidance. Limited evidence exists to suggest that acetylcholinesterase inhibitors improve memory, so trials should include measures to assess impact. The use of transcranial direct current stimulation (tDCS) is not recommended for memory rehabilitation. Conclusion: These recommendations for memory rehabilitation post-TBI reflect the current evidence and highlight the limitations of group instruction with heterogeneous populations of TBI. Further research is needed on the role of medications and tDCS to enhance memory.

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

Cited by 25 publications

References 51 publications

Cerebrolysin in Patients with TBI: Systematic Review and Meta-Analysis

Cerebrolysin in Patients with TBI: Systematic Review and Meta-Analysis

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

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part V: Memory

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