A rapidly growing body of evidence shows the importance and effectiveness of cognitive rehabilitation for people with traumatic brain injury (TBI). A serious update of the groundbreaking INCOG guidelines for cognitive rehabilitation following TBI is presented within the January/February special issue of the Journal of Head Trauma Rehabilitation (JHTR). The official journal of the Brain Injury Association of America, JHTR is published within the Lippincott portfolio by Wolters Kluwer.

The INCOG 2.0 guidelines for cognitive rehabilitation reflect the “rapid pivot to telehealth-assisted rehabilitation” within the wake of the COVID-19 pandemic and recent tools to assist in translating the updated recommendations into clinical practice, based on an introduction by Mark Bayley, MD, of University of Toronto, Jennie Ponsford of Monash University in Australia and colleagues of the INCOG international Expert Panel.

Cognitive rehabilitation after TBI: High priority, persistent challenges

Improving the practice of cognitive rehabilitation is an ongoing priority for patients with TBI, reflecting the “diffuse damage to the brain networks which are essential for attention, memory, executive functions, and cognitive elements of communication,” Dr. Bayley and coauthors write. They highlight the repeatedly expanding evidence base on cognitive rehabilitation after moderate to severe TBI, with greater than 160 interventional studies published for the reason that original INCOG guidelines in 2014.

Along with the “especially complex and highly individualized” nature of cognitive rehabilitation, barriers remain to translating research evidence into clinical practice – contributing to “significant variations in implementation of best practice cognitive rehabilitation,” the Expert Panel writes. INCOG 2.0 seeks to deal with these barriers by adding tools to advertise clinical implementation, as a part of ongoing efforts to shut the “evidence-practice gap.”

What’s recent in INCOG 2.0? Latest evidence, recent tools to advertise implementation

The 2022 update addresses critical issues in cognitive rehabilitation after TBI, mirroring the topics addressed in the unique INCOG guidelines:

• Overview introducing the overall principles of cognitive rehabilitation, including an enhanced section on telerehabilitation.
• Latest and emerging evidence on management of posttraumatic amnesia, including recent findings on structured error-controlled and procedural learning approaches.
• Rehabilitation of attention and processing speed – reflecting ongoing limitations within the evidence for behavioral interventions.
• Latest approaches to executive function, including the “evolving and strengthening” evidence on metacognitive strategy instruction and the usage of telerehabilitation to advertise recovery.
• Revised and updated recommendations for cognitive-communication disorders. A key focus is the growing appreciation of the importance of the role of social cognition in forming and maintaining relationships after TBI.
• Strategies for rehabilitation of memory impairment, which proceed to be probably the most widely used cognitive rehabilitation interventions.

“The Way forward for INCOG (Is Now),” based on a concluding article by Peter Bragge, PhD, of Monash University, Melbourne, Australia, and colleagues. They discuss recent advances within the review and guideline sciences, corresponding to “living” guidelines which are kept up thus far on a more continuous basis, and their relevance to INCOG 2.0 and future updates. The brand new document incorporates enhanced guidance for clinicians and healthcare administrators and revised clinical algorithms to support decision making and individualized interventions.

The members of the Expert Panel reaffirm their commitment to prioritizing and continually improving advances in research and clinical practice in cognitive rehabilitation. Dr. Bayley and colleagues write: “We recognize that much work stays and hope that INCOG 2.0 is a positive step toward promoting higher outcomes for those living with the consequences of TBI.”

Source:

Journal reference:

Bayley, M.T., et al. (2023) INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: What’s Modified From 2014 to Now?. Journal of Head Trauma Rehabilitation. doi.org/10.1097/HTR.0000000000000826.