INCOG Recommendations for Management of Cognition Following Traumatic Brain Injury, Part IV

TLDR

Cognitive‑communication disorders are common after traumatic brain injury and can severely affect long‑term outcomes. The INCOG group aimed to create evidence‑based guidelines for assessing and treating cognitive‑communication disorders in TBI and to outline future research priorities. An expert panel reviewed the literature, selected recommendations, and developed decision algorithms, prioritization, and audit criteria to facilitate implementation. Strong evidence supports person‑centered, individualized rehabilitation—including assistive‑technology training, partner involvement, contextual practice, group formats, errorless learning, and metacognitive strategies—to improve cognitive‑communication outcomes after TBI.

Abstract

Introduction: Cognitive-communication disorders are common in individuals with traumatic brain injury (TBI) and can have a major impact on long-term outcome. Guidelines for evidence-informed rehabilitation are needed, thus an international group of researchers and clinicians (known as INCOG) convened to develop recommendations for assessment and intervention. Methods: An expert panel met to select appropriate recommendations for assessment and treatment of cognitive-communication disorders based on available literature. To promote implementation, the team developed decision algorithms incorporating the recommendations, based on inclusion and exclusion criteria of published trials, and then prioritized recommendations for implementation and developed audit criteria to evaluate adherence to best practice recommendations. Results: Rehabilitation of individuals with cognitive-communication disorders should consider premorbid communication status; be individualized to the person's needs, goals, and skills; provide training in use of assistive technology where appropriate; include training of communication partners; and occur in context to minimize the need for generalization. Evidence supports treatment of social communication problems in a group format. Conclusion: There is strong evidence for person-centered treatment of cognitive-communication disorders and use of instructional strategies such as errorless learning, metacognitive strategy training, and group treatment. Future studies should include tests of alternative service delivery models and development of participation-level outcome measures.