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

Abstract

INCOG 2.0 guidelines expert panel (2022)

Equity considerations in clinical practice guidelines for traumatic brain injury and homelessness: a systematic review

“…A minority of CPGs for TBI considered equity, including disadvantaged populations, in guideline development. Disadvantaged populations highlighted in CPGs for TBI and CPGs for homelessness included individuals: experiencing homelessness; 16 , 25 of a non-white race/ethnicity; 28 , 29 of a lower socioeconomic status or experiencing financial barriers to accessing services; 27 , 30 living in underserved regions (remote and rural areas, limited access to care in small medical centres); 31 , 32 , 33 with a history of incarceration or who are in correction and detention facilities; 28 , 34 who experienced intimate partner violence; 28 of cultural and ethnic groups; 26 , 27 , 29 , 35 , 36 , 37 , 38 , 39 , 40 , 41 and from aboriginal communities. 42 , 43 , 44 , 45 Up to five CPGs for TBI (≤8.8%) discussed TBI burden, 27 , 42 , 44 , 45 , 46 biology of the condition, patient adherence to intervention, baseline risks, and/or care 42 , 44 for disadvantaged populations, and up to six CPGs for TBI (≤10.5%) dedicated part of or the entire CPG to the care of disadvantaged populations, 42 , 43 , 44 considered their perspective 42 , 44 , 45 , 47 , 48 , 49 and provided separate recommendations, 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ,…”

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

“…Multiple review studies have been conducted in the past five years to update evidence-based clinical recommendations for the most effective practices of cognitive rehabilitation [6][7][8][9][10][11]41,42 . Collectively, these studies provide practicing clinicians with levels of recommendations based on strong evidence from the literature (practice standards), to areas with lesser evidence (practice guidelines and practice options).…”

“…The INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury [6][7][8][9][10][11]42 provide a series of important updates regarding such clinical practice guidelines, specifically relevant to post-traumatic amnesia, attention/processing speed, executive function, social communication, and memory. These guidelines provide a summary of Level A, B, and C evidence across the aforementioned cognitive domains and provide strong support for the use of metacognitive strategy training and environmental modification in the cognitive rehabilitation of TBI.…”

“…This may include functional improvements in various activities of daily living, improved quality of life, improved social relationships or emotional regulation, and/or ability to return to work/school. Currently, rehabilitation of moderate to severe TBI remains biased toward participation in activities of daily living (ADLs); however, cognition has a vital role to play in functional return to instrumental activities of daily living (IADLs), particularly in the generally younger inpatient rehabilitation population 10 . This may directly impact a TBI survivor's ability to live independently, return to work, and engage in the community 22 .…”

“…Widespread effects on physical and/or cognitive abilities, emotional processing, and/or changes impacting behavior and social relationships may persist in the short-or long-term, depending on the injury type and the severity level 3,4 . Moderatesevere TBI, defined by a Glasgow Coma Scale 5 rating of 12 or less, is associated with numerous cognitive sequelae, which may include difficulty with memory, attention, executive functions, understanding literal or figurative language, using appropriate words to express oneself, analyzing situations, and making appropriate decisions [6][7][8][9][10] . The effects of these difficulties are myriad and may impact daily living, participation in meaningful activities, employment, and education; which in turn may negatively impact quality of life and result in withdrawal from social activities 11,12 .…”