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

Abstract

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.

Speech pathologists' perspectives on the use of augmentative and alternative communication devices with people with acquired brain injury and reflections from lived experience

“…The American Speech-Language-Hearing Association (ASHA) describes Augmentative and Alternative Communication (AAC) as any strategy or equipment that supplements or compensates for impairments a person experiences in order to understand or express a message (ASHA, n.d.). This includes unaided strategies such as facial expressions, gestures and signs, light technology or non-electronic options such as alphabet boards, choice cards or communication books, and high-tech / electronic specialised speech generating devices like a Lightwriter™ or Grid Pad™ (ASHA, n.d.; Fager et al, 2006; International Society for Augmentative and Alternative Communication (ISAAC), n.d.; Jamwal et al, 2017; Togher et al, 2023). Electronic AAC options can be accessed through direct touch, switching and scanning, or other alternate access options, including eye gaze, head stick or mouse control.…”

“…The communication changes experienced after ABI require a range of interventions. A combination of restorative and compensatory communication strategies is recommended and, in some instances, interventions will include the development or application of augmentative and/or alternative communication systems (Fried-Oken, et al, 2012; Togher et al, 2023). The American Speech-Language-Hearing Association (ASHA) describes Augmentative and Alternative Communication (AAC) as any strategy or equipment that supplements or compensates for impairments a person experiences in order to understand or express a message (ASHA, n.d.).…”

“…Speech pathologists are trained in speech-language production and comprehension, and can assess language and communication abilities, individual goals, and support needs (MacDonald, 2017; Togher et al, 2023). They are the main allied health professionals that undertake AAC assessment, trials, training and education, and make recommendations to individuals with ABI who may benefit from such communication aids (ASHA, n.d.).…”

“…These include, for example, posture, seating and physical capacity, and new learning ability, behaviour and perceptual skills of the person with ABI. Physiotherapists, neuropsychologists and occupational therapists may therefore also assess and input across these areas of consideration (Togher et al, 2023). This multi-disciplinary approach then informs recommendations regarding AAC learning needs and direct or alternate access requirements; device mounting, reach and access; and positioning and postural support of the person with ABI (Cook, et al, 2020).…”

“…Specific to the person, it is well recognised that individual preferences must be closely considered in relation to the use of augmentative or alternative communication options (WHO/UNICEF, 2022; Togher et al, 2023). Research highlights the importance of matching an AAC system with the goals and preferences of the individual using the product, and including the person with an ABI throughout the entire assessment, recommendation and implementation phases of AAC to reduce the risk of AAC abandonment and maximise acceptance (Blackstone et al, 2002; Fager et al, 2006).…”