INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part III: Executive Functions

Authors

Eliyas Jeffay, KITE Research Institute
Jennie Ponsford, Monash University
Amber Harnett, Lawson Health Research Institute
Shannon Janzen, Lawson Health Research Institute
Eleni Patsakos, University of Toronto
Jacinta Douglas, La Trobe University
Mary Kennedy, Chapman UniversityFollow
Ailene Kua, University of Toronto
Robert Teasell, Lawson Health Research Institute
Penny Welch-West, University of Western Ontario
Mark Theodore Bayley, University of Toronto
Robin Green, University of Toronto

Document Type

Article

Publication Date

1-2023

Abstract

Introduction:

Moderate-to-severe traumatic brain injury (MS-TBI) causes debilitating and enduring impairments of executive functioning and self-awareness, which clinicians often find challenging to address. Here, we provide an update to the INCOG 2014 guidelines for the clinical management of these impairments.

Methods:

An expert panel of clinicians/researchers (known as INCOG) reviewed evidence published from 2014 and developed updated recommendations for the management of executive functioning and self-awareness post-MS-TBI, as well as a decision-making algorithm, and an audit tool for review of clinical practice.

Results:

A total of 8 recommendations are provided regarding executive functioning and self-awareness. Since INCOG 2014, 4 new recommendations were made and 4 were modified and updated from previous recommendations. Six recommendations are based on level A evidence, and 2 are based on level C. Recommendations retained from the previous guidelines and updated, where new evidence was available, focus on enhancement of self-awareness (eg, feedback to increase self-monitoring; training with video-feedback), meta-cognitive strategy instruction (eg, goal management training), enhancement of reasoning skills, and group-based treatments. New recommendations addressing music therapy, virtual therapy, telerehabilitation-delivered metacognitive strategies, and caution regarding other group-based telerehabilitation (due to a lack of evidence) have been made.

Conclusions:

Effective management of impairments in executive functioning can increase the success and well-being of individuals with MS-TBI in their day-to-day lives. These guidelines provide management recommendations based on the latest evidence, with support for their implementation, and encourage researchers to explore and validate additional factors such as predictors of treatment response.

Comments

This article was originally published in Journal of Head Trauma Rehabilitation, volume 38, issue 1, in 2023. https://doi.org/10.1097/HTR.0000000000000834

Recommended Citation

Jeffay, Eliyas PhD, CPsych; Ponsford, Jennie AO, PhD, MA(Clinical Neuropsychology); Harnett, Amber RN, MSc; Janzen, Shannon MSc; Patsakos, Eleni MSc; Douglas, Jacinta PhD, MSc(Psych); Kennedy, Mary PhD, CCC-SLP; Kua, Ailene MSc, PMP; Teasell, Robert MD, FRCPC; Welch-West, Penny MClSc, SLP Reg CASLPO; Bayley, Mark MD, FRCPC; Green, Robin PhD, CPsych. INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part III: Executive Functions. Journal of Head Trauma Rehabilitation 38(1):p 52-64, January/February 2023. | https://doi.org/10.1097/HTR.0000000000000834

Peer Reviewed

1

Copyright

The authors

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.