INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part IV: Cognitive-Communication and Social Cognition Disorders
Journal of Head Trauma Rehabilitation
Togher, L., Douglas, J., et al. (2023).
Journal of Head Trauma Rehabilitation, 38(1), 65-82.
This guideline is an update of the INCOG guideline by Togher et al. (2014). This guideline provides recommendations for the management of cognitive-communication and social cognition in adults with traumatic brain injury (TBI). This guideline targets all healthcare professionals, including SLPs, who work with adults with TBI. This guideline is part of a series of guidelines published by the INCOG (International Group of Cognitive Researchers and Clinicians) working group.
INCOG Expert Panel
For individuals with TBI, a cognitive-communication evaluation and rehabilitation program "should be culturally responsive and take into account the person’s premorbid physical and psychosocial variables, including gender identity; native, first, and preferred languages; literacy and language proficiency; cognitive abilities; communication style considering expectations in the person’s cultural linguistic background and tradition; and gender identity" (p. 68; Level C Evidence). Additionally healthcare providers should receive cultural competence training (Level C Evidence).
Individuals with cognitive-communication and social cognition disorders following TBI should be provided with interventions and materials grounded in the principles of cognitive-communication rehabilitation and include direct or indirect interventions such as:<br />
<ul>
<li>communication partner training and,</li>
<li>communication strategy and metacognitive awareness training (Level A Evidence).</li>
</ul>
Treatment should be individualized, provide opportunity for practice, target communication skills in situations where the person lives, works, studies, and socializes and use goal attainment scaling to measure person-centered intervention outcomes (Level A Evidence).
For individuals with cognitive-communication and social cognitive disorders post TBI, direct or indirect interventions should focus on: <br />
<ul>
<li><span style="color: #333333;">reintegration to daily functions, productive activities, participation and competence, </span></li>
<li><span style="color: #333333;">modification of the communication environment, and assistance with adjustment to impairments, </span></li>
<li><span style="color: #333333;">communication coping treatment, confidence, self-esteem, and identity formation and, </span></li>
<li><span style="color: #333333;">provision of education and information regarding the nature of acquired cognitive-communication disorders to both the patient and communication partners (Level C Evidence).</span></li>
</ul>
For individuals with TBI, "clinicians should consider evaluating aspects of social cognition ability, including emotion perception, theory of mind (ToM), and emotional empathy. Social cognition interventions, which aim at improving emotion perception, perspective taking, ToM, and social behavior, are recommended. Computerized social cognition treatments are not recommended given lack of evidence of generalization to real-life activities" (p. 73; Level A Evidence).
It is recommended that individuals with a severe communication impairment following TBI receive an evaluation by a trained clinician to determine the need for augmentative and alternative communication (AAC) use and intervention. The individual and communication partner should receive ongoing training to effectively use AAC aids (Level C Evidence).
"Telerehabilitation is as efficacious, feasible, and acceptable for communication partner training compared to in-person intervention" for individuals with cognitive-communication and social cognition disorders post TBI (p. 75; Level B Evidence).
