INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part V: Memory
Journal of Head Trauma Rehabilitation
Velikonja, D., Ponsford, J., et al. (2023).
Journal of Head Trauma Rehabilitation, 38(1), 83-102.
This clinical practice guideline is an update of the INCOG guideline by Velikonja et al. (2014). This guideline provides recommendations for the management of memory disorders in adults with traumatic brain injury (TBI). The target audience of this guideline is any healthcare professionals, including SLPs, working 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
Internal compensatory strategies are recommended for individuals with memory impairment due to TBI. Internal strategies may be most effective for individuals with mild-to-moderate memory impairments and/or some preserved executive cognitive skills. The following strategies can be selected separately or combined in a structured program and/or taught in a group or individual format: <br />
<ul>
<li><span style="color: #333333;">instructional strategies (e.g., visual imagery, Preview, Question, Read, State, Test [PQRST], repeated practice, and retrieval practice)</span></li>
<li><span style="color: #333333;"> metacognitive strategies (eg, self-awareness and self-regulation). </span></li>
</ul>
<span style="color: #333333;">For individuals with severe memory impairment secondary to TBI, internal compensatory strategies may be used in conjunction with external memory compensatory strategies (Level A Evidence).</span>
Environmental supports and reminders (e.g., mobile/smartphones, notebooks, and whiteboards) are recommended for individuals with memory impairments post TBI, especially for those with severe memory impairment. "Individuals with TBI and their caregivers must be trained in how to use these supports. The selection of environmental supports and reminders should take into account the following factors: <br />
<ul>
<li><span style="color: #333333;">age,</span></li>
<li><span style="color: #333333;">severity of impairment, </span></li>
<li><span style="color: #333333;">premorbid use of electronic and other memory devices, </span></li>
<li><span style="color: #333333;">cognitive strengths and weaknesses (e.g., executive cognitive skills),</span></li>
<li><span style="color: #333333;">physical comorbidities,</span></li>
<li><span style="color: #333333;"> affordability, portability, and reliability" (p. 89; Level A Evidence).</span></li>
</ul>
"Cognitive skills training for [individuals with moderate-severe TBI, across all levels of memory impairment, should be strategy-focused and conducted by a TBI-experienced therapist who can facilitate the functional integration of the strategy being practiced into meaningful and practical tasks" (p. 90; Level B Evidence).
"Group-based interventions may be considered for teaching memory strategies with individuals with moderate-severe TBI, but there is no evidence that it is more effective than individually oriented rehabilitation. Consider reducing heterogeneity in group membership, encourage participation for an adequate number of sessions, and teach generalization of learned skills" (p. 90; Level A Evidence).
Key instructional practices that can promote learning for individuals with TBI-related memory impairments include: <br />
<ul>
<li><span style="color: #333333;">clearly selecting, defining and training intervention goals that are relevant/ecologically valid, breaking down tasks into smaller components (e.g., task analysis when training multistep procedures), </span></li>
<li><span style="color: #333333;">allowing sufficient time and opportunity for practice, use of distributed practice, </span></li>
<li><span style="color: #333333;">teaching strategies using variations in the stimuli/information (e.g., multiple exemplars) and teaching strategies to promote effortful processing of in- formation/stimuli (e.g., verbal elaboration, visual imagery), </span></li>
<li><span style="color: #333333;">using techniques that constrain errors (e.g., errorless learning, spaced retrieval), and </span></li>
<li><span style="color: #333333;">using behavioral memory strategies in the acquisition phase of learning (e.g., focus on context and imagery) (Level A Evidence).</span></li>
</ul>
