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

Journal of Head Trauma Rehabilitation

Jeffay, E., Ponsford, J., et al. (2023).

Journal of Head Trauma Rehabilitation, 38(1), 52-64.

This clinical practice guideline is an update of the INCOG guideline by Tate et al. (2014). This guideline provides recommendations for the management of executive function and self-awareness skills 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

The majority of the recommendations included in this guideline are based on literature from nonmilitary civilian populations, mostly male sex and middle-aged adults. Therefore caution should be used with applying these recommendations for individuals who fall outside of these characteristics (e.g., younger ages).

For individuals with impaired executive function due to TBI, self-monitoring and feedback are recommended to enhance self-awareness. Strategies that encourage self-monitoring of performance and involve feedback should be used and self-awareness training such as video feedback to improve the ability to recognize and correct errors during task performance should be considered for individuals with impaired self-awareness (Level A Evidence).

For individuals with executive functioning impairment due to TBI, metacognitive strategy instruction is recommended. Metacognitive strategies should be used for difficulties across a range of executive functioning impairments, including problem-solving, planning and organization, and other elements of executive function. Metacognitive strategies should include: <br /> <ul> <li><span style="color: #333333;">self-monitoring, </span></li> <li><span style="color: #333333;">incorporatiation of feedback into future performance, </span></li> <li><span style="color: #333333;">emotional self-regulation training, and </span></li> <li><span style="color: #333333;">target individualized problems in everyday situations and functional outcomes (Level A Evidence).</span></li> </ul>

"Strategies to improve the capacity to analyze and synthesize information should be used with individuals with TBI who have impaired reasoning skills." Additionally, group-based format should be considered for remediation of executive function and problem solving deficits(p. 57; Level A Evidence).

It is recommended that clinicians consider the use of virtual reality programs, when available, in addition to in-person visits to provide timely and equitable access to care for individuals with executive dysfunction post TBI (Level A Evidence).

Remotely-delivered interventions targeting executive function are recommended for individuals with TBI if most convenient or the only mode of access (Level C Evidence). However, remotely-delivered group-based executive function treatments may not achieve the same outcomes as in-person treatment and requires further evaluation (Level C Evidence).

No recommendations at this time.