American Speech-Language-Hearing Association Clinical Practice Guideline: Cognitive Rehabilitation for the Management of Cognitive Dysfunction Associated With Acquired Brain Injury
American Journal of Speech-Language Pathology
Guideline Development Panel, Brown, J., et al. (2022).
American Journal of Speech-Language Pathology, 31(6), 2455-2526.
This evidenced-based clinical practice guideline is sponsored by the American Speech-Language-Hearing Association (ASHA). It provides recommendations for the provision of cognitive rehabilitation to adults with cognitive dysfunction associated with acquired brain injury (ABI). The target audience of this guideline is speech-language pathologists working with adult populations, however other audiences include patients, their families and carepartners, other rehabilitation specialists, payers, and policy-makers.
American Speech-Language-Hearing Association (ASHA)
<div>"ASHA recommends that adults with cognitive dysfunction associated with ABI receive holistic, integrated cognitive rehabilitation that is clinician directed, person centered, and evidence based (p. 2471; Recommendation, Low Certainty of Evidence). Additional recommendations pertaining to cognitive rehabilitation include: </div>
<ul>
<li><span style="color: #333333;">implementation of restorative and compensatory treatments based on the needs of the individual, their cognitive severity, and stage of recovery;</span></li>
<li><span style="color: #333333;">domain-specific treatments targeting impaired memory, attention, executive function, and/or social communication skills, which may include one or more treatment approach for the management of generalized cognitive dysfunction;</span></li>
<li><span style="color: #333333;">integration of decontextualized and contextualized treatment approaches with an emphasis on contextualized activities to maximize function and self-awareness;</span></li>
<li><span style="color: #333333;">use of computer-based treatment when part of a clinician-directed plan of care; and</span></li>
<li><span style="color: #333333;"> consideration of demographic and other factors that may contribute to the patient’s response to treatment (Recommendation; Executive Summary p. 2456).</span></li>
</ul>
<div>ASHA recommends that the timing, dosage, and format of cognitive rehabilitation be considered when treating adults with cognitive dysfunction associated with ABI. Specifically, treatment should:</div>
<ul>
<li><span style="color: #333333;">be initiated as early as possible and be extended beyond the acute phase of recovery based on progress, trajectory of functional improvement, and attainment of meaningful goals;</span></li>
<li><span style="color: #333333;">incorporate the use of group treatment when needed to increase opportunities of peer interaction and generalization; and</span></li>
<li><span style="color: #333333;"> utilize a telehealth delivery method to increase access to care (Recommendation; Executive Summary p. 2456).</span></li>
</ul>
<div>"Speech-language pathologists (SLPs) play a central role in the screening, assessment, and treatment of adults with cognitive dysfunction associated with ABI" (p. 2456; Consensus Recommendation). Additional consensus-based recommendations pertaining to assessment and treatment include: </div>
<ul>
<li><span style="color: #333333;">a timely, symptom-focused assessment of cognitive-communication skills by an SLP;</span></li>
<li><span style="color: #333333;">a comprehensive assessment using a variety of objective, subjective and ecologically valid measures; </span></li>
<li><span style="color: #333333;">use of tools such as the Goal Attainment Scale to assist in the development of individualized, meaningful, time-limited, and measurable treatment goals;</span></li>
<li><span style="color: #333333;"> use of patient-reported outcome measures to facilitate tracking of perceived functional progress and patient satisfaction;</span></li>
<li>a plan of care developed in concert with the patient and carepartners with consideration of the patient's views, cultural and linguistic background, premorbid lifestyle, and activity limitation and participation restrictions; and</li>
<li>dynamic assessment and monitoring of functional performance to determine response to treatment (Recommendation; Executive Summary p. 2456).</li>
</ul>
