INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part I: Posttraumatic Amnesia

Journal of Head Trauma Rehabilitation

Ponsford, J., Trevena-Peters, J., et al. (2023).

Journal of Head Trauma Rehabilitation, 38(1), 24-37.

This clinical practice guideline is an update of the INCOG guideline by Ponsford et al. (2014). It provides recommendations for the assessment and management of posttraumatic amnesia (PTA). The target audience of this guideline is any healthcare professional, including speech-language pathologists, working with adults with traumatic brain injury (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

Individuals with TBI should receive a daily PTA assessment using the Westmead Post-Traumatic Amnesia Scale until resolution of PTA (p. 26; Level B Evidence).

"To manage and minimize agitation and confusion associated with PTA, individuals with TBI should remain in a secure and supervised environment, ideally the hospital, until they have emerged from PTA. It is recommended to: <br /> <ul> <li><span style="color: #333333;">maintain a quiet, safe, and consistent environment and avoid overstimulation; </span></li> <li><span style="color: #333333;">consider the use of low-stimulation rooms; </span></li> <li><span style="color: #333333;">evaluate the impact of visitors, assessment, and therapy, and limit these activities if they cause agitation or excessive fatigue; </span></li> <li><span style="color: #333333;">allow rest and sleep as needed, facilitating night-time sleep and daytime wakefulness as tolerated; </span></li> <li><span style="color: #333333;">minimize the use of physical restraints to allow the person to move around freely; </span></li> <li><span style="color: #333333;">have consistent healthcare professionals or trained caregivers working with the person with TBI; </span></li> <li><span style="color: #333333;">establish, and utilize, the most reliable and simple means of communication; </span></li> <li><span style="color: #333333;">provide frequent reassurance; </span></li> <li><span style="color: #333333;">present familiarizing information as tolerated by the person; </span></li> <li><span style="color: #333333;">identify and address triggers for agitation; </span></li> <li><span style="color: #333333;">supervised listening to patient-preferred music may reduce agitation; and help family members understand PTA, and how to best engage and minimize triggering agitation." (p. 28; Level C Evidence)</span></li> </ul>

A speech-language pathologist should monitor swallowing and communication for persons with TBI. Treating team members should use short and simple communication and keep repeated orientation and memory questioning to a minimum (p. 29; Level C Evidence).