Introduction: Traumatic brain injury, due to its diffuse nature and high frequency of injury to frontotemporal and midbrain reticular activating systems, may cause disruption in many aspects of attention: arousal, selective attention, speed of information processing, and strategic control of attention, including sustained attention, shifting and dividing of attention, and working memory. An international team of researchers and clinicians (known as INCOG) convened to develop recommendations for the management of attentional problems.
Methods: The experts selected recommendations from published guidelines and then reviewed literature to ensure that recommendations were current. Decision algorithms incorporating the recommendations based on inclusion and exclusion criteria of published trials were developed. The team then prioritized recommendations for implementation and developed audit criteria to evaluate adherence to these best practices.
Results: The recommendations and discussion highlight that metacognitive strategy training focused on functional everyday activities is appropriate. Appropriate use of dual task training, environmental modifications, and cognitive behavioral therapy is also discussed. There is insufficient evidence to support mindfulness meditation and practice on de-contextualized computer-based tasks for attention. Administration of the medication methylphenidate should be considered to improve information-processing speed.
Conclusion: The INCOG recommendations for rehabilitation of attention provide up-to-date guidance for clinicians treating people with traumatic brain injury.
NHMRC Centre of Research Excellence in Traumatic Brain Injury Psychosocial Rehabilitation, Canberra, Australia (Drs Ponsford, Togher, and Tate); School of Psychological Sciences, Monash University and Epworth Hospital, Melbourne, Australia (Dr Ponsford); National Trauma Research Institute, Monash University and the Alfred Hospital, Melbourne, Australia (Dr Ponsford); Neuro Rehabilitation Program, Toronto Rehabilitation Institute, University of Toronto, Toronto, Canada (Dr Bayley); Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada (Dr Wiseman-Hakes); Speech Pathology, Faculty of Health Sciences, The University of Sydney, New South Wales, Australia (Dr Togher); Neuropsychology, Acquired Brain Injury Program, Hamilton Health Sciences, Hamilton, Ontario, Canada (Dr Velikonja); Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada (Ms Velikonja); Lawson Health Research Institute, London, Canada (Mss McIntyre and Janzen); Royal Rehabilitation Centre Sydney, New South Wales, Australia (Dr Tate); and Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School—Northern, University of Sydney, Australia (Dr Tate).
Corresponding Author: Jennie Ponsford, MA, PhD, School of Psychological Sciences, Monash University, Clayton, 3800, Victoria, Aistralia (firstname.lastname@example.org).
The authors gratefully acknowledge the support of the Victorian Transport Accident Commission (TAC) through its Victorian Neurotrauma Initiative (VNI), Monash University, and the Ontario Neurotrauma Foundation (ONF) for their support of this project.
The authors declare no conflicts of interest.