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INCOG Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: Methods and Overview

Bayley, Mark Theodore MD; Tate, Robyn PhD; Douglas, Jacinta Mary PhD; Turkstra, Lyn S. PhD; Ponsford, Jennie PhD; Stergiou-Kita, Mary PhD, MSc, BSc OT; Kua, Ailene MSc; Bragge, Peter PhD

Section Editor(s): Bayley, Mark Theodore MD; Bragge, Peter PhD; Ponsford, Jennie PhD

Journal of Head Trauma Rehabilitation: July/August 2014 - Volume 29 - Issue 4 - p 290–306
doi: 10.1097/HTR.0000000000000070
Original Articles

Introduction: Traumatic brain injury results in complex cognitive sequelae. However, clinicians have difficulty implementing the available evidence. An international group of researchers and clinicians (known as INCOG) convened to develop clinical practice guidelines for cognitive rehabilitation posttraumatic brain injury.

Methods: The Guidelines Adaptation and Development cycle was used to derive the recommendations. Previously published cognitive rehabilitation recommendations were identified and tabulated. An expert panel met to select appropriate recommendations. Afterward, the team enhanced the recommendations by reviewing available literature. To address shortfalls of previous guidelines, the team developed decision algorithms incorporating the recommendations based on inclusion and exclusion criteria of published trials and expert opinion. The team then prioritized the recommendations for implementation and developed audit criteria to evaluate adherence to best practice.

Results: The team recommends that individuals have detailed assessments of cognition after resolution of posttraumatic amnesia. Cognitive assessment and rehabilitation should be tailored to the patient's neuropsychological profile, premorbid cognitive characteristics, and goals for life activities and participation. Clinical algorithms and audit tools to evaluate current practice are provided.

Conclusion: Cognitive rehabilitation should be offered to select individuals with traumatic brain injury. These guidelines provide assistance to clinicians who want to provide evidence-based care.

Supplemental Digital Content is Available in the Text.

Brain and Spinal Cord Rehabilitation Program (Dr Bayley), Toronto Rehabilitation Institute/University Health Network (Dr Kua), Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Dr Bayley); Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School–Northern, University of Sydney, Royal Rehabilitation Centre, Sydney, New South Wales, Australia (Dr Tate); Department of Human Communication Sciences, La Trobe University, Melbourne, Victoria, Australia (Dr Douglas); Department of Communication Sciences and Disorders, University of Wisconsin–Madison (Dr Turkstra); School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia (Dr Ponsford); Toronto Rehabilitation Institute, Toronto, Ontario, Canada (Dr Stergiou-Kita); Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada (Dr Stergiou-Kita); and National Trauma Research Institute & Monash University, Melbourne, Victoria, Australia (Dr Bragge).

Corresponding Author: Mark Theodore Bayley, MD, Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute/University Health Network, 190 Elizabeth St, Toronto, ON M5G 2C4, Canada (

The project described in this article was funded by the Victorian Neurotrauma Initiative—a research program of the Transport Accident Commission and Monash University's Strategic Grants Scheme (Lead CI: Peter Bragge) and the Ontario Neurotrauma Foundation (Lead CI: Mark Bayley). The authors gratefully acknowledge the support of the Victorian Transport Accident Commission through its Victorian Neurotrauma Initiative, Monash University, and the Ontario Neurotrauma Foundation for their support of this project.

The authors declare no conflicts of interests.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

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