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INCOG Recommendations for Management of Cognition Following Traumatic Brain Injury, Part IV: Cognitive Communication

Togher, Leanne BAppSc, PhD; Wiseman-Hakes, Catherine PhD; Douglas, Jacinta BAppSc, MSc; Stergiou-Kita, Mary PhD; Ponsford, Jennie MA, PhD; Teasell, Robert MD, FRCPC; Bayley, Mark MD; Turkstra, Lyn S. PhD, CCC-SLP

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 353–368
doi: 10.1097/HTR.0000000000000071
Original Articles

Introduction: Cognitive-communication disorders are common in individuals with traumatic brain injury (TBI) and can have a major impact on long-term outcome. Guidelines for evidence-informed rehabilitation are needed, thus an international group of researchers and clinicians (known as INCOG) convened to develop recommendations for assessment and intervention.

Methods: An expert panel met to select appropriate recommendations for assessment and treatment of cognitive-communication disorders based on available literature. To promote implementation, the team developed decision algorithms incorporating the recommendations, based on inclusion and exclusion criteria of published trials, and then prioritized recommendations for implementation and developed audit criteria to evaluate adherence to best practice recommendations.

Results: Rehabilitation of individuals with cognitive-communication disorders should consider premorbid communication status; be individualized to the person's needs, goals, and skills; provide training in use of assistive technology where appropriate; include training of communication partners; and occur in context to minimize the need for generalization. Evidence supports treatment of social communication problems in a group format.

Conclusion: There is strong evidence for person-centered treatment of cognitive-communication disorders and use of instructional strategies such as errorless learning, metacognitive strategy training, and group treatment. Future studies should include tests of alternative service delivery models and development of participation-level outcome measures.

Speech Pathology, Faculty of Health Sciences, The University of Sydney, Australia (Dr Togher); NHMRC Centre of Research Excellence in Traumatic Brain Injury Psychosocial Rehabilitation, Australia (Drs Togher and Ponsford and Ms Douglas); Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada (Dr Wiseman-Hakes); Department of Human Communication Sciences, La Trobe University, Victoria, Australia (Ms Douglas); Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada (Dr Stergiou-Kita); School of Psychology and Psychiatry, Monash University and Epworth Hospital, Melbourne, Australia (Dr Ponsford); National Trauma Research Institute, Monash University and The Alfred Hospital (Dr Ponsford); Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, Parkwood Hospital, London, Ontario, Canada (Dr Teasell); Department of Physical Medicine and Rehabilitation, Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada (Dr Teasell); UHN–Toronto Rehabilitation Institute and Division of Physical Medicine and Rehabilitation University of Toronto, Toronto, Ontario, Canada (Dr Bayley); and Department of Communication Sciences and Disorders, University of Wisconsin-Madison (Dr Turkstra).

Corresponding Author: Leanne Togher, BAppSc, PhD, Speech Pathology, Faculty of Health Sciences, The University of Sydney, Rm. No 155, 75 East St, Lidcombe NSW, Australia (

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.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins