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INCOG Recommendations for Management of Cognition Following Traumatic Brain Injury, Part V: Memory

Velikonja, Diana PhD; Tate, Robyn PhD; Ponsford, Jennie PhD; McIntyre, Amanda MSc; Janzen, Shannon MSc; Bayley, Mark MD, FRCPC

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

The Journal of Head Trauma Rehabilitation: July/August 2014 - Volume 29 - Issue 4 - p 369–386
doi: 10.1097/HTR.0000000000000069
Original Articles

Introduction: Traumatic brain injury results in complex cognitive sequelae. Impairments in memory are among the most common sequelae resulting in significant functional problems. An international team of researchers and clinicians (known as INCOG) was formed to develop recommendations for the management of impairments in memory.

Methods: The experts met to select appropriate recommendations and then reviewed available literature to ensure 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 the best practice recommendations.

Results: The recommendations for rehabilitation of memory impairments support the integration of internal and external compensatory strategies implemented using appropriate instructional techniques that consider functional relevance and important patient characteristics. Restorative strategies have regained significant popularity, given broader access to computer technology; however, evidence for efficacy of these techniques remains weak and the choice in using these should be guided by special considerations.

Conclusion: There is good evidence for the integration of internal and external compensatory memory strategies that are implemented using instructional procedures for rehabilitation for memory impairments. The evidence for the efficacy of restorative strategies currently remains weak.

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 (Dr Velikonja); NHMRC Centre of Research Excellence in Traumatic Brain Injury Psychosocial Rehabilitation, Sydney, New South Wales, Australia (Drs Tate and Ponsford); Royal Rehabilitation Centre, Sydney, New South Wales, Australia (Dr Tate); Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School–Northern, University of Sydney, Sydney, New South Wales, Australia (Dr Tate); School of Psychology and Psychiatry, Monash University and Epworth Hospital, Melbourne, Victoria, Australia (Dr Ponsford); National Trauma Research Institute, Monash University and the Alfred Hospital, Melbourne, Victoria, Australia (Dr Ponsford); Lawson Health Research Institute, St. Joseph's Parkwood Hospital, London, Ontario, Canada (Mss McIntyre and Janzen); and Neuro Rehabilitation Program, Toronto Rehabilitation Institute, University of Toronto, Toronto, Ontario, Canada (Dr Bayley).

Corresponding Author: Diana Velikonja, PhD, Acquired Brain Injury Program, Regional Rehabilitation Centre, Hamilton Health Sciences, 300 Wellington St North, Hamilton, ON L8L 0A4, Canada (

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 INCOG developers, contributors, and supporting partners shall not be liable for any damages, claims, liabilities, costs, or obligations arising from the use or misuse of this material, including loss or damage arising from any claims made by a third party.

The authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins