Media release

From: Monash University

An international team of leading traumatic brain injury researchers, led by University of Toronto in collaboration with Monash University, have published a major update to the ground-breaking INCOG guidelines for cognitive rehabilitation following traumatic brain injury (TBI).

Originally published in 2014, the newly released ‘INCOG 2.0’ guidelines reflect the most up-to-date evidence for rehabilitation of cognitive function following TBI, and have been published in a special issue of the Journal of Head Trauma Rehabilitation.

More than 20,000 Australians are hospitalised with a TBI every year. A TBI happens when a sudden, external, physical assault damages the brain and can range from mild, temporary symptoms through to much more serious, long-term complications.

Studies show that patients can greatly benefit from a range of intervention therapies during the early recovery phase to enhance functional independence and optimise their ability to function and enjoy life. The INCOG 2.0 guidelines summarises the gold standard recommendations for health professionals involved in rehabilitation of patients with TBI.

Guideline co-lead, Professor Jennie Ponsford of Monash’s Turner Institute for Brain and Mental Health and Director of the Monash-Epworth Rehabilitation Research Centre, said that despite being confused and agitated, patients have been shown to respond to a range of therapies resulting in increased independence, shorter length of stay in hospital and significant cost savings.

“A major contribution from the Monash researchers involved in the guidelines has been identifying the most effective therapies and strategies during early recovery from TBI, including structured activities of daily living, training and physical therapy, and ways of minimising agitation. More effective interventions at later stages of recovery are those embedded into the patient’s everyday life, involving family and significant others.” said Professor Ponsford.

“There is also increasing evidence to support the use of technology, such as smartphones, aiding independence.”

Professor Ponsford also said a major addition to the updated version of the guidelines is a new section on telerehabilitation, which was necessitated due to the COVID-19 pandemic:

“In recent years there has been a rapid pivot to telehealth-assisted rehabilitation and therefore the authors recognised a timely need for updated evidence-based recommendations for in-person and virtual cognitive rehabilitation. It’s crucial to be able to reach people in rural and remote regions to allow for continuing treatment and Monash researchers are leading the way in evaluating delivery of rehabilitation via telehealth.”

Corresponding author, Dr Mark Bayley from University of Toronto, said that prior to publication of the first version of INCOG, the team prioritised cognitive rehabilitation among all other areas within the field of TBI rehabilitation for a number of reasons.

“TBI causes diffuse damage to the brain networks that are essential for attention, memory, executive functions, and cognitive aspects of communication. At the same time, ongoing systematic reviews highlight that cognitive rehabilitation is one of the rapidly growing evidence bases within the field of TBI rehabilitation, however clinicians have challenges applying the evidence in this field to everyday practice, resulting in a significant knowledge-to-practice gap,” said Dr Bayley.

“Our guidelines aim to address this gap by giving health professionals such as doctors, speech pathologists, physiotherapists, neuropsychologists and occupational therapists the tools and information they need to optimise cognitive rehabilitation.”

Professor Peter Bragge from Monash’s BehaviourWorks Australia and Director of the Monash Sustainable Development Institute Evidence Review Service reflected on how the underlying review methods that support the guidelines have advanced since the original INCOG guidelines were published in 2014.

“COVID-19 and the ongoing acceleration of technology have led to exponential increases in demand for up-to-date knowledge to support decision-making. However in responding to these pressures, guideline developers should ensure that key principles of guideline production are followed. These include ensuring guidelines respond to real-world patient needs; allocating professional development time to health professionals to keep up with new knowledge; and measuring practice to ensure it is consistent with best-available knowledge” said Professor Bragge.

Other Monash researchers involved in developing the guidelines include Dr Adam McKay and Dr Jessica Trevana Peters from the Monash Epworth Rehabilitation Research Centre.

The full guidelines, entitled INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: What's Changed From 2014 to Now? can be found here.

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