Guidelines for Cognitive Rehabilitation

Ponsford, J., Velikonja, D., Janzen, S., Harnett, A., McIntyre, A., Wiseman-Hakes, C., Togher, L., Teasell, R., Kua, A., Patsakos, E., Welch-West, P., & Bayley, M. T. (2023). INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part II: Attention and Information Processing Speed. The Journal of head trauma rehabilitation, 38(1), 38–51. https://doi.org/10.1097/HTR.0000000000000839

• Findings: The INCOG 2.0 Guidelines (Part II) synthesize current evidence on treating attention deficits that are caused after moderate to severe traumatic brain injury (MS-TBI). They recommended screening for/addressing factors contributing to attentional problems (such as hearing, vision, fatigue, sleep-wake disturbance, anxiety, depression, pain, substance use, and medication). They recommend metacognitive strategy training focused on everyday activities, and provide evidence that methylphenidate and MLC901 (NeuroAiD IITM) can enhance selective attention in individuals with mild-moderate TBI.

American College of Surgeons (ACS) Best Practice Guidelines

American College of Surgeons. (2024). Best practices guidelines: The management of traumatic brain injury [PDF]. American College of Surgeons.https://www.facs.org/media/vgfgjpfk/best-practices-guidelines-traumatic-brain-injury.pdf

• Findings: This ACS TQP Best Practices Guidelines provides evidence-based information regarding caring for the TBI patient. It highlights key points about patient management, post-acute care, and how to implement and integrate these best practice guidelines.

Pappadis, M. R., Lundine, J. P., Kajankova, M., Hreha, K. P., Doria, N., Cai, X. C., & Flanagan, J. E. (2023). Education on the consequences of traumatic brain injury for children and adolescents with TBI and families/caregivers: a systematic scoping review. Brain injury, 37(1), 1–23. https://doi.org/10.1080/02699052.2022.2145357

• Findings: This scoping review found that TBI education was provided primarily in the emergency department or outpatient/community setting, and that educational topics varied. It also found that greater efforts are needed to target education or training specifically to children or adolescents with TBI and for their siblings.

Cicerone, K. D., Goldin, Y., Ganci, K., Rosenbaum, A., Wethe, J. V., Langenbahn, D. M., Malec, J. F., Bergquist, T. F., Kingsley, K., Nagele, D., Trexler, L., Fraas, M., Bogdanova, Y., & Harley, J. P. (2019). Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014. Archives of physical medicine and rehabilitation, 100(8), 1515–1533. https://doi.org/10.1016/j.apmr.2019.02.011

• Findings: This systematic review looked at 186 articles. It found evidence supporting cognitive rehabilitation supporting attention deficits after TBI/stroke, visual scanning for neglect after right-hemisphere stroke, compensatory strategies for mild memory deficits, language deficits after left-hemisphere stroke, social-communication deficits after TBI, metacognitive strategy training for deficits in executive functioning, and comprehensive-holistic neuropsychological rehabilitation to reduce cognitive and functional disability after TBI or stroke.

Elliott, M., & Parente, F. (2014). Efficacy of memory rehabilitation therapy: a meta-analysis of TBI and stroke cognitive rehabilitation literature. Brain injury, 28(12), 1610–1616. https://doi.org/10.3109/02699052.2014.934921

• Findings: This meta-analysis of 26 studies found that memory rehabilitation was an effective therapeutic intervention.

Chen, J., Zhu, T., Yu, D., Yan, B., Zhang, Y., Jin, J., Yang, Z., Zhang, B., Hao, X., Chen, Z., Yan, C., & Yu, J. (2023). Moderate Intensity of Treadmill Exercise Rescues TBI-Induced Ferroptosis, Neurodegeneration, and Cognitive Impairments via Suppressing STING Pathway. Molecular neurobiology, 60(9), 4872–4896. https://doi.org/10.1007/s12035-023-03379-8

• Findings: This study found that moderate-intensity treatment exercise rescues TBI-induced ferroptosis (iron-dependent form of regulated cell death) and rescues cognitive deficits. Treadmill exercise also reduced anxiety, enhanced spatial memory recovery, and improved social novelty, which is a key aspect of social interaction. This study suggests that exercise is an effective intervention for TBI-induced motor and cognitive disorders.

Noël, F., Gagnon, M. P., Lajoie, J., Côté, M., Caron, S. M., Martin, A., Labrie-Pichette, A., & Carvalho, L. P. (2023). Inpatient Physical Therapy in Moderate to Severe Traumatic Brain Injury in in Older Adults: A Scoping Review. International journal of environmental research and public health, 20(4), 3367. https://doi.org/10.3390/ijerph20043367

• Findings: This study found that physiotherapy is effect in TBI acute rehabilitation in the elderly, and that it can prevent complications arising from the primary injury and improve functional capacities. It suggests that that the elderly population benefits from physiotherapy interventions as much as adults.

Tramontano, M., Belluscio, V., Bergamini, E., Allevi, G., De Angelis, S., Verdecchia, G., Formisano, R., Vannozzi, G., & Buzzi, M. G. (2022). Vestibular Rehabilitation Improves Gait Quality and Activities of Daily Living in People with Severe Traumatic Brain Injury: A Randomized Clinical Trial. Sensors (Basel, Switzerland), 22(21), 8553. https://doi.org/10.3390/s22218553

• Findings: This study found that vestibular rehabilitation (VR) treatments showed improvements in activity of daily living (ADL) and gait smoothness and quality in patients with severe TBI.

Olsson, S. E., Singh, H., Kerr, M. S., Podlesh, Z., Chung, J., & Tjan, A. (2023). The role of transcranial magnetic stimulation in treating depression after traumatic brain injury. Brain Stimulation, 16(2), 456–457. https://doi.org/10.1016/j.brs.2023.02.005

• Findings: This review found that rTMS was an effective treatment for patients with post-concussion depression.

Leung, A. Y., Metzger‑Smith, V., He, Y., Cordero, J., Ehlert, B., Song, D., Lin, L., Shahrokh, G., Tsai, A., Vaninetti, M., Rutledge, T., Polston, G., Sheu, R., & Lee, R. (2018). Left dorsolateral prefrontal cortex rTMS in alleviating MTBI‑related headaches and depressive symptoms. Neuromodulation: Technology at the Neural Interface, 21(4), 390–401. https://doi.org/10.1111/ner.12615

• Findings: This study found that a short course of TMS at the left dorsolateral prefrontal cortex can alleviate mild TBI headaches and lead to improvements in mood.

Virtual Reality-based cognitive training

Johansen, T., Matre, M., Tornås, S., Løvstad, M., Ponsford, J. L., Olsen, A., & Lund, A. (2025). I thought it would be difficult, but this is actually something I can do - experiences with Virtual Reality-based cognitive training in persons with TBI. Annals of medicine, 57(1), 2490218. https://doi.org/10.1080/07853890.2025.2490218

• Findings: This qualitative study investigated the experiences of participants, aged 18-65 with TBI, who use Virtual Reality (VR)  for rehabilitation at home. The researchers concluded that participants found VR easy to use, engaging and motivating, but emphasized that there should be individual tailoring of this intervention to make it a more effective treatment.