IHad万na RebabilVol.38,No.1,Pp.38-51Copyright 2023 The Authors.Published by Wolters Kluwer Health,Inc.OPENINCOG 2.0 Guidelines for CognitiveRehabilitation Following TraumaticBrain Injury,Part II:Attention andInformation Processing SpeedJennie Ponsford,A0,PhD,MA;Diana Velikonja,PhD,MScCP;Shannon Janzen,MSc;Amber Harnett,MSc,BSc;Amanda Mclntyre,RN;Catherine Wiseman-Hakes,PhD,Reg CASLPO;Leanne Togher,PhD,BAppSc;Robert Teasell,MD,FRCPC;Ailene Kua,MSc,PMP:Eleni Patsakos,MSc;Penny Welch-West,MCLSc,SLP Reg CASLPO;Mark Theodore Bayley,MD,FRCPCIntroduction:Moderate to severe traumatic brain injury (MS-TBI)commonly causes disruption in aspects ofattention due to its diffuse nature and injury to frontotemporal and midbrain reticular activating systems.Attentionalimpairments are a common focus of cognitive rehabilitation,and increased awareness of evidence is needed tofacilitate informed clinicalpractice.Methods:An expert panel of clinicians/researchers(known as INCOG)reviewedevidence published from 2014 and developed updated guidelines for the management of attention in adults,as wellas a decision-making algorithm,and an audit tool for review of clinical practice.Results:This update incorporated27 studies and made 11 recommendations.Two new recommendations regarding transcranial stimulation and anherbal supplement were made.Five were updated from INCOG 2014 and 4 were unchanged.The team recommendsscreening for and addressing factors contributing to attentional problems,including hearing,vision,fatigue,sleep-wake disturbance,anxiety,depression,pain,substance use,and medication.Metacognitive strategy training focusedon everyday activities is recommended for individuals with mild-moderate attentional impairments.Practice on de-contextualized computer-based attentional tasks is not recommended because of lack of evidence of generalizationbut direct training on everyday tasks,induding dual tasks or dealing with background noise,may lead to gainsfor performance of those tasks.Potential usefulness of environmental modifications is also discussed.There isinsufficient evidence to support mindfulness-based meditation,periodic alerting,or noninvasive brain stimulationAuthor Affdliations:Monasb-Epworth Rebabilitation Research CentreThe autbors gratefully acnowledge the support of the Ministry of Health of theTirner Institute for Brain and Mental Healtb,School of psycbologicalprovinc of Onario,Canada.Sciences,Monasb University,Mdbourne,Aistralia,and EpworthHealtbcare,Melbourne Australia(Dr Pongford);Acquired Brain InjuryThe proiect describ灰d in this manuscrip西funded through版Miws)Program,Hamilon Health Scieces,Hamilton,Ontario,Canada,andof Health of the province of Ontario,Canada (Lead:Dr Mark Bayley).Departmen of pspchiatry and Bebavioural Neirosciencs,DeGrooteThe authors declare that no competing financial interests exist.The authorsSchool of Medicine,McMaster University.Hamilton,Ontario,Canadafiurther declare that the fiunders did mt participate in the organization of
