IHad万uma RebabilVol.38,No.1,pp.24-37Copyright 2023 The Authors.Published by Wolters Kluwer Health,Inc.OPENINCOG 2.0 Guidelines for CognitiveRehabilitation Following TraumaticBrain Injury,Part I:PosttraumaticAmnesiaJennie Ponsford,A0,PhD,MA;Jessica Trevena-Peters,BOT/PsySc,DPsych;Shannon Janzen,MSc;Amber Harnett,MSc,BSc;Shawn Marshall,MD,MSc,FRCPC;Eleni Patsakos,MSc;Ailene Kua,MSc,PMP;Amanda Mclntyre,RN;Robert Teasell,MD,FRCPC;Catherine Wiseman-Hakes,PhD,Reg CASLPO;Diana Velikonja,PhD,MScCP;Mark Theodore Bayley,MD,FRCPC;Adam McKay,PhD,MPsych;on Behalf of the INCOG Expert PanelIntroduction:Posttraumatic amnesia(PTA)is a common occurrence following moderate to severe traumatic braininjury (TBI)and emergence from coma.It is characterized by confusion,disorientation,retrograde and anterogradeamnesia,poor attention and frequently,agitation.Clinicians and family need guidelines to support managementpractices during this phase.Methods:An intemational team ofresearchers and clinicians(known as INCOG)met toupdate the INCOG guidelines for assessment and management of PTA.Previous recommendations and audit criteriawere updated on the basis of review of the literature from 2014.Results:Six management recommendations weremade:1 based on level A evidence,2 on level B,and 3 on level C evidence.Since the first version of INCOG (2014).3 recommendations were added:the remainder were modified.INCOG 2022 recommends that individuals shouldbe assessed daily for PTA,using a validated tool (Westmead PTA Scale),until PTA resolution.To date,no cognitiveor pharmacological treatments are known to reduce PTA duration.Agitation and confusion may be minimized bya variety of environmental adaptations including maintaining a quiet,safe,and consistent environment.The use ofneuroleptic medications and benzodiazepines for agitation should be minimized and their impact on agitation andcognition monitored using standardized tools.Physical therapy and standardized activities of daily living trainingusing procedural and errorless leaming principles can be effective,but delivery should be tailored to concurrentlevelsof cognition,agitation,and fatigue.Conclusions:Stronger recommendations regarding assessment of PTA durationAuthor Affdliations:Monash Epwonb Rebabiltation Researd Cenre,Tirner Institute for Brain and Menta Healtb,Scbool of PsycbologicalWe gratgfully adnowledge the support of the Ministry of Healtb of the provinceScienes,Monash University Melboume,Australa Dr Pongford,of Ontario,Canada.Trevena-Peters and McKay);Epwonb HealtbCare,Melbourne,AustraliaThe project described in this artick was funded through tbe Ministry of HealthDrs Ponsford and McKay);Lauson Healtb Research Istitute,Parkwoodof the province of Ontario,Canada.The authors declare that the finders didInstitide,London,Ontario,Canada (Mss lanzen,Harnett,and Mclntyrenot participate in the organization of the project nor the expert panel proces,and Dr Tiase);The Otau Hospital Rebabilitation Center,Universityofevidence sy
