Evidence-Based Practice Guidelines for Cognitive-Communication Disorders after Traumatic Brain Injury: Initial Committee Report. (ANCDS Bulletin Board)

Article excerpt

Jack Avery, Carl Coelho, McKay Sohlberg, Lyn Turkstra, Mark Ylvisaker, and Kathryn Yorkston (ad hoc member)

There is growing interest in the evidence that supports clinical rehabilitation practice. This evidence can be observed in several media, including conference presentations delivered by experts, experimental studies published in peer-reviewed journals, and even in the general press. The Academy of Neurologic Communication Disorders and Sciences (ANCDS) created a Writing Committee for Evidence-based Practice Guidelines (EBPG) in Cognitive-Communication Disorders after Traumatic Brain Injury (TBI), as a part of ANCDS's larger EBPG project. For an introduction to ANCDS's guidelines project, readers are referred to Golper and colleagues (2001). For a summary of the application of EBPG to speech-language pathology, readers are referred to Yorkston and colleagues (2001). The activities of the Cognitive-Communication Disorders Writing Committee are described in this report.

DEVELOPING EBPG FOR CLINICAL DECISION-MAKING

The ANCDS EBPG Coordinating Committee appointed a chair of the Cognitive-Communication TBI Committee. Committee members were selected on the basis of expertise in managing cognitive-communication disorders in individuals with TBI of varying levels of severity, as well as their experience in conducting clinical research and knowledge of the treatment literature. They have expertise with TBI survivors across the lifespan (from children to adults) and across service delivery models (from medical rehabilitation to community and school settings). Committee members have extensive knowledge of the range of management approaches, including intervention aimed at discrete cognitive processes, training specific skills, developing functional compensatory and supportive systems, and behavior management. Several members have participated on advisory boards of cognitive rehabilitation programs across the country and are on committees of other organizations concerned with rehabilitating TBI survivors (e.g., American Psycholo gical Association, American Speech-Language and Hearing Association).

BASIC ASSUMPTIONS ABOUT COGNITIVE-COMMUNICATION DISORDERS

The committee was convened and the charge of creating EBPGs for managing cognitive-communication disorders after TBI was discussed. The committee agreed that the term traumatic brain injury applies to survivors of nonprogressive, acquired traumatic injury to the brain including specific regions (e.g., frontal lobes). Managing cognitive-communication disorders includes the assessment and treatment of underlying cognitive processes (e.g., attention, memory, self-monitoring, executive function) as they interact and are manifested in communication behavior, broadly understood (listening, reading, writing, speaking, gesturing), and at all levels of language (phonological, morphologic, syntactic, semantic, pragmatic).

The committee identified several assumptions about the nature and management of cognitive-communication disorders after TBI that served as the basis for the project's scope and organization (see Table 1).

This project is intended to assist speech-language pathologists (SLPs) when making clinical decisions about the course of assessment and intervention for cognitive-communication disorders. Ultimately, the purpose of these EBPGs is to ensure and improve quality of care provided to TBI individuals with cognitive-communication disorders.

Evidence for Cognitive Rehabilitation: A Brief Review

Several recent publications have emerged in the rehabilitation literature summarizing evidence for cognitive rehabilitation, a broadly defined field of intervention that includes cognitive-communication intervention (e.g., Carney et al., 1999; Chesnut et al., 1999; Cicerone et al., 2000; Coelho, DeRuyter, & Stein, 1996; NIH consensus report, 1998). One of the earliest publications by Coelho and colleagues reviewed the treatment efficacy research through 1994, citing varying amounts of evidence for attention, memory, pragmatics, and executive function training. …