Evidence-informed intervention ideas: Addressing cognition for adults with traumatic brain injury

Clients with a traumatic brain injury (TBI) frequently experience cognitive symptoms, such as reduced attention, memory impairments, decreased insight, and executive dysfunction. Because these symptoms can interfere with a client’s ability to participate in valued occupations, such as activities of daily living (ADLs) and work, occupational therapy practitioners working with this population should provide interventions that address cognition. Practitioners are encouraged to use these Evidence-Informed Intervention Ideas as a guide for clinical decision making but should review the Systematic Review Brief on this topic (Radomski, Giles, Carroll, Anheluk, & Yunek, 2022) for more specific information.

Evidence-Informed Intervention Ideas

• Complete a task analysis to break down the steps and provide appropriate support for the client
• Begin ADL training early in recovery
• Provide just the right amount of support so that the client is not using trial and error to learn, and instead is successful with each step of the task (errorless learning)
• Use whole tasks and routines to facilitate learning (procedural learning)
• Provide client education on the following topics:
  • Traumatic brain injury
    • Possible symptoms
    • Natural course of symptoms
    • Common problems associated with TBI (e.g., return-to-work challenges, relationship issues, sleep disturbances), including secondary conditions (e.g., depression, headaches)
  • Importance of physical activity for recovery
  • Symptom management
    • Sleep hygiene
    • Strategies to improve mental health, such as stress reduction techniques, and cognitive behavioral therapy (CBT) principles to support occupational engagement
    • Headache management strategies
• Coordinate with care team, family, or caregivers
  • Work with other members of the client’s care team (e.g., nurses, caregivers, physicians, psychologists, chaplain) to address barriers and symptoms as appropriate
  • Educate family and caregivers on TBI symptoms and strategies that are being implemented
  • Connect the client with peers who have a similar condition
• Implement compensatory strategies
  • Create a daily schedule and routines to support pacing and memory
  • Have the client use a workbook to track their goals and progress
  • Teach the client the “Goal - Plan – Do – Check" strategy, based on the Cognitive Orientation to daily Occupational Performance (CO-OP) Model
  • Teach the client how to use a problem-solving strategy (i.e., define problem, brainstorm solutions, evaluate pros/cons of different solutions, choose a solution, implement the solution, monitor the effectiveness of the solution, evaluate outcome)
  • Set up memory aids (e.g., a daily calendar, reminders, to-do lists in order of priority)
  • Teach strategies for memory and learning (e.g., writing things down, repetition, chunking, rhymes, acronyms, visual imagery)
  • Teach skills to support attention and focus (e.g., asking questions, paraphrasing, using self-talk)
  • Use an app to set up a custom prompting system for each step of a task, and/or automatic reminders for safety
• Environment considerations
  • Address safety concerns in any environment
  • Reduce external distractions
  • Provide orientation to the environment and tools before starting a task
  • Complete tasks in the client's typical environment instead of a simulated environment when possible

Reference: Radomski, M. V., Giles, G. M., Carroll, G., Anheluk, M., & Yunek, J. (2022). Cognitive interventions to improve a specific cognitive impairment for adults with TBI (June 2013-October 2020). American Journal of Occupational Therapy, 76 (2), 7613393170. https://doi.org/10.5014/ajot.2022/76S2017

Checklist developed by Victoria Southwell, OTS