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PURPOSE: Traumatic brain injury (TBI) is a leading cause of death and injury in the United States. In fact, it is estimated that 1.5 million Americans experience them every year (CDC, 2022). Visual impairments may be a symptom following TBI (Richman, 2014). This affects an individual’s ability to perform activities of daily living (ADLs) such as dressing, hygiene, and functional mobility, including the reading required for these activities. The purpose of this systematic review was to synthesize the evidence and intervention options within the scope of occupational therapy for adults post-TBI experiencing visual symptoms.
DESIGN: We conducted a systematic review of the literature from 2002 to 2022 that included adults 18 years and older post TBI, had a measurable ADL outcome, and were within the scope of occupational therapy.
METHOD: We reviewed 163 articles and abstracts from CINAHL, Cochrane, PubMed, and Scopus databases. Eighty-seven articles were retrieved for full review and seven met inclusion criteria. U.S. Preventative Task Force levels of certainty and grade definitions were used to describe the strength of evidence.
RESULTS: Articles were themed by intervention type: oculomotor and compensatory scanning training, and training in device use. Five articles ranging from Level I-III evidence focused on oculomotor and compensatory scanning training and provide moderate strength of evidence to improve ADL performance post-TBI. Oculomotor and compensatory scanning training dosages ranged from 20 to 90 minutes sessions 1-2 times a week, for 4 to 11 weeks. Two articles, one each of Level II and III evidence, addressed training in device use, providing low strength of evidence to improve ADL performance post-TBI. These devices may include the BrainPort Vision Pro, prisms, a dichoptic device, or a cheiroscope with 4-10 hours of training.
CONCLUSION: Based on moderate strength of evidence, we recommend routine use of oculomotor and compensatory scanning training for individuals experiencing visual symptoms post-TBI. Device use training should be done on a case-by-case basis due to low strength of evidence. Many of the interventions in this systematic review were exercise- rather than occupation-based. Rote eye exercises without link to occupation may be considered outside the occupational therapy scope of practice, therefore integration with occupation and collaboration with an eye care professional is important.
Practitioners should consider collaborating with researchers to design occupation-based interventions that can be tested with larger sample sizes to determine effective interventions to improve ADL performance in adults post-TBI experiencing visual symptoms. Professional development can ensure occupational therapists have advanced training and education in oculomotor and compensatory scanning.
IMPACT STATEMENT: Current research supports oculomotor and compensatory scanning training for adults post-TBI experiencing visual symptoms. Future research should continue to explore occupation-based interventions for this population to maximize visual function for performance of everyday activities.
Centers for Disease Control and Prevention. (2022, January 6). Multiple cause of death data on CDC wonder. Centers for Disease Control and Prevention. https://wonder.cdc.gov/mcd.html
Richman, E. (2014, March). Traumatic brain injury and visual disorders: What every ophthalmologist should know. American Academy of Ophthalmology; EyeNet Magazine. https://www.aao.org/eyenet/article/traumatic-brain-injury-visual-disorders-what-every-2
Jarman, Connor BS; Vander Haar, Olivia BMS; Wobken, Lauren BS; Smallfield, Stacy DrOT, MSOT, OTR/L, BCG, FAOTA; and Whitlow, Molly PhD, MPH, "Occupational Therapy Interventions for ADLs in Adults Post-TBI with Visual Symptoms: A Systematic Review" (2022). Student Systematic Reviews: Occupational Therapy. 2.