Clinical Practice Guidelines for Occupational Therapists in the Evaluation and Treatment of Oculomotor Impairment Following Traumatic Brain Injury

Abstract

Purpose of review Currently, a lack of guidelines exists regarding best practices for occupational therapists (OTs) in the treatment and evaluation of oculomotor dysfunction following traumatic brain injury (TBI). Furthermore, individuals with TBI would benefit significantly from collaboration between OTs and optometrists during inpatient rehab. Recent findings Although few articles examine interdisciplinary models of inpatient rehab care that include optometry, a recent pilot study is explored. Emerging evidence from the field of optometry supports the use of restorative approaches for oculomotor impairment in mild TBI; however, cases with moderate to severe TBI are not addressed. Summary We describe an interdisciplinary approach involving collaboration between optometry and occupational therapy, yielding a comprehensive model to effectively evaluate and treat oculomotor impairments in those with TBI and facilitate improved performance in daily activities. We also provide guidelines useful for OTs working in settings where collaboration with optometry is not feasible.

Exploring the Impact of a Hybrid Telehealth Program for Adults Living With Low Vision

“…The primary barriers to this program evaluation were the lack of standardized outcome measures and the small sample size. This was partly due to the dynamic environment of the COVID-19 pandemic and the need for rapid innovation and partly because there is a lack of validated performance-based assessments for those with low vision 10. In addition, further research is needed to create or adapt tools to fit the telehealth platform.…”

“…9 In addition, many individuals experience vision loss related to brain injury. 6,10 Despite the prevalence of those impacted by low vision, there are a limited number of clinicians who specialize in the treatment and rehabilitation of those living with low vision. 3 As of November 2021, only 106 of the 126 610 practicing occupational therapists in the United States had a specialty certification in low vision (SCLV) from the American Occupational Therapy Association (AOTA).…”

“…The most common diseases that result in low vision are age-related macular degeneration, diabetic retinopathy, and glaucoma,6–8 and the risk of acquiring these diseases increases with age 9. In addition, many individuals experience vision loss related to brain injury 6,10…”

Low Vision and Driving

“…Eye diseases such as age-related macular degeneration (AMD), diabetic retinopathy, macular edema, glaucoma, and cataracts are often identified as leading causes of vision loss and visual impairment in older adults 6,12,19. In addition, visual impairment may result from brain injury, stroke, or optic nerve disease, which can affect people of all ages 20. Degenerative eye diseases such as AMD produce distinct visual changes such as reduced visual acuity, which can impact driving ability 22.…”

Subconcussion, Concussion, and Cognitive Decline: The Impact of Sports Related Collisions

“…Similarly, increasing the proportion of contextualized functional therapies (versus decontextualized, clinic-based therapies) as part of the OT regimen following TBI has been found to increase treatment efficacy in a similarly heterogeneous cohort [ 97 ]. Oculomotor impairment has been implicated as a contributor to long-term functional impairment following mild TBI, and pilot study data has suggested that closer collaboration between occupational therapy and optometry may be indicated for patients with these symptoms [ 98 ]. Occupational therapy targeting impairments in ability to drive a vehicle have also been shown to be effective in a cohort of returning combat veterans who suffered mild TBI as well as other injuries [ 99 ].…”