Oculomotor Treatment in Traumatic Brain Injury Rehabilitation: A Randomized Controlled Pilot Trial

Abstract

Importance: Vision impairments are common after traumatic brain injury (TBI). Little evidence exists to assist clinicians with effective interventions for impaired oculomotor skills in people with TBI. Objective: To pilot a randomized controlled trial (RCT) of oculomotor treatment in TBI rehabilitation. Design: An impairment-based oculomotor protocol was compared with an activity-based standard of care in a two-group RCT. Participants were masked to assignment. Setting: Inpatient rehabilitation. Participants: For 1 yr, 138 people with TBI, ages 18–65 yr, were screened. Twenty-six were eligible; 6 declined. Inclusion criteria: oculomotor impairment. Exclusion criteria: inpatient stay <6 wk, blind, no functional arm use, unable to follow a three-step command, attention <30 min, or in another clinical trial. Intervention: Participants were randomized into an experimental group (n = 10) receiving the Six Eye Exercises protocol or a control group (n = 10) receiving a standard-of-care protocol for 30 min/day, 5 days/wk, for 4 wk. Oculomotor and related functional impairments were measured at baseline and posttreatment. Outcomes and Measures: Measures were chosen before the start. Primary outcome measure: Craig Hospital Eye Evaluation Rating Scale for oculomotor status. Secondary measures for functional status: King-Devick Test, Delis–Kaplan Executive Function System Trail Making Test: Condition 1 Visual Scanning, Modified Nelson–Denny Reading Test, and Subjective Vision Symptom Scale. Results: Sixteen participants finished. Fatigue was the primary reason for withdrawal. No other negative effects were noted. Selected outcome measures captured positive improvements in both groups. Conclusions and Relevance: Study findings suggest conducting an appropriately powered RCT to evaluate efficacy of oculomotor treatment in this population. What This Article Adds: Oculomotor dysfunction seems to improve during inpatient TBI rehabilitation with remedial treatment. Best practice in occupational therapy has not yet been established. An appropriately powered RCT could positively contribute to the evidence available to clinicians.

Concussion-Related Vision Disorder Practice Patterns in Occupational Therapy: A Survey

“…The data from this study suggests that there is no set standard of practice regarding intervention and treatment for concussion-related vision disorders by occupational therapists across the country. More studies like Berryman et al (2020) need to be conducted to establish evidence for best practice. Data also suggests that occupational therapy is uncertain of whom to refer for proper identification but want to work with eye care specialists in the remediation of this problem to improve occupational performance.…”

“…They identify specific objective measures to assess concussion-related vision disorders in occupational therapy in order to develop functional goals in specific tasks. In addition, Berryman and Ravage (2011;Berryman et al, 2020) agree that occupational therapists are key contributors to addressing visual impairments in the ABI population from evaluation through intervention. They also identify as functions of the occupational therapist assessing and treating the areas of visual perception, visual-motor integration, and participation in ADLs that involve visual input, like driving.…”

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

“…In addition, many limitations exist in completed studies, including small sample sizes, a lack of controls, and a lack of well-described patient populations or interventions [ 16 •]. One pilot study, a small, randomized control trial, compared an oculomotor vision exercise protocol with an activity-based standard of care for improving oculomotor function in patients with TBI [ 48 •• ] . Both groups received an evaluation from an optometrist and treatment from OTs.…”

Oculomotor control in children with Special Educational Needs (SEN): the development and piloting of a novel app-based therapeutic intervention

“…Rehabilitation in CVI in the most severe cases has focused on the patient's fixation and pursuit of a target [10]. Saccade, tracking (pursuit) and fixation exercises are commonly used rehabilitation methods across different patient groups and ages [11,12]. A scoping review by Williams and colleagues [13] highlighted two studies where training eye movements resulted in improvements [14,15].…”