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Hong HT, Jeong MG, Kim KT. Feasibility of Computerized Visuomotor Integration System for Visual Field Defects and Spatial Neglect in Poststroke Patients. Ann Rehabil Med 2024; 48:146-154. [PMID: 38658046 PMCID: PMC11058365 DOI: 10.5535/arm.230028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/18/2024] [Accepted: 03/05/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE To develop a computerized visuomotor integration system for assessment and training of visual perception impairments and evaluate its safety and feasibility in patients with a stroke. Visual field defects and spatial neglect lead to substantial poststroke impairment. Most diagnostic assessments are anchored in traditional methods, and clinical effects of rehabilitation treatments are limited. METHODS The CoTras Vision system included two evaluations and four training modules. The evaluation modules were based on the Albert's test and Star cancellation test, and training modules were based on visual tracking, central-peripheral integration, and visuomotor perception techniques. Bland-Altman plots for agreement with the traditional paper-and-pencil test were performed, and the modified Intrinsic Motivation Inventory, Patient Satisfaction Questionnaire, and Simulator Sickness Questionnaire were conducted. RESULTS Ten patients with acute stroke completed the study. Bland-Altman plots revealed good agreements for Albert's test (mean difference, -0.3±4.5) and Star cancellation test (mean difference, 0.3±0.7). The mean±standard deviation scores of the modified Intrinsic Motivation Inventory, Patient Satisfaction Survey, and Simulator Sickness Questionnaire were 84.7±30.6, 40.5±7.9, and 34.0±34.5 respectively. CONCLUSION The CoTras Vision system is feasible and safe in patients with stroke. Most patients had a high degree of motivation to use the system and did not experience severe adverse events. Further studies are needed to confirm its usefulness in stroke patients with visual field defects and hemineglect symptoms. Furthermore, a large, well-designed, randomized controlled trial will be needed to confirm the treatment effect of the CoTras Vision system.
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Affiliation(s)
- Hyeon-Taek Hong
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
- Department of Rehabilitation Science, Graduate School, Daegu University, Gyeongsan, Korea
| | - Myeong Geun Jeong
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Kyoung Tae Kim
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
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Kemp AM, O'Brien KH, Wallace T. Reconceptualizing Recovery After Concussion: A Phenomenological Exploration of College Student Experiences. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:867-882. [PMID: 36108288 DOI: 10.1044/2022_ajslp-22-00076] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Typical measures of recovery from concussion-such as symptom scales, neurocognitive testing, or exertion measures-may not capture individualized experiences of concussion. This report examines how college students with concussion interact with and consider their recovery. METHOD Sixteen college students who sustained concussions while in college completed 40- to 75-min semistructured interviews. All were enrolling to become mentors in a peer mentoring program for students with concussion. Questions addressed experiences as a college student with concussion, life changes following concussion, and role of peers in recovery. Using phenomenological reduction, analysis focused on the phenomenon of recovery and motivation for participation in a mentoring program. RESULTS Two main themes were found: (a) What Recovery Looks Like and (b) Gaining Perspective, Learning to Cope and Adapting to Change. Thirteen participants denied the label of "recovered" even though all had been deemed recovered and discharged from medical care. Instead, two subthemes emerged within What Recovery Looks Like: Ongoing Recovery and Reconceptualizing Recovery. Perceptions of recovery were influenced by effort, capacity, and resilience. In the second theme, students described strategies, resources, and supports used to cope with their injuries; most commonly used was emotion-focused coping. CONCLUSIONS College students with concussion consider recovery as an ongoing process rather than a dichotomized condition. Student experiences may not be reflected in commonly used symptom scales or objective assessments. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21084925.
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Affiliation(s)
- Amy M Kemp
- Department of Communication Sciences and Special Education, University of Georgia, Athens
| | - Katy H O'Brien
- Department of Communication Sciences and Special Education, University of Georgia, Athens
| | - Tracey Wallace
- SHARE Military Initiative at Shepherd Center, Crawford Research Institute, Complex Concussion Clinic, Atlanta, GA
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Kaldenberg J, Newman R, Jimenez C, Walker M. Vision Therapy Interventions to Support Occupational Performance for People With Traumatic Brain Injury With Visual Symptoms (June 2013-October 2020). Am J Occup Ther 2022; 76:23917. [PMID: 36165888 DOI: 10.5014/ajot.2022/76s2006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of interventions that address visual impairments and visual perception to improve occupational performance for adults with traumatic brain injury.
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Affiliation(s)
- Jennifer Kaldenberg
- Jennifer Kaldenberg, DrPH, MSA, OTR/L, SCLV, FAOTA, is Interim OTD Program DirectorClinical Associate Professor, Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Robin Newman
- Robin Newman, OTD, MA, OTR/L, CLT, FAOTA, is Clinical Assistant Professor, Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Christine Jimenez
- Christine Jimenez, OTS, is a graduate student at Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Mary Walker
- Mary Walker, OTS, is a graduate student at Boston University College of Health & Rehabilitation Sciences: Sargent College
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Crampton A, Teel E, Chevignard M, Gagnon I. Vestibular-ocular reflex dysfunction following mild traumatic brain injury: A narrative review. Neurochirurgie 2021; 67:231-237. [PMID: 33482235 DOI: 10.1016/j.neuchi.2021.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/10/2021] [Indexed: 12/28/2022]
Abstract
Mild traumatic brain injury (mTBI) is a prevalent injury which occurs across many populations, including children and adolescents, athletes, military personnel, and the elderly. mTBI can result in various subjective symptoms and clinical deficits, such as abnormalities to the vestibulo-ocular reflex (VOR). Over 50% of individuals with mTBI are reported to have VOR abnormalities, which strongly contribute to feelings of dizziness and unsteadiness. Dizziness is a strong predictor for prolonged recovery following mTBI and is additionally linked with mental health difficulties and functional limitations affecting likelihood of return to work. Early diagnosis, and subsequent treatment, of VOR deficits following mTBI may greatly improve recovery outcomes and a patient's quality of life, but a thorough comprehension of the related pathophysiology is necessary to understand the assessments used to diagnose VOR abnormalities. Therefore, the purpose of this article is i) provide readers with an introduction on the VOR physiology to facilitate understanding about mTBI-related abnormalities, and ii) to discuss current assessments that are commonly used to measure VOR function following mTBI. As the VOR and oculomotor (OM) systems are heavily linked and often work in tandem, discussion of the relevant aspects of the OM system is also provided.
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Affiliation(s)
- Adrienne Crampton
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada.
| | - Elizabeth Teel
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada
| | - Mathilde Chevignard
- Rehabilitation Department for Children with Acquired Neurological Injury and Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals, Paris, France; Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France; GRC 24 HaMCRe, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada; Montreal Children Hospital, McGill University Health Center, Montreal, QC, Canada
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Clinical Practice Guidelines for Occupational Therapists in the Evaluation and Treatment of Oculomotor Impairment Following Traumatic Brain Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021; 9:93-99. [PMID: 34094719 PMCID: PMC8171233 DOI: 10.1007/s40141-021-00310-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 02/08/2023]
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.
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Gartz R, Dickerson A, Radloff JC. Comparing Component-Based and Occupation-Based Interventions of a Person with Visual Deficits' Performance. Occup Ther Health Care 2020; 35:40-56. [PMID: 33347359 DOI: 10.1080/07380577.2020.1862443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed to compare the effectiveness of component-based, occupation-based, and a combined intervention for visual-scanning to improve occupational performance. This exploratory case study used a 55-year-old female, seven years post-stroke with visual field deficits, who completed a component-based intervention (Vision Coach), an occupation-based intervention (IADL activities that incorporated scanning tasks), and a combined intervention. The Assessment of Motor and Process Skills (AMPS) was completed prior to and after each intervention. Participant's data was compared between interventions and AMPS standardization sample, with observable improvements in motor skills and process skills. Visual-scanning training as a compensatory method appears to be effective for chronic visual field deficits post-stroke, particularly using component-based and occupation-based interventions in combination.
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Affiliation(s)
- Rachel Gartz
- Rehabilitation - SCI/GR, Vidant Medical Center, Greenville, NC, USA
| | - Anne Dickerson
- Occupational Therapy, East Carolina University, Greenville, NC, USA
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Berryman A, Rasavage K, Politzer T, Gerber D. Oculomotor Treatment in Traumatic Brain Injury Rehabilitation: A Randomized Controlled Pilot Trial. Am J Occup Ther 2020; 74:7401185050p1-7401185050p7. [PMID: 32078510 DOI: 10.5014/ajot.2020.026880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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.
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Affiliation(s)
- Amy Berryman
- Amy Berryman, OTR, MSHSA, is Occupational Therapist, Craig Hospital, Englewood, CO;
| | - Karen Rasavage
- Karen Rasavage, OTR, is Occupational Therapist, Craig Hospital, Englewood, CO
| | - Tom Politzer
- Tom Politzer, OD, FAAO, FNORA, is Optometrist, Craig Hospital, Englewood, CO
| | - Don Gerber
- Don Gerber, PsyD, ABPP, is Neuropsychologist, Craig Hospital, Englewood, CO
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Blackwell C, Cary K, Holst K, Mandle K, Dryg L, Clemens S, Lemke JH, Castro S, Hendricks E, Kelly R. Dynavision Normative Data for Healthy Adults: Reaction Test Program. Am J Occup Ther 2020; 74:7401185060p1-7401185060p6. [PMID: 32078511 DOI: 10.5014/ajot.2020.036251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Previous research has calculated normative data for the Dynavision D2 Visuomotor Training (D2) System among healthy athletes to understand concussion management, but to date no studies have identified the norms for healthy adults over a large age range (18-80 yr) for physical response speed. OBJECTIVE To provide normative data for the D2 for physical response speed in adults ages 18-80 yr. DESIGN Cross-sectional, descriptive study to obtain normative data on physical response speed using the D2 for adults in age categories 18-40, 41-60, and 61-80 yr. SETTING Genesis Physical Therapy and Wellness Center, a Midwestern outpatient hospital-based therapy center. PARTICIPANTS Three hundred adults, stratified into three different age categories. Normal standards with quartiles were identified for each age and sex category. OUTCOMES AND MEASURES Multiple regression model of the inverse response times. RESULTS The results showed a significant difference in physical response speed between men and women and between the different age groups. Women in all age categories were slower than men. Physical response speed increased with age in both sexes, but each had significantly different age and sex main effects (p < .0005). CONCLUSIONS AND RELEVANCE Occupational therapy practitioners can use the normative standards identified in this study in their assessment of clients with visual and cognitive deficits after a brain injury, stroke, or other neurologic pathology. WHAT THIS ARTICLE ADDS This study's results can be added to the battery of other common evaluation measures that occupational therapists use to evaluate visual and cognitive deficits after neurological impairments.
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Affiliation(s)
- Cherie Blackwell
- Cherie Blackwell, OTR/L, CHT, is Occupational Therapist, Genesis Physical Therapy and Wellness Center, Bettendorf, IA;
| | - Kathy Cary
- Kathy Cary, COTA, is Certified Occupational Therapy Student, Genesis Physical Therapy and Wellness Center, Bettendorf, IA
| | - Kami Holst
- Kami Holst, MOTR/L, is Occupational Therapist, Genesis Physical Therapy and Wellness Center, Bettendorf, IA
| | - Kristen Mandle
- Kristen Mandle, MOTR/L, is Occupational Therapist, Genesis Physical Therapy and Wellness Center, Bettendorf, IA
| | - Lori Dryg
- Lori Dryg, MA, CCC-SLP, CBIS, is Speech-Language Pathologist, Genesis Physical Therapy and Wellness Center, Bettendorf, IA
| | - Susan Clemens
- Susan Clemens, OTR/L, CBIS, is Occupational Therapist, Genesis Physical Therapy and Wellness Center, Bettendorf, IA
| | - Jon H Lemke
- Jon H. Lemke, PhD, is Chief Biostatistician, Genesis Physical Therapy and Wellness Center, Bettendorf, IA
| | - Sarah Castro
- Sarah Castro, MPH, is Infection Preventionist, Unity Point Health Trinity, Rock Island, IL. At the time of this research, she was Senior Research Support Liaison, Genesis Health System, Davenport, IA
| | - Emma Hendricks
- Emma Hendricks, BA, is Master's Student, Clinical Mental Health Counseling, University of Iowa, Iowa City. At the time of this research, she was Undergraduate Student, Genesis Physical Therapy and Wellness Center, Bettendorf, IA
| | - Ryan Kelly
- Ryan Kelly, MA, is PhD Student, Department of Statistics, University of Pittsburgh, Pittsburgh, PA. At the time of this research, he was Master's Student, Genesis Medical Center, Bettendorf, IA
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Yoo PY, Scott K, Myszak F, Mamann S, Labelle A, Holmes M, Guindon A, Bussieres AE. Interventions Addressing Vision, Visual-perceptual Impairments Following Acquired Brain Injury: A Cross-sectional Survey. The Canadian Journal of Occupational Therapy 2020; 87:117-126. [PMID: 31896281 DOI: 10.1177/0008417419892393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND. The existing literature on the effectiveness of interventions targeting vision, visual-perceptual impairments following acquired brain injury (ABI) is scarce and unlinked to occupational performance. PURPOSE. To explore current occupational therapy practice in vision-rehabilitation among adults with ABI in Canada, and to determine the evidence-practice gaps. METHODS. An online survey was made available through the Canadian Association of Occupational Therapists (CAOT) website, and disseminated to seven public healthcare institutions in Quebec. The survey collected respondent demographic information, and the types and frequency of treatments delivered. Descriptive statistics were conducted to determine interventions' frequency. Participant comments were collected and grouped into recurring themes. FINDINGS. Over half (55%) of respondents regularly use evidence-based interventions when addressing visual acuity (VA) and visual field (VF) deficits, but only very few (3%) use it when dealing with oculomotor function and visual stress impairments. IMPLICATIONS. Results gave a glimpse of interventions used and suggested the need for further research in vision rehabilitation.
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Active Rehabilitation After Childhood and Adolescent Mild Traumatic Brain Injury: a Narrative Review and Clinical Practice Implications. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-0207-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Simpson-Jones ME, Hunt AW. Vision rehabilitation interventions following mild traumatic brain injury: a scoping review. Disabil Rehabil 2018; 41:2206-2222. [DOI: 10.1080/09638288.2018.1460407] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Mary E. Simpson-Jones
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Anne W. Hunt
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
- Clinical Study Investigator Bloorview Research Institute, Toronto, Canada
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Fontenot JL, Bona MD, Kaleem MA, McLaughlin WM, Morse AR, Schwartz TL, Shepherd JD, Jackson ML. Vision Rehabilitation Preferred Practice Pattern®. Ophthalmology 2018; 125:P228-P278. [DOI: 10.1016/j.ophtha.2017.09.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/26/2017] [Indexed: 11/29/2022] Open
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Tapia RN, Eapen BC. Rehabilitation of Persistent Symptoms After Concussion. Phys Med Rehabil Clin N Am 2017; 28:287-299. [DOI: 10.1016/j.pmr.2016.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Powell JM. Special Issue on Occupational Therapy for Adults With Traumatic Brain Injury. Am J Occup Ther 2016; 70:7003170010p1-4. [PMID: 27089284 DOI: 10.5014/ajot.2016.703002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Awareness of the incidence and consequences of traumatic brain injury (TBI) has increased in recent years, along with interest in knowing how best to treat this complex condition. This editorial provides an overview of the various factors that contribute to the complexity of TBI and introduces the six systematic reviews and one qualitative study included in this special issue of the American Journal of Occupational Therapy focusing on interventions for TBI from an occupational therapy perspective. Issues with the generation and interpretation of research evidence are discussed, along with the importance of valuing clinician expertise and client perspectives along with research findings in implementing evidence-based and evidence-informed practice.
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Affiliation(s)
- Janet M Powell
- Janet M. Powell, PhD, OTR/L, FAOTA, is Associate Professor and Head, Division of Occupational Therapy, University of Washington, Seattle;
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