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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 cognitive interventions to improve occupational performance for adults with traumatic brain injury.

Vision impairment is common in the first year after traumatic brain injury (TBI), including among service members whose brain injuries occurred during deployment in Iraq and Afghanistan. Occupational therapy practitioners provide routine vision screening to inform treatment planning and referral to vision specialists, but existing methods are lacking because many tests were developed for children and do not screen for vision dysfunction typical of TBI. An expert panel was charged with specifying the composition of a vision screening protocol for servicemembers with TBI. A modified nominal group technique fostered discussion and objective determinations of consensus. After considering 29 vision tests, the panel recommended a nine-test vision screening that examines functional performance, self-reported problems, far–near acuity, reading, accommodation, convergence, eye alignment and binocular vision, saccades, pursuits, and visual fields. Research is needed to develop reliable, valid, and clinically feasible vision screening protocols to identify TBI-related vision disorders in adults.

Date Presented 04/07/19 We conducted a validation study on a performance-based assessment of EF called Front Desk Duty in mild stroke patients. Preliminary findings suggest that FDD can be scored reliably and distinguishes between groups of healthy adults and those with mild stroke who fail an EF screen. This study expands the repertoire of available multitasking assessments, which will contribute to better identification of people with mild stroke who could benefit from OT intervention. Primary Author and Speaker: Ginger Carroll Additional Authors and Speakers: Romina Takimoto Contributing Authors: Mary Radomski, Jerry Halsten, Shayne Hopkins, Kristen Johnson, Kristina Kath, Rob Kreiger, Amy Meyers, Stacey Rabusch

More occupational therapists are needed to provide client-centered, evidence-based rehabilitation to the large numbers of service members who sustained mild traumatic brain injury (mTBI) while deployed in Afghanistan and Iraq. The Proponency for Rehabilitation and Reintegration tasked a team of occupational and physical therapists to assemble evidence-based best practices specific to mTBI. Despite the fact that evidence-based reviews, guidelines, and research regarding occupational therapy for mTBI are sparse, the team developed the Clinical Practice Guidance: Occupational Therapy and Physical Therapy for Mild Traumatic Brain Injury. Occupational therapy practice recommendations specific to client education, vision, cognition, resumption of roles, and emotional well-being are summarized for civilians and characterized as practice standards or practice options. By using evidence-informed and holistic services, occupational therapists have the potential to lead rehabilitation and reintegration efforts for service members with mTBI and advance changes in the profession itself.

Date Presented 3/30/2017 Results of this pilot and feasibility study indicate that women with breast cancer who received a brief occupational therapy intervention for cancer-related cognitive dysfunction experienced pre–post improvements in self-reported cognition and occupational functioning. Primary Author and Speaker: Shayne Hopkins Contributing Authors: Mary Vining Radomski, Marsha Finkelstein, Mattie Anheluk, Kristin Berling, Michele Darger, Kim Grabe, M. Tracy Morrison, Joette Zola, Nancy Hutchison

Objective. This study sought to determine whether persons with traumatic brain injury who received outpatient occupational therapy services achieved self-identified goals related to tasks of daily life. Method. Sixteen participants completed the study. Occupational therapists used their usual treatment procedures to restore independence in home and community occupational functioning. The Canadian Occupational Performance Measure identified the five most important problems that interfered with independence in the roles the participant valued as well as the participant’s perception of performance ability and satisfaction with performance. Goal Attainment Scaling documented achievement of the five self-identified goals. The Independent Living Skills Evaluation (ILSE) and the Reintegration to Normal Living Scale(RNL) measured changes in overall instrumental activities of daily living and community reintegration. Results. The participants significantly achieved (p < .001) their goals from admission to discharge, rated themselves as performing significantly better (p < .001), and were significantly more satisfied (p = .001) with performance after treatment than before. Additionally, they improved significantly on the ILSE (p < .001) and the RNL (p < .001) from admission to discharge. There were no significant changes in performance from discharge to followup on any of the scales. Conclusion. Although causality cannot be inferred, it can be concluded that participants attending outpatient occupational therapy significantly improved, and improvements were sustained after discharge, but no further improvement occurred spontaneously.

OBJECTIVE. To determine the effectiveness of interventions addressing cognitive impairments to improve occupational performance for people with traumatic brain injury. METHOD. A total of 37 studies met inclusion criteria: 9 Level I systematic reviews, 14 Level I studies, 5 Level II studies, and 9 Level III studies. RESULTS. Strong evidence supports use of direct attention training, dual-task training, and strategy training to optimize executive functioning, encoding, and use of memory compensations, including assistive technology. However, in most studies, occupational performance was a secondary outcome, if it was evaluated at all. CONCLUSION. Although evidence supports many intervention approaches used by occupational therapy practitioners to address cognitive impairments of adults with traumatic brain injury, more studies are needed in which occupational performance is the primary outcome of cognitive intervention.

As occupational therapists, we can advance our stature in cognitive rehabilitation by first narrowing our scope of practice to become the team experts in compensatory strategy training, the domain of cognitive rehabilitation most consistent with our history and expertise. Supported and aided by our professional association, we must also intensify our contribution to this developing field through research and individual and professional involvement in transdisciplinary organizations. Increased involvement and leadership from occupational therapy promise to improve the prospect that cognitive rehabilitation services will improve day-to-day performance for survivors of brain injury.