Download Meredith McCaffery Maguire - Thomas Jefferson University

The Overlooked Deficits of Acquired Brain Injury: Bringing Visual Rehabilitation Into
Focus
Speaker Qualifications: Jennifer Bebey is a Master’s degree student in the occupational therapy
(OT) department at Thomas Jefferson University (TJU) who completed a level II fieldwork in
acute care at Albert Einstein Medical Center working with a variety of patients with neurological
conditions including traumatic brain injury (TBI) and stroke. Meredith McCaffery Maguire is a
Master’s degree student in the Department of OT at TJU. She completed a level II fieldwork at
HealthSouth Rehabilitation Hospital working with a variety of patients with brain injury. Caitlin
McCormick is a Master’s degree student in the OT department at TJU. She completed a level II
fieldwork at Good Shepherd Raker Home Center working with individuals with neurological
impairments. Erika Ortiz is a Master’s degree student at the OT department at TJU who
completed a level II fieldwork at Thomas Jefferson University Hospital working with individuals
with non-traumatic acquired brain injury (ABI). Yolanda Scarpati is a Master’s degree student
in the OT department at TJU who completed a level II fieldwork in acute care at Bryn Mawr
Hospital working with a variety of patients with ABI.
Author Block: Jennifer Bebey, OTS, Thomas Jefferson University, Philadelphia, PA; Meredith
McCaffery Maguire, OTS, Thomas Jefferson University, Philadelphia, PA; Caitlin McCormick,
OTS, Thomas Jefferson University, Philadelphia, PA; Erika Ortiz, OTS, Thomas Jefferson
University, Philadelphia, PA; Yolanda Scarpati, OTS, Thomas Jefferson University,
Philadelphia, PA.
Primary Focus: Rehab, Disability & Participation
Learning Objectives:
1. Recognize the association between ABI and visual deficits and its impact on occupational
performance
2. Understand the systematic review process of appraising the literature
3. Describe the evidence that supports OT’s role in treating individuals with ABI and visual
deficits
4. Interpret current evidence for application into the clinical setting
Abstract:
Each year, 2.5 million Americans experience a form of ABI, including TBI and stroke
(Englehardt, Richman & Weiss, 2003). Visual impairments often co-occur post-ABI, with 25%
of stroke survivors experiencing visual field cuts and 40% of people with a TBI experiencing
vision impairment (Englehardt et al., 2003; Rowe et al., 2009). Although vision impairment postABI impacts rehabilitation outcomes and occupational performance, it is frequently overlooked
by healthcare practitioners (Nelms, 2000). OTs are uniquely suited to address the impact of
visual deficits on occupational performance. This systematic appraisal of the literature examines
interventions to address visual deficits in individuals with ABI.
PubMed, Ovid Medline, and CINAHL databases were searched using terms pertaining to visual
impairment, ABI, visual rehabilitation, and occupational therapy. Inclusion criteria required that
articles be peer-reviewed, Level I-V evidence, published between 2004 and 2014, included adult
participants, and addressed outcomes related to daily functioning and participation. Exclusion
criteria further refined the search to exclude articles that contained pharmaceutical or surgical
interventions, populations <50% ABI or focused on neurological conditions, and articles that
examined assessments as opposed to interventions. Final eligible articles were critically analyzed
using Law and McDermid (2008) Evaluation of Quality of an Intervention Study.
Emerging evidence supports the use of OT visual rehabilitation interventions in clinical practice
to improve functional performance in adults with ABI (Radomski, Davidson, Voydetich &
Erickson, 2009). In order to provide ethical, evidence-based services, OTs and other clinicians
must understand the increased incidence and complexity of visual deficits associated with ABI.
Evidence emphasizes the importance of immediate visual evaluation and optometrist referrals
followed by client-centered intervention for best patient outcomes (Englehardt et al., 2003).
Reviewed articles highlighted the use of a variety of compensatory and remedial interventions
including prism lenses (Carman-Merrifield, 2005), environmental modifications (Copolillo &
Ivanoff, 2012), and oculomotor training (Kapoor, Ciuffreda, & Han, 2004). This review found
promising preliminary evidence to support OT intervention for neurovisual deficits; however,
more rigorous studies are needed to inform clinical practice.
References
Carman-Merrifield, C. (2005, September). Vision rehabilitation strategies following traumatic
brain injury and stroke. In International Congress Series (Vol. 1282, pp. 55-59). Elsevier.
Copolillo, A., & Ivanoff, S. D. (2011). Assistive technology and home modification for people
with neurovisual deficits. Neuro Rehabilitation, 28, 211-229. Retrieved from DOI
10.3233/NRE-2011-0650
Englehardt, N., Richman, J., & Winston, M. (2003). Sight unseen acquired brain injury can
disrupt vision, but the problem often remains hidden and neglected. Advance for Physical
Therapy & Rehab, 12(2), 69.
Kapoor, N., Ciuffreda, K. J., & Han, Y. (2004). Oculomotor rehabilitation in acquired brain
injury: A case series. Arch Phys Med Rehabil, 85, 1667-78.
Law, M. C., & MacDermid, J. (Eds.). (2008). Evidence-based rehabilitation: A guide to
practice. Slack Incorporated.
Nelms, A. (2000) New visions: collaboration between and optometrists can make a difference in
treating brain injury. OT Practice. 5(15) 14-18.
Radomski, M. V., Davidson, L., Voydetich, D., & Erickson. M. W. (2009). Occupational therapy
for service members with mild traumatic brain injury. American Journal of Occupational
Therapy, 64, 646–655.
Rowe, F., Brand, D., Jackson, C. A., Price, A., Walker, L., Harrison, S., & Freeman, C. (2009).
Visual impairment following stroke: Do stroke patients require vision assessment? Age
and Ageing, 38(2), 188-193.
Level of material being presented: Introductory
Target audience: Mixed