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Occupational Therapy Practice Guidelines for Adults With Traumatic Brain Injury
Steven Wheeler1, Amanda Acord-Vira2
1Steven Wheeler, PhD, OTR/L, FAOTA, CBIS, is Professor and Chair of Occupational Therapy, Division of Occupational Therapy, West Virginia University, Morgantown; swheeler@hsc.wvu.edu.
Importance:
Occupational therapy practitioners are uniquely qualified to address the occupational needs of people with traumatic brain injury (TBI) and their caregivers to maximize participation, health, and well-being.
Objective:
These Practice Guidelines are informed by systematic reviews of the effectiveness of interventions that address impairments and skills to improve the occupational performance of people with TBI, as well as interventions for caregivers of people with TBI. The purpose of these guidelines is to summarize the current evidence available to assist clinicians' clinical decision-making in providing interventions for people with TBI and their caregivers.
Method:
We reviewed six systematic reviews and synthesized the results into clinical recommendations to be used in occupational therapy clinical practice.
Results:
Sixty-two articles served as the basis for the clinical recommendations.
Conclusions And Recommendations:
Strong to moderate evidence supports multimodal sensory stimulation, unimodal auditory stimulation, physical activity, virtual reality, cognitive interventions, vision therapy, goal-focused interventions, individual and group training and education, and caregiver supports. Occupational therapy practitioners should incorporate these interventions into individual and group sessions to maximize recovery and promote occupational participation. Additional interventions are also available, based on emerging evidence and expert opinion, including prevention approaches, complexity of injury, and the use of occupation-based performance assessments. What This Article Adds: These Practice Guidelines provide a summary of evidence in clinical recommendations tables supporting occupational therapy interventions that address impairments resulting from and skills to improve occupational performance after TBI. The guidelines also include case study examples and evidence graphics for practitioners to use to support clinical reasoning when selecting interventions that address the goals of the person with TBI and their caregiver's needs.
