Evidence for your Practice: Interventions Addressing Vision, Visual-perceptual Impairments Following Acquired Brain Injury: A Cross-sectional Survey.

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Article: Yoo, P. Y., Scott, K., Myszak, F., Mamann, S., Labelle, A., Holmes, M., Guindon, A., & Bussieres, A. E. (2020). Interventions Addressing Vision, Visual-perceptual Impairments Following Acquired Brain Injury: A Cross-sectional Survey. Canadian Journal of Occupational Therapy, 87(2), 117–126.   https://doi-org.ezproxy.library.ubc.ca/10.1177/0008417419892393

Study Aim: To increase the understanding of intervention methods currently used by Canadian occupational therapists treating patients with visual and visual-perceptual impairments following an acquired brain injury (ABI), and to determine if these approaches are evidence based.

Key Findings: This cross-sectional survey was administered to a total of 25 Canadian occupational therapists working or having worked with adult patients presenting vision or visual-perceptual impairments as a result of ABI, in the last five years. The survey comprised two main sections: interventions commonly used and demographics.

Survey questions based on intervention methods supported by the literature were organized into four visual subsections:

1. Visual Acuity

• Only 57% of the intervention items were “often” or “always” used by respondents
• Evidence-based interventions included:
• Referring patients to optometrist/ ophthalmologist for optical devices
• Implementing general principles to increase the visibility of the task/environment
• Prescribing non-optical assistive devices
• Referring to low vision centres or specialized rehabilitation services
• Using strategies for the management of glare sources

2. Visual Field (VF)

• 52.2% of the intervention items were “often” or “always” used by respondents
• Evidence-based interventions included:
• Placement of items in the field of good vision
• Increasing awareness of VF loss
• Visual scanning training
• Anchoring techniques for reading tasks or for activities of daily living
• Implementation of general principles to increase the visibility of the task/environment
• Dynavision
• Referring to optometrist/ ophthalmologist for prism or occlusion optical devices 
• Education on scrolling text or saccadic eye movement for reading, training for vertical oriented text reading, visual rehabilitation therapy (VRT), and audiovisual stimulation

3. Oculomotor Function

• Less than half of participants reported using several of the oculomotor function interventions
• Evidence-based interventions included:
• Audiovisual stimulation “AVT”
• Red/green reading sheets
• Gaze stabilization activities, including: “Word games and puzzles,” “computer activities,” and “worksheets”

4. Visual Stress

• 75% of respondents indicated that they rarely/never use several of the visual stress interventions
• Evidence-based interventions included:
• Binasal Occlusion (BNO)
• Blue light filters on electronic devices
• Filters/coloured overlays, and tinted filters
• Referring to optometrist/ophthalmologist for optical devices or therapy.

Bottom Line for OT: Only about half of the occupational therapists in this study reported regular use of evidence-based interventions when targeting visual acuity and visual field, and very few use them for oculomotor dysfunction and visual stress. Further research is needed to explore reasons for the evidence-based practice gaps in vision rehabilitation. This study helps highlight the need for clinicians to explore current evidence-based interventions being used by fellow occupational therapists.

Post by CAOT-BC fieldwork student Amber Sands

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