Participation and Quality of Life for Persons With Oculomotor Impairments After Acquired Brain Injury (ABI)

Individuals with acquired brain injury (ABI) are a major diagnostic group served by occupational therapists (OTs) working in the rehabilitation and disability practice area. Common visual impairments include visual field deficits (VFD) and oculomotor impairments (Kaldenburg, 2014). While research has explored the incidence of visual impairments and symptoms associated with ABI (Armstrong, 2018; Rowe & VIS Group UK, 2013) and the activity of daily living limitations with VFD (Warren, 2009), there is a lack of knowledge about participation in everyday activities and social roles for those with oculomotor impairments. Thus, the extent of the disability is unknown.

The purpose of this study was to explore participation difficulties and quality of life for persons with ABI-related oculomotor impairments. The specific aims were to (1) describe participation in everyday activities and social roles, and quality of life; and (2) provide preliminary recommendations for OTs and health care providers on which specific participation areas to assess and identify possible tools to use. Specifically, we explored the emotional and psychological influences of ABI-related oculomotor impairments and the potential impact on social and emotional aspects of participation.

This study used a cross sectional descriptive approach. Forty adult participants, ages 18 - 77 years, with ABI-related oculomotor impairments were recruited from regional outpatient clinics. The most common diagnosis was concussion/mild traumatic brain injury. One-time semi-structured interviews were conducted using self-report tools measuring visual symptoms (ABI Vision Questionnaire), quality of life (PROMIS 10), and participation in everyday activities and social roles (Assessment of Life Habits). Open-ended follow-up questions were also done to understand the nature of those items described as difficult.

Visual symptoms were significant for 96.7% of the participants. Quality of life scores for both physical and mental health were approximately one standard deviation below the US population norms. The everyday activities and social roles identified as very difficult or harder for 82% or more of the participants were: recreation, work, education, house maintenance, and volunteering. Approximately 68% of participants described isolated tasks involving communicating in a group, reading, computer use, and driving as very difficult. It appears that the isolated tasks (e.g. reading) were perceived as less difficult than when put together in the context of social role performance (e.g. work). Correlations between scores of symptoms and participation (ρ = -.701), and symptoms and physical quality of life (ρ = -.644) showed significant moderate negative relationships. Regression analysis indicated the proportion of variance in participation variance explained by symptoms was 0.473 (R²). Narrative responses further explained the difficulties and were grouped into three themes: challenges of the task and environment, self-identified personal difficulties, and changes to habits/priorities/roles. The findings suggested a complex and dynamic situation. While visual symptoms may explain almost half the difficulties with participation, additional influences may include other sensory sensitivities, cognition, balance and fatigue.

This study aligns with the AOTF research priority of emotional and physiological influences. It is important for OTs to know the symptoms of ABI-related oculomotor impairments as well as the activity and roles that are likely to be disrupted so they can direct therapy efforts where it matters most. Findings suggest benefits from OTs’ use of assessment tools that highlight the identified symptoms and participation areas (e.g. ABI Vision Symptom Survey and COPM).

References

Armstrong, R. A. (2018). Visual problems associated with traumatic brain injury. Clinical and Experimental Optometry. doi:10.1111/cxo.12670

Kaldenberg, J. (2014). Optimizing vision and visual processing. In M. V. Radomski & C. A. Trombly Latham (Eds.) Occupational Therapy for Physical Dysfunction (7th ed., pp. 699-724). Baltimore, MD: Lippincott Williams & Wilkins.

Rowe, F., & VIS Group UK. (2013). Symptoms of stroke-related visual impairment. Strabismus, 21(2), 150-154. doi:10.3109/09273972.2013.786742

Warren, M. (2009). Pilot study on activities of daily living limitations in adults with hemianopsia. American Journal of Occupational Therapy, 63, 626–633. doi:10.5014/ajot.63.5.626