Abstract
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 the effectiveness of binasal occlusion interventions that address visual impairments and visual perception to improve occupational performance for adults with traumatic brain injury.
Full Systematic Review Question
This systematic review addressed the question “What is the evidence for the effectiveness of interventions that address visual impairments and visual perception to improve occupational performance for people with traumatic brain injury (TBI)?”
Current Theme Reported
The main theme of the studies included in this systematic review brief are interventions that include binasal occlusion.
Clinical Scenario
Traumatic brain injury (TBI) can have significant impact on the visual system leading to deficits in visual field, visual acuity, oculomotor skills, and visual processing abilities (Cockerham et al., 2009), with estimates as high as 90% of all people with TBI experiencing visual consequences (Jacobson & Marcus, 2011). Visual and visual perceptual deficits as a result of TBI can significantly impact participation in meaningful everyday activities (Greenwald et al., 2012; Kerkhoff, 2000). More specifically, diplopia post TBI has significant impact on quality of life and occupational performance (Cockerham et al., 2009). Binasal occlusion (BNO) is a technique to address diplopia that utilizes translucent or opaque nasally placed and superior temporally angled tape adhered to spectacle lenses to partially occlude the bilateral visual field.
Summary of Key Findings
Two studies using BNO to address diplopia and improve occupational performance for people with TBI were included in this review (Table 1). The levels of evidence used in this review are from Oxford Centre for Evidence-Based Medicine (2009).
Evidence Table for Binasal Occlusion Interventions
Note. BI = base-in prisms; BNO = binasal occlusion; mTBI = mild traumatic brain injury; VEP = visually evoked potential.
Bottom Line for Occupational Therapy Practice
The systematic review provides low strength of evidence that BNO can improve visual motion sensitivity symptoms status post TBI (Ciuffreda et al., 2013; Yadav & Ciuffreda, 2014). Prisms alongside BNO may potentially contribute to greater visual performance (Yadav & Ciuffreda, 2014). Occupational therapy practitioners should consult with a neuro-optometrist/ophthalmologist on a case-by-case basis to consider the use of BNO and/or prisms to manage/resolve visual motion sensitivity symptoms in adults with TBI. The intensity and duration of BNO/prism use should be prescribed by the consulting neuro-optometrist/ophthalmologist in consideration of the impact on the visual system and the client’s quality of life. Much research on BNO and prism use has been done in a static environment. Occupational therapy practitioners, however, can integrate BNO/prisms in the context of dynamic function-oriented activities in conjunction with the prescribing provider to maximize client outcomes. Additional research is needed to support the effects of BNO interventions as a means of symptom management to impact occupational performance and participation for people living with TBI.
Footnotes
*
Indicates articles included in the systematic review brief.