Structured Abstract
Brain Injury Structured Abstract - BI#12
Compensatory strategies may improve visual processing in people with acquired brain injuries
CITATION: Dirette, D. K., & Hinojosa, J. (1999). The effects of a compensatory intervention on processing deficits of adults with acquired brain injuries. Occupational Therapy Journal of Research, 19(4), 223-240.
LEVEL OF EVIDENCE: IIBb (Internal validity not reported.)
This non-randomized 2 matched group comparison design study, sample size ranged below 20 per condition (15 in each group) with moderate external validity provided a IIB level of evidence.
RESEARCH OBJECTIVE/QUESTION
To evaluate the effects of a compensatory intervention (computer training with cueing) in processing of visual information in persons with traumatic brain injury.
DESIGN
| |
RCT |
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Single Case |
|
Case Control |
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Cohort |
X |
Before-After |
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Cross-Sectional |
This study design is used to evaluate a group of individuals who are undergoing the same treatment. Information regarding a group of people is collected both before and after treatment. This is a common design that is generally paralleled with a single case/individual study. A before-after design usually involves more than one person whereas a single case study may involve only one individual. Participants were assigned to the experimental or control group and received pre and post-tests during the study to evaluate intervention.
SAMPLING PROCEDURE
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Random |
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Consecutive |
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Controlled |
X |
Convenience |
Individuals were chosen strictly on a volunteer basis for completion of the study.
SAMPLE
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N = 20 |
M age = 38 |
Male = 22 |
Ethnicity = NR |
Female = 8 |
NR = Not reported
Severity of injury was determined according to length of loss of consciousness, CT scan results and Glasgow Coma Scale scores. The participants' average coma duration, time of injury, and ethnicity were not reported.
PARTICIPANT CHARACTERISTICS
Mild, Moderate, & Severe Traumatic Brain Injury
MEDICAL DIAGNOSIS/CLINICAL DISORDER
Traumatic Brain Injury
OT TREATMENT DIAGNOSIS
Physical substrates: Sensory motor substrates: Sensory and perceptual systems: Sensory processing/sensory sensitivity, deficit/impaired.
OUTCOMES
Sensory Processing
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Measures |
Reliability |
Validity |
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1. Paced Auditory Serial Task |
NR |
NR |
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2. Matching Accuracy Test |
NR |
NR |
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3. Functional Computer Tasks |
NR |
NR |
NR = Not Reported
Outcome - OT terminology
I. Performance Component
A. Sensorimotor Component
b. Sensory processing
(4) Visual
Outcome - ICIDH-2 terminology
Body structure: Neuropsychological function
INTERVENTION
1. Remedial computer activities without cueing
2. Compensatory computer activity using cueing
Description
a) Piller's Internal Cueing Methods
i) Chunking: Mentally grouping information into segments to condense information.
ii) Pacing: Taking intermittent pauses to decrease the effects of proactive interference
iii) Verbalization: Orally repeating information gathered, using an additional modality
b) Not using internal cueing
Who delivered
- Occupational therapists, College degree
- Speech pathologists performed pre-post test, Master's degree
Setting
Not Clear
Frequency Pre- and Post-Tests
1 Hour session: Week 1, Week 6
Frequency
1 Hour weekly session: 45 Minutes treatment, 15 Minutes measurement
Duration
6 Weeks
RESULTS
- The results of the analysis of variance of pre-test and post-test treatment indicated significant improvement (80%) in th two groups. However, there was no difference in performance due to the treatment of compensatory techniques on processing deficits
- The exploratory analysis revealed no significant correlations among the pre-test (r = .02 to r = .27), post test (r = .02 to r = .09) and weekly measures r = .01 to r = .27) with the treatment group variable, indicating no relationship between group participation and scores on these measures
- Auxiliary Analysis: The correlations with weekly accuracy measures were not significant
- Post Hoc Analysis: Turkey test indicated that none of the differences in pairs of weekly accuracy measures were significant
CONCLUSIONS
Biases
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X |
Attention |
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Masking/blinding |
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Drop outs |
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Contamination |
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Co-intervention |
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The study did not support that individuals with traumatic brain injury who receive instruction in the use of internal compensatory strategies for processing of visual information will improve their scores on functional measures.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice - Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Beatriz C. Abreu, PhD, OTR, FAOTA, and colleagues. For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.
