Abstract
The American Occupational Therapy Association (AOTA) Evidence-Based Practice Project has developed a table summarizing the research opportunities in the area of adults with traumatic brain injury. The table provides an overview of the state of current available evidence on interventions within the scope of occupational therapy practice and is based on the systematic reviews from the AOTA Practice Guidelines Series. Researchers, students, and clinicians can use this information in developing innovative research to answer important questions within the occupational therapy field.
Planning a research project requires consideration of many factors. Level of interest and knowledge in a specific area, access to appropriate populations of participants, support of mentors and other researchers, and funding availability all help determine the focus of a future project. An additional component to be considered is whether adequate, up-to-date research has already been completed on a topic; if sufficient evidence is available in a given core area, this area might not be the best choice for another research project.
The best research topic may be one in which either little research has been done or the research to date is insufficient, inconclusive, or mixed. In addition, when research conducted to date provides a low level of evidence and is of limited quality, additional high-quality research in the area is needed.
The “Research Opportunities Table in the Area of Adults With Traumatic Brain Injury” provides an overview of the state of current available evidence on interventions within the scope of occupational therapy practice. The table is based on the systematic reviews from the American Occupational Therapy Association’s (AOTA’s) Practice Guidelines Series. The table lists specific interventions and indicates either that the evidence is strong to support the intervention or that moderate, mixed, or few studies support the intervention and therefore it is a priority area for future research. Researchers, students, and clinicians can use this information in developing innovative research to answer important questions within the field of occupational therapy. Please refer to Occupational Therapy Practice Guidelines for Adults With Traumatic Brain Injury (Wheeler & Acord-Vira, 2016) and the May/June 2016 issue of the American Journal of Occupational Therapy (Powell, 2016) for more information on the topic area and the systematic review process. To access the tables online and search for research opportunities in other practice areas, visit http://www.aota.org/researchopportunitiestables.
Researchers are also encouraged to enter their projects into AOTA’s Researcher Database at http://myaota.aota.org/research/. This database provides AOTA with information such as relevant clinical settings and populations; International Classification of Functioning, Disability and Health level (World Health Organization, 2001); funder (if any); and key words to help guide research advocacy and policy initiatives.
Research Opportunities Table in the Area of Adults With Traumatic Brain Injury
| Intervention | Strength of Evidence |
| Arousal and Alertness of People in a Coma or Persistent Vegetative State | |
| Multimodal sensory stimulation to improve arousal and enhance clinical outcomes | Strong evidence |
| Increased complexity, rather than intensity, of stimulation to increase intervention effectiveness | Area for future research |
| Motor Function | |
| Exercise programs (aquatic, hand, and standard [e.g., balance]) to improve motor function | Strong evidence |
| Computer-based interventions (e.g., virtual reality, gaming systems, 3D immersive games) to improve upper-extremity motor function and postural and dynamic balance | Area for future research |
| Rehabilitation and multidisciplinary rehabilitation programs to improve motor function | Area for future research |
| Cognitive Impairments | |
| General memory interventions (involving restorative and/or compensatory approaches) to improve memory | Strong evidence |
| Attention regulation interventions with or without goal or problem-solving training to improve attention and executive functioning | Strong evidence |
| Executive function strategy training such as goals management training and metacognitive strategy instruction to improve attention and executive functioning | Strong evidence |
| Training in encoding techniques to improve recall | Strong evidence |
| Training in use of cognitive assistive technology (except voice recorders and navigation devices) to improve memory | Strong evidence |
| Memory-specific compensatory approaches to improve memory | Strong evidence |
| Cognitive interventions to improve self-awareness | Area for future research |
| Computer-based interventions to enhance occupational performance | Area for future research |
| General restorative and/or compensatory approaches to improve attention and executive dysfunction | Area for future research |
| Visual and Visual–Perceptual Impairments | |
| Scanning training to improve search skills when measured with digit search, computer tests, and a functional search task | Strong evidence |
| Cognitive rehabilitation to improve performance in neuropsychological measures focused on visual perception | Strong evidence |
| Scanning training accompanied by a visual and/or auditory stimulus to improve visual search skills and reading performance | Area for future research |
| Vision therapy to remediate oculomotor signs and symptoms | Area for future research |
| Cognitive compensatory strategies such as pacing, chunking, and self-talk to improve ADL performance | Area for future research |
| Cognitive strategies focused on social skills training to improve the ability to name basic emotions, interpret comments, and determine whether a person is lying or being sarcastic | Area for future research |
| Psychosocial, Behavioral, or Emotional Impairments | |
| Intervention | Strength of Evidence |
| Arousal and Alertness of People in a Coma or Persistent Vegetative State | |
| Multimodal sensory stimulation to improve arousal and enhance clinical outcomes | Strong evidence |
| Increased complexity, rather than intensity, of stimulation to increase intervention effectiveness | Area for future research |
| Motor Function | |
| Exercise programs (aquatic, hand, and standard [e.g., balance]) to improve motor function | Strong evidence |
| Computer-based interventions (e.g., virtual reality, gaming systems, 3D immersive games) to improve upper-extremity motor function and postural and dynamic balance | Area for future research |
| Rehabilitation and multidisciplinary rehabilitation programs to improve motor function | Area for future research |
| Cognitive Impairments | |
| General memory interventions (involving restorative and/or compensatory approaches) to improve memory | Strong evidence |
| Attention regulation interventions with or without goal or problem-solving training to improve attention and executive functioning | Strong evidence |
| Executive function strategy training such as goals management training and metacognitive strategy instruction to improve attention and executive functioning | Strong evidence |
| Training in encoding techniques to improve recall | Strong evidence |
| Training in use of cognitive assistive technology (except voice recorders and navigation devices) to improve memory | Strong evidence |
| Memory-specific compensatory approaches to improve memory | Strong evidence |
| Cognitive interventions to improve self-awareness | Area for future research |
| Computer-based interventions to enhance occupational performance | Area for future research |
| General restorative and/or compensatory approaches to improve attention and executive dysfunction | Area for future research |
| Visual and Visual–Perceptual Impairments | |
| Scanning training to improve search skills when measured with digit search, computer tests, and a functional search task | Strong evidence |
| Cognitive rehabilitation to improve performance in neuropsychological measures focused on visual perception | Strong evidence |
| Scanning training accompanied by a visual and/or auditory stimulus to improve visual search skills and reading performance | Area for future research |
| Vision therapy to remediate oculomotor signs and symptoms | Area for future research |
| Cognitive compensatory strategies such as pacing, chunking, and self-talk to improve ADL performance | Area for future research |
| Cognitive strategies focused on social skills training to improve the ability to name basic emotions, interpret comments, and determine whether a person is lying or being sarcastic | Area for future research |
| Psychosocial, Behavioral, or Emotional Impairments | |
| CBT interventions to address psychosocial, behavioral, and emotional impairments and to improve occupational performance | Strong evidence |
| Goal-directed outpatient rehabilitation to improve self-ratings of performance and satisfaction | Strong evidence |
| Goal-directed outpatient rehabilitation to improve goal attainment, occupational performance, psychosocial reintegration, and adjustment levels | Area for future research |
| Functional skills training to improve social participation, community reintegration, independent living, emotional well-being, and quality of life | Area for future research |
| CBT modified to include MBCT to decrease depression and motivational interviewing to improve anxiety | Area for future research |
| Aerobic exercise to improve self-esteem, depression, quality of life, and community activity | Area for future research |
| Group and individual-based education interventions to improve psychosocial, behavioral, and emotional skills and impairments | Area for future research |
| Social skills training interventions to improve occupational performance | Area for future research |
| Peer mentoring interventions to improve perception of community integration, levels of anxiety and depression, satisfaction with social integration, or social activity levels | Area for future research |
| CBT administered in the virtual context to address community integration and adaptive coping | Area for future research |
| Everyday Activities and Areas of Occupation and Social Participation | |
| Activity-based interventions focused on client-centered goals and delivered in a relevant environmental context to improve occupational performance | Area for future research |
| Multidisciplinary and interdisciplinary rehabilitation approaches to improve occupational performance and participation outcomes after moderate to severe TBI | Area for future research |
| Training in social behaviors and decoding emotions to improve partner-directed behaviors such as reciprocal conversation skills | Area for future research |
| Virtual reality driving rehabilitation program to improve simulated driving performance in steering on open roads, turning, reacting to unexpected driving hazards, and adhering to traffic laws | Area for future research |
| Social training programs to improve social participation | Area for future research |
| CBT interventions to address psychosocial, behavioral, and emotional impairments and to improve occupational performance | Strong evidence |
| Goal-directed outpatient rehabilitation to improve self-ratings of performance and satisfaction | Strong evidence |
| Goal-directed outpatient rehabilitation to improve goal attainment, occupational performance, psychosocial reintegration, and adjustment levels | Area for future research |
| Functional skills training to improve social participation, community reintegration, independent living, emotional well-being, and quality of life | Area for future research |
| CBT modified to include MBCT to decrease depression and motivational interviewing to improve anxiety | Area for future research |
| Aerobic exercise to improve self-esteem, depression, quality of life, and community activity | Area for future research |
| Group and individual-based education interventions to improve psychosocial, behavioral, and emotional skills and impairments | Area for future research |
| Social skills training interventions to improve occupational performance | Area for future research |
| Peer mentoring interventions to improve perception of community integration, levels of anxiety and depression, satisfaction with social integration, or social activity levels | Area for future research |
| CBT administered in the virtual context to address community integration and adaptive coping | Area for future research |
| Everyday Activities and Areas of Occupation and Social Participation | |
| Activity-based interventions focused on client-centered goals and delivered in a relevant environmental context to improve occupational performance | Area for future research |
| Multidisciplinary and interdisciplinary rehabilitation approaches to improve occupational performance and participation outcomes after moderate to severe TBI | Area for future research |
| Training in social behaviors and decoding emotions to improve partner-directed behaviors such as reciprocal conversation skills | Area for future research |
| Virtual reality driving rehabilitation program to improve simulated driving performance in steering on open roads, turning, reacting to unexpected driving hazards, and adhering to traffic laws | Area for future research |
| Social training programs to improve social participation | Area for future research |
Note. ADL = activity of daily living; CBT = cognitive–behavioral therapy; MCBT = mindfulness-based cognitive–behavioral therapy; TBI = traumatic brain injury.
Acknowledgments
This work is based on the May/June 2016 issue of the American Journal of Occupational Therapy (Powell, 2016) and the Occupational Therapy Practice Guidelines for Adults With Traumatic Brain Injury (Wheeler & Acord-Vira, 2016), developed in collaboration with the AOTA Evidence-Based Practice Project.
