Pathway of care for visual and vestibular rehabilitation after mild traumatic brain injury: a critical review.
Lucille Xiang, Surbhi Bansal, Albert Y Wu and 1 others
PMID 35918848WHAT IT FOUND
Only eight low-quality studies describe care pathways for visual and vestibular symptoms after mild brain injury.
Sequential referral is common, but evidence for combined treatment is limited to case reports. Standardized protocols and timing for referral remain undefined.
Key findings
01The review identified only eight studies describing care pathways, all of which were retrospective cohorts, case series, or case reports, with none comparable to a randomized trial.
02Existing models often use sequential referral, where patients receive standard care first, then vestibular therapy if symptoms persist, and finally vision therapy if visual deficits remain.
03Combined visual and vestibular treatment approaches are described in case studies and chart reviews, but their efficacy and applicability to the general mild TBI population have not been determined.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Only eight studies met the inclusion criteria, all of which were observational or case-based, with no randomized controlled trials. The studies included were at critical risk of bias, particularly due to small sample sizes and lack of control groups. The natural history of visual and vestibular deficits after mTBI is unknown, making it difficult to determine the ideal timing for referral or intervention. There is no standardized assessment protocol for visual and vestibular screening in primary care, leading to potential under-identification of visual symptoms. The review excluded moderate and severe TBI, so findings do not apply to those populations. Most included patients were under 55 years old, limiting generalizability to older adults.
Declared interests
The authors report no conflict of interest.
The easy way to misread this
Do not interpret the positive outcomes in the case reports and small cohorts as evidence that combined visual-vestibular therapy is superior to sequential care. The review explicitly states that none of the included studies were comparable to a randomized trial and that the efficacy of these pathways is not yet established.