OT-OD Synergy During Management of the Concussed: A Case Report Illustrating Seamless Care ‘Handoffs’

Abstract

Background: Concussion is a change in brain function following an applied or directed force to the head or body with or without loss of consciousness. Common causes of concussion include falls, motor vehicle accidents, and sport-related accidents. Despite heightened awareness, as well as potential preventative approaches, the occurrence of concussion has increased in the United States and ranges from 1.6-3.8 million persons yearly. Once managed acutely, disposition plus education are pivotal to successful outcomes. Complex pathology and/or poor compliance to post-injury recommendations may prolong symptomatology and require a multi-faceted rehabilitation plan. This may also pose longterm clinical challenges related to function for activities of daily living, many of which are impacted by vision. Therefore, an interprofessional, collaborative treatment team, augmented with vision specialists and inclusive of neuro-optometry (OD), neuroophthalmology, and occupational therapy (OT), becomes integral to optimized assessments and therapeutic remediation for visually symptomatic individuals with concussion. Case Report: In this case report, a 44-year-old female post-concussion is initially managed with an incomplete care team rendering an incomplete recovery. This is followed by an exacerbation of her original clinical manifestations, a functional decompensation, and a return presentation to her care team. In response, a more complete inter-professional care team is assembled, including OT and OD, and a re-tooled management plan is constructed, exemplifying seamless ‘handoffs’. Conclusion: This case demonstrates the importance of appropriately recognizing and managing visual deficits in a patient’s postconcussive recovery. Further, the incorporation of an inter-professional vision team, including OT and OD, is highlighted, drawing particular attention to synergistic skill sets and seamless interplay. If properly coordinated and launched at the start of the care timeline, patients benefit from an expedited and more complete functional recovery. Overall, this case illustrates that the inter-disciplinary vision team is integral to successful concussion management in the setting of visual dysfunction.