More occupational therapists are needed to provide client-centered, evidence-based rehabilitation to the large numbers of service members who sustained mild traumatic brain injury (mTBI) while deployed in Afghanistan and Iraq. The Proponency for Rehabilitation and Reintegration tasked a team of occupational and physical therapists to assemble evidence-based best practices specific to mTBI. Despite the fact that evidence-based reviews, guidelines, and research regarding occupational therapy for mTBI are sparse, the team developed the Clinical Practice Guidance: Occupational Therapy and Physical Therapy for Mild Traumatic Brain Injury. Occupational therapy practice recommendations specific to client education, vision, cognition, resumption of roles, and emotional well-being are summarized for civilians and characterized as practice standards or practice options. By using evidence-informed and holistic services, occupational therapists have the potential to lead rehabilitation and reintegration efforts for service members with mTBI and advance changes in the profession itself.

Background Occupational therapy (OT) is a vital service that supports older adults’ ability to age in place. Given the barriers to accessing care, video telehealth is a means of providing OT. Even within Veterans Health Administration (VHA), a pioneer in telehealth, video telehealth by OT practitioners to serve older adults is not well understood. Objective This study examines VHA OT practice using video telehealth with older veterans using an implementation framework. Methods A web-based national survey of VHA OT practitioners conducted between September and October 2019 contained a mix of mostly closed questions with some open-text options. The questions were developed using the Promoting Action on Research Implementation in Health Services model with input from subject matter experts. The questions gathered the extent to which VHA OT practitioners use video telehealth with older veterans; are comfortable with video telehealth to deliver specific OT services; and, for those using video telehealth with older veterans, the barriers, facilitators of change, and perceived benefits of video telehealth. Results Of approximately 1455 eligible VHA OT practitioners, 305 participated (21.0% response rate). Most were female (196/259, 75.7%) occupational therapists (281/305, 92.1%) with a master’s degree (147/259, 56.8%) and 10 years or fewer (165/305, 54.1%) of VHA OT practice. Less than half (125/305, 41.0%) had used video telehealth with older veterans, and users and nonusers of video telehealth were demographically similar. When asked to rate perceived comfort with video telehealth to deliver OT services, participants using video telehealth expressed greater comfort than nonusers, which was significant for 9 of the 13 interventions: activities of daily living (P<.001), instrumental activities of daily living (P=.004), home safety (P<.001), home exercise or therapeutic exercise (P<.001), veteran or caregiver education (P<.001), durable medical equipment (P<.001), assistive technology (P<.001), education and work (P=.04), and wheelchair clinic or seating and positioning (P<.001). More than half (74/125, 59.2%) of those using video telehealth reported at least one barrier, with the most frequently endorsed being Inadequate space, physical locations and related equipment. Most (92/125, 73.6%) respondents using video telehealth reported at least one facilitator, with the most frequently endorsed facilitators reflecting respondent attitudes, including the belief that video telehealth would improve veteran access to care (77/92, 84%) and willingness to try innovative approaches (76/92, 83%). Conclusions Most VHA OT survey respondents had not used video telehealth with older veterans. Users and nonusers were demographically similar. Differences in the percentages of respondents feeling comfortable with video telehealth for specific OT interventions suggest that some OT services may be more amenable to video telehealth. This, coupled with the primacy of respondent beliefs versus organizational factors as facilitators, underscores the need to gather clinicians’ attitudes to understand how they are driving the implementation of video telehealth.

Biased responding on the Sternberg Recognition Memory Test was observed in four patients with traumatic brain injury. None of these individuals met the Diagnostic and Statistical Manual's (DSM-IV) criteria for malingering. Individual recognition memory scores were high shortly after injury, declined to chance or below at the 6- and 12-month evaluations, and then showed substantial recovery by the 24-month evaluation. Recall memory performance actually declined slightly across this same 2-year period. Recognition memory scores were related to the extent to which the patients endorsed somatic items on the Hamilton Rating Scale for Depression (HAM-D). Poor performance was associated with high somatic scores. The relationship between memory and somatic scores on the HAM-D in this case series suggests that unconscious processes can influence memory performance and, because of this, that clinicians should not use such performance as a primary indicator of malingering. More importantly, biased responding and actual memory deficits may coexist. This is indicated in the current cases by the failure of recall memory to improve during the 2 years these patients were followed.

BACKGROUND Occupational therapy (OT) is a vital service that supports older adults’ ability to age in place. Given the barriers to accessing care, video telehealth is a means of providing OT. Even within Veterans Health Administration (VHA), a pioneer in telehealth, video telehealth by OT practitioners to serve older adults is not well understood. OBJECTIVE This study examines VHA OT practice using video telehealth with older veterans using an implementation framework. METHODS A web-based national survey of VHA OT practitioners conducted between September and October 2019 contained a mix of mostly closed questions with some open-text options. The questions were developed using the Promoting Action on Research Implementation in Health Services model with input from subject matter experts. The questions gathered the extent to which VHA OT practitioners use video telehealth with older veterans; are comfortable with video telehealth to deliver specific OT services; and, for those using video telehealth with older veterans, the barriers, facilitators of change, and perceived benefits of video telehealth. RESULTS Of approximately 1455 eligible VHA OT practitioners, 305 participated (21.0% response rate). Most were female (196/259, 75.7%) occupational therapists (281/305, 92.1%) with a master’s degree (147/259, 56.8%) and 10 years or fewer (165/305, 54.1%) of VHA OT practice. Less than half (125/305, 41.0%) had used video telehealth with older veterans, and users and nonusers of video telehealth were demographically similar. When asked to rate perceived comfort with video telehealth to deliver OT services, participants using video telehealth expressed greater comfort than nonusers, which was significant for 9 of the 13 interventions: activities of daily living (<i>P</i>&lt;.001), instrumental activities of daily living (<i>P</i>=.004), home safety (<i>P</i>&lt;.001), home exercise or therapeutic exercise (<i>P</i>&lt;.001), veteran or caregiver education (<i>P</i>&lt;.001), durable medical equipment (<i>P</i>&lt;.001), assistive technology (<i>P</i>&lt;.001), education and work (<i>P</i>=.04), and wheelchair clinic or seating and positioning (<i>P</i>&lt;.001). More than half (74/125, 59.2%) of those using video telehealth reported at least one barrier, with the most frequently endorsed being <i>Inadequate space, physical locations and related equipment</i>. Most (92/125, 73.6%) respondents using video telehealth reported at least one facilitator, with the most frequently endorsed facilitators reflecting respondent attitudes, including the belief that video telehealth would improve veteran access to care (77/92, 84%) and willingness to try innovative approaches (76/92, 83%). CONCLUSIONS Most VHA OT survey respondents had not used video telehealth with older veterans. Users and nonusers were demographically similar. Differences in the percentages of respondents feeling comfortable with video telehealth for specific OT interventions suggest that some OT services may be more amenable to video telehealth. This, coupled with the primacy of respondent beliefs versus organizational factors as facilitators, underscores the need to gather clinicians’ attitudes to understand how they are driving the implementation of video telehealth. CLINICALTRIAL