{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T18:02:56Z","timestamp":1792519376042,"version":"4.5.0"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"9-10","funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["I01 HX002279-01A2"],"award-info":[{"award-number":["I01 HX002279-01A2"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,29]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Traumatic brain injury (TBI) can trigger vision-based sequelae such as oculomotor and accommodative abnormalities, visual\u2013vestibular integrative dysfunction, visual field loss, and photosensitivity. The need for diagnosis and management of TBI-related vision impairment has increased because of the increasing frequencies of combat warfighters returning from Iraq and Afghanistan with TBIs. The purpose of this research was to learn the sequelae of rehabilitation service delivery to veterans with TBI-related visual dysfunction after they are diagnosed. To accomplish this, we investigated vision rehabilitation assessments and interventions provided to veterans with TBI-related visual dysfunction at the Department of Veterans Affairs (VA) specialty polytrauma facilities for the 2 years following their injury. The research questions asked what assessments, interventions, and prescribed assistive devices were provided by VA specialty clinics (e.g., occupational therapy, polytrauma, and blind rehabilitation) and how service delivery was affected by demographic and clinical variables.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>A retrospective design was used to analyze VA data using natural language processing of unstructured clinician notes and logistic regression of structured data. Participants included 350 veterans with TBI who received rehabilitation at one of the five VA Polytrauma Rehabilitation Centers (Tampa, FL; Richmond, VA; Minneapolis, MN; San Antonio, TX; and Palo Alto, CA) between 2008 and 2017 and who were administered the 2008 congressionally mandated \u201cTraumatic Brain Injury Specific Ocular Health and Visual Functioning Exam.\u201d The outcome variables were vision assessments, interventions, and prescribed assistive technology discovered via natural language processing of clinician notes as well as the vision rehabilitation specialty clinics providing the clinical care (polytrauma, occupational therapy, outpatient blind rehabilitation, inpatient blind rehabilitation, optometry, and low vision) extracted from VA structured administrative data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Veterans receiving rehabilitation for TBI-related vision dysfunction were most frequently assessed for saccades, accommodation, visual field, and convergence. Intervention was provided most frequently for eye-hand coordination, saccades, accommodation, vergence, and binocular dysfunction. Technology provided included eyeglasses, wheelchair\/scooter, walker\/cane, aids for the blind, and computer. There was an overlap in the services provided by specialty clinics. Services available and delivered were significantly associated with the comorbidities of each patient and the specialty clinics available at each VA Polytrauma Rehabilitation Center.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The delivery of patient services should be driven by the needs of veterans and not by system-level factors such as the availability of specific vision rehabilitation services at specific locations. Traditional low vision and blind rehabilitation programs were not designed to treat the comorbidities and symptoms associated with TBI. To address this challenge, blind rehabilitation and neurologic recovery cross training is needed. Our findings document how five VA Polytrauma Rehabilitation Centers implemented this training in 2008. The next step is to extend and standardize this new paradigm to community care, where these post-deployment patients now reside.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usad120","type":"journal-article","created":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T20:09:34Z","timestamp":1682539774000},"page":"e2982-e2986","source":"Crossref","is-referenced-by-count":4,"title":["Retrospective Analysis of Vision Rehabilitation for Veterans With Traumatic Brain Injury\u2013Related Vision Dysfunction"],"prefix":"10.1093","volume":"188","author":[{"given":"Sandra L","family":"Winkler","sequence":"first","affiliation":[{"name":"Research Service, James A. Haley Veterans\u2019 Hospital , Tampa, FL 33612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dezon","family":"Finch","sequence":"additional","affiliation":[{"name":"Research Service, James A. Haley Veterans\u2019 Hospital , Tampa, FL 33612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imelda","family":"Llanos","sequence":"additional","affiliation":[{"name":"Research Service, James A. Haley Veterans\u2019 Hospital , Tampa, FL 33612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jemy","family":"Delikat","sequence":"additional","affiliation":[{"name":"Research Service, James A. Haley Veterans\u2019 Hospital , Tampa, FL 33612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Marszalek","sequence":"additional","affiliation":[{"name":"Research Service, James A. Haley Veterans\u2019 Hospital , Tampa, FL 33612, USA"},{"name":"Psychology Department, College of Arts and Sciences, University of Missouri, Kansas City , Kansas City, MO 64110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Candice","family":"Rice","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation Service, South Texas Veterans Health Care System , San Antonio, TX 78229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chrystyna","family":"Rakoczy","sequence":"additional","affiliation":[{"name":"Research Service, James A. Haley Veterans\u2019 Hospital , Tampa, FL 33612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinping","family":"Wang","sequence":"additional","affiliation":[{"name":"Research Service, North Florida South Georgia Veteran Health Care System , Gainesville, FL 32608, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kendra","family":"Pollard","sequence":"additional","affiliation":[{"name":"Technology Based Eye Care Services, Veterans Affairs , Minneapolis, MN 55417, USA"},{"name":"National Program Director, VHA Ophthalmology Service , Washington, DC 20420, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn C","family":"Cockerham","sequence":"additional","affiliation":[{"name":"National Program Director, VHA Ophthalmology Service , Washington, DC 20420, USA"},{"name":"Stanford University School of Medicine , Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,4,26]]},"reference":[{"issue":"1","key":"2023083018200126800_R1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1097\/OPX.0000000000000825","article-title":"Visual dysfunctions at different stages after blast and non-blast mild traumatic brain injury","volume":"94","author":"Capo-Aponte","year":"2017","journal-title":"Optom Vis Sci"},{"issue":"1","key":"2023083018200126800_R2","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.pmr.2018.09.001","article-title":"Vision rehabilitation after traumatic brain injury","volume":"30","author":"Fox","year":"2019","journal-title":"Phys Med Rehabil Clin N Am"},{"issue":"1","key":"2023083018200126800_R3","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1097\/OPX.0000000000001824","article-title":"Veterans with traumatic brain injury-related ocular injury and vision dysfunction: vision rehabilitation utilization","volume":"99","author":"Winkler","year":"2022","journal-title":"Optom Vis Sci"},{"key":"2023083018200126800_R4","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.optm.2006.11.011","article-title":"Occurrence of oculomotor dysfunctions in acquired brain injury: a retrospective analysis","volume":"78(4)","author":"Ciuffreda","year":"2007","journal-title":"Optometry"},{"issue":"18","key":"2023083018200126800_R5","doi-asserted-by":"publisher","first-page":"2206","DOI":"10.1080\/09638288.2018.1460407","article-title":"Vision rehabilitation interventions following mild traumatic brain injury: a scoping review","volume":"41","author":"Simpson-Jones","year":"2019","journal-title":"Disabil Rehabil"},{"issue":"4","key":"2023083018200126800_R6","doi-asserted-by":"publisher","first-page":"422","DOI":"10.5014\/ajot.2014.011445","article-title":"Composition of a vision screen for servicemembers with traumatic brain injury: consensus using a modified nominal group technique","volume":"68","author":"Radomski","year":"2014","journal-title":"Am J Occup Ther"},{"issue":"1","key":"2023083018200126800_R7","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1097\/OPX.0000000000001828","article-title":"Veterans with traumatic brain injury-related ocular injury and vision dysfunction: recommendations for rehabilitation","volume":"99","author":"Winkler","year":"2022","journal-title":"Optom Vis Sci"},{"key":"2023083018200126800_R8","article-title":"Researcher\u2019s guide to VA data","volume-title":"VA Information Resource Center","author":"VIReC"},{"key":"2023083018200126800_R9","first-page":"130","article-title":"A prototype tool set to support machine-assisted annotation"},{"issue":"7872","key":"2023083018200126800_R10","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/s0140-6736(74)91639-0","article-title":"Assessment of coma and impaired consciousness. 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