Finding the Just-Right Challenge: OT knowledge of top-down versus bottom-up approaches to TBI cognitive rehabilitation

The ongoing study aims to strengthen the practice of occupational therapy in cognitive rehabilitation of adults with mild‐traumatic brain injury (TBI). Traditional approaches for TBI model bottom‐up tasks (procedural and repetitive), which are helpful in the initial stages of recovery. However, to improve functional cognition for generalized long‐term benefits, top‐down approaches (effortful and innovative) are more effective. A questionnaire was developed and sent to occupational therapists (OTs). Participants identified treatment strategies as top‐down or bottom up. Participants identified 77% of the top‐down strategies correctly, compared to only 53% of the bottom‐up strategies. This shows that OTs are misattributing bottom‐up strategies as top‐down. Based on prior research, top‐down strategies are the most effective at providing the just‐right challenge for long‐term cognitive improvements. This is the first step in discovering how to further educate OTs on effectively utilizing and discerning between top‐down and bottom‐ up strategiesto establish long‐term benefitsin functional cognition. (Faculty Sponsor: Dr. Asha Vas)