Bottom-up and top-down cognitive rehabilitation following mild traumatic brain injury - Occupational therapists' perspective: An online survey study

Background: Mild traumatic brain injuries (mTBIs) can result in long-lasting cognitive deficits. Comprehensive rehabilitation efforts need to integrate varied training approaches to address cognitive challenges and subsequently improve long-term functional outcomes

Objectives: The goal of this pilot study was to learn about occupational therapists' interpretation and practice of bottom-up and top-down cognitive rehabilitation activities for adults with mTBI.

Study Design: An online survey study was conducted.

Methods: A TBI expert team developed a case study with 30 functionally based treatment activities that closely align with the current rehabilitation practice. Of the 30 activities, the team identified 15 as bottom-up and 15 as top-down based on the definitions in the literature and clinical experience. The case study was sent in an online survey format to Occupational Therapists (OTs) across the country.

Results: Out of 67 participants who agreed to participate, 30 completed the survey. The majority of the participants (87.5%) indicated that they were familiar with bottom-up and top-down treatment activities. Descriptive analyses found that the agreement between the authors and participants on bottom-up activities was 47.5% and on top-down activities was 77.56%; significant Intraclass Correlation Coefficient (0.939, 95% confidence interval [0.903, 0.966], P < 0.001) on all the items suggests that there was nearly perfect agreement in all item scores between the participants. These responses were consistent across OTs with varying levels of education, experience, and geographical locations.

Conclusions: Increased knowledge and awareness of the distinction between bottom-up and top-down activities could equip clinicians with effective training tools to improve cognitive training. Future studies could address limitations of the study, including small sample size, descriptive statistical approach, and potentially biased view of the treatment activities by the authors.