Talk:Traumatic brain injury

Sports Related Traumatic Brain Injuries

Sports Related Traumatic Brain Injuries is an orphan (no other articles link to it). Any ideas on integrating this material? ~KvnG 22:47, 24 March 2014 (UTC)

Therapeuic hypothermia

... might actually be good doi:10.1186/cc13835. JFW | T@lk 19:55, 28 April 2014 (UTC)

Moved

All of this was inserted at Neurodevelopmental disorder, and is off-topic there. I am copying it here in case anything can be incorporated here. SandyGeorgia (Talk) 21:28, 27 February 2015 (UTC)

In industrial nations, the most common causes of childhood brain trauma are overwhelmingly falls and transportation-related incidents. Child maltreatment such as shaken baby syndrome can produce neurodevelopmental consequences including blindness, neuromotor deficits and cognitive impairment. According to information published by the American Association of Neurological Surgeons, sports injuries account for 21% of the US incidence, however their site includes transportation-related sports injuries. They assert that cycling produced 64,993 head injuries requiring emergency room visits in 2007 while the second most common cause, football, only produced 36,412.

There are age differences for the effects of traumatic brain injury (TBI) in children due to changes in skull formation. Infants’ skulls are divided into eight separated bones, which can spread during TBI and decrease the cranial pressure and brain swelling. These bones normally fuse by two years of age. In contrast, children are more vulnerable during TBI than adolescents, because they have wider subarachnoid spaces with blood vessels, which can become damaged by the shearing forces.

Psychiatric disorders may worsen or develop de novo in a child following TBI. Statistically about 54% to 63% of children develop novel psychiatric disorders about 24 months after severe TBI, and 10% to 21% after mild or moderate TBI, the most common of which is changes in personality. The symptoms include affective instability, aggression, disinhibited behavior, apathy, and may last for 6 to 24 months on average. Other disorders that may arise are ADHD, PTSD, OCD, anxiety disorder, depressive disorder and mania. Most symptoms decrease between 12 to 24 months. The superior frontal lesions correlate with the type of outcome, but more importantly, subcortical network damage may affect the recovery due to the lesions in white matter tracts.

Studies show that children with severe TBI are affected in intellectual functioning, executive functioning (including speed processing and attention), and verbal immediate and delayed memory with some recovery during the first 2 years post-injury. Such children are at more risk for long term consequences of TBI, because of the crucial developmental stage at which recovery takes place. The dynamics of recovery are correlated with pre-injury adaptive ability and environmental social factors (e.g. family support).

References

Semi-protected edit request on 28 February 2015

I would like to add information to the section "Severity" about the age differences on severity or, perhaps, add a section about "pediatric TBI". It's important to mention about it because there are major differences that take place. Here is information I'd like to be added:

There are age differences for the effects of traumatic brain injury (TBI) in children due to changes in skull formation. Infants’ skulls are divided into eight separated bones, which can spread during TBI and decrease the cranial pressure and brain swelling. These bones normally fuse by two years of age. In contrast, children are more vulnerable during TBI than adolescents, because they have wider subarachnoid spaces with blood vessels, which can become damaged by the shearing forces.

Psychiatric disorders may worsen or develop de novo in a child following TBI. Statistically about 54% to 63% of children develop novel psychiatric disorders about 24 months after severe TBI, and 10% to 21% after mild or moderate TBI, the most common of which is changes in personality. The symptoms include affective instability, aggression, disinhibited behavior, apathy, and may last for 6 to 24 months on average. Other disorders that may arise are ADHD, PTSD, OCD, anxiety disorder, depressive disorder and mania. Most symptoms decrease between 12 to 24 months. The superior frontal lesions correlate with the type of outcome, but more importantly, subcortical network damage may affect the recovery due to the lesions in white matter tracts.

Studies show that children with severe TBI are affected in intellectual functioning, executive functioning (including speed processing and attention), and verbal immediate and delayed memory with some recovery during the first 2 years post-injury. Such children are at more risk for long term consequences of TBI, because of the crucial developmental stage at which recovery takes place.

Ebuglo (talk) 16:48, 28 February 2015 (UTC)

References

Hi, Ebuglo. I've altered your post a bit to add PMIDs to your sources (I hope you don't mind). Your final source, PMID 22271691, is a primary study, so that sentence isn't cited according to WP:MEDRS, but the other sources are recent reviews. I haven't checked your text, but will ping Doc James and Jfdwolff, who are better equipped to determine if the text can be added, and where. Best regards, SandyGeorgia (Talk) 22:59, 28 February 2015 (UTC)

Hi, SandyGeorgia Thank you for checking PMIDs. Indeed, I didn't catch the mistake about the last article. Thus I have deleted the last sentence. Doc James and Jfdwolff , please, let me know if that would be possible to incorporate my added content accordingly. Kind regards. — Preceding unsigned comment added by Ebuglo (talk • contribs) 15:07, March 2, 2015 Ebuglo (talk) 20:08, 2 March 2015 (UTC)

Ebuglo, you can sign your entries by adding four tildes ( ~~~~ ) after them; pinging other editors doesn't always work, and it doesn't work on unsigned entries. I cannot add your proposed text as I don't have full journal access, and this is listed as (not sure it is) a Good Article, so I'd rather have Doc James or Jfdwolff look at the proposed content. SandyGeorgia (Talk) 15:31, 2 March 2015 (UTC)

last paragraph is empty of content, pretty much. affected to what extent, in what kinds of injury? thx. Jytdog (talk) 21:00, 2 March 2015 (UTC)

I apologize for interference. I agree that this content does not quite fit into this page. I found another page with similar content on pediatric trauma. Ebuglo (talk) 18:38, 3 March 2015 (UTC)

i think you are doing great; i should have said that i find the 1st 2 paragraphs fine. The third just doesn't say anything. If you fix that i would support adding this to the article. Jytdog (talk) 18:46, 3 March 2015 (UTC)

Ebuglo Sorry for the delay. I'd say the sources are all very good. The current page doesn't distinguish between adults and children. I'd say a discussion about the longer-term outcomes from (M)TBI is highly relevant. Could you tell us where in the article (i.e. which sections) you would like to make these additions? JFW | T@lk 06:58, 4 March 2015 (UTC)

Reverted new additions as

Concerns include:

1. The references used are mostly more than 20 years old. You will notice that most of the references currently in the article are from the last 10 years.
2. Some of your additions were unreferenced
3. This "An increase in use of helmets could reduce the incidence of TBI" was changed to "An increase in use of helmets could reduce the incidence of TBI as could common use for more casual sports participants or users." I do not understand what this change means?#This has no ref "Traditional sports that are being studied in the 2000s (e.g., monitors on contact and impact) include all physical contact ballsports from high school through professional levels, and long-term effects on professional boxers."
4. We typically use heading per WP:MEDMOS
5. The references added are not formatted for per the other references present in the article
6. We typically keep the lead at 4 paragraphs

Best Doc James (talk · contribs · email) 01:01, 16 May 2015 (UTC)

Unable to find evidence for this ref "O'Keefe, J. (1994). Long term services and supports for persons with traumatic brain injuries. Journal of Head Trauma Rehabilitation, 9(2): 42-60."

Trimmed some primary sources. Doc James (talk · contribs · email) 12:18, 17 May 2015 (UTC)

Removed this as it was discussed above [1] Doc James (talk · contribs · email) 12:20, 17 May 2015 (UTC)

Adding to external links section

Hi,

I wonder if it'd be possible to add a link to the Headway - the brain injury association website in the external links section? It's www.headway.org.uk

We have a large library of information and offer help and support to people affected by brain injury in the UK. I notice there is another UK charitable organisation listed, the Children's Trust's Brain Injury Hub, so this will add our support for adults with a brain injury.

Many thanks,

Andrew Headwayuk (talk) 10:47, 24 November 2015 (UTC)

We typically have very few external links. Try DMOZ. Doc James (talk · contribs · email) 12:04, 24 November 2015 (UTC)

Semi-protected edit request on 1 August 2016

Stuhoffphd65 (talk) 18:56, 1 August 2016 (UTC) Please remove the following information from the "chronic" subheading, since it has not been validated by a phase III clinical trial and therefore conjecture:

The most effective research documented intervention approach is the activation database guided EEG biofeedback approach, which has shown significant improvements in memory abilities of the TBI subject that are far superior than traditional approaches (strategies, computers, medication intervention). Gains of 2.61 standard deviations have been documented. The TBI's auditory memory ability was superior to the control group after the treatment.

Not done: please establish a consensus for this alteration before using the {{edit semi-protected}} template. Seems arguable since it is reliably sourced. Welcome to Wikipedia, and please remember to sign your posts at the end, not at the beginning.  Temporal Sunshine Paine  19:09, 7 August 2016 (UTC)

Semi-protected edit request on 8 November 2016

One of the things that needs to be added to this article is what is known as Tau. When a violent brain injury occurs, there's a buildup of the protein, Tau, which negatively affects the brain. Tau is most commonly seen in Alzheimer's patients, so if an individual has suffered form a TBI, this buildup will increase as they age. This protein is present in many other neurodegeerative diseases, so that's how doctors are able to track the degradation of the brain after a TBI.

Tau is a protein that was first discovered in 1975 by Marc Kirschner at Princeton University and was produced through alternative splicing of a single gene called MAPT (microtubule-associated protein tau) (REF 1, 2015). Tau proteins are mainly active in the distal portions of axons where they stabilize microtubules as well as providing flexibility. The proteins work together with a globular protein called tubulin to stabilize microtubules and aid the assembly of tubulin in the microtubules. Tau proteins achieve their control of microtubule stability through isoforms and phosphorylation (REF 2, 2013). Tau has been associated with Alzheimer's disease and other neurodegenerative conditions. Under ordinary conditions, tau is essential to neuron health, but in Alzheimer's the protein aggregates into two abnormal forms: "neurofibrillary tangles," and collections of two, three, or four or more tau units known as "oligomers” (REF 3, 2016). Hyperphosphorylation of tau proteins is what creates the neurofibrillary tangles by causing the helical and straight filaments to tangle. This contributes to the pathology of Alzheimer’s disease (REF 2, 2013). Tau oligomers, on the other hand, have been found to be very toxic to nerve cells. They are also thought to have an additional damaging property. When they come into contact with healthy tau proteins, they cause them to also clump together into oligomers, and so spread toxic tau oligomers to other parts of the brain. Scientists have found that traumatic brain injuries also generate tau oligomers. The destructive protein assemblages form within four hours after injury and persist for at least two weeks. This is long enough to suggest that they might contribute to lasting brain damage (REF 2, 2013). Researchers from the University of Texas Medical Branch have found that a substantial amount of Tau is enough to play an important role in the effects of traumatic brain injury. Those effects can include memory deficits, which have been recently shown by UTMB researchers to be induced by tau oligomers. Other long-term ramifications of TBI include seizures, and disruptions in the sleep-wake cycle (REF 3, 2016).

References

1. Mandelkow, E.-M., and E. Mandelkow. "Biochemistry and Cell Biology of Tau Protein in Neurofibrillary Degeneration." Cold Spring Harbor Perspectives in Medicine 2.7 (2012).

2. Krishnamurthy, S., Sengupta, U., Castillo-Carranza, D., Dr. Prough, D., Dr. Jackson, G., Dr. DeWitt, D. (2013). “From trauma to tau – researchers tie brain injury to toxic form of protein.” http://www.utmbhealth.com/wtn/Page.asp?PageID=WTN000831

3. Gerson, J., Castillo-Carranza, D., Sengupta, U., Bodani, R., Prough, D., DeWitt, D. (2016). “Traumatic brain injury induces mental impairments using mechanisms linked with Alzheimer’s.” http://www.utmb.edu/newsroom/article10817.aspx

Emiemilyyy (talk) 23:38, 8 November 2016 (UTC)

ω Awaiting- Provide more WP:RS.The first two of your sources are inaccessible.Also have a look at WP:MEDPRI(they are gen. of a low and controversial quality.Aru@baska^{❯❯❯ Vanguard} 16:44, 8 December 2016 (UTC)

In the *Demographics* section, after this sentence: "However, when matched for severity of injury, women appear to fare more poorly than men" Add this sentence: "This is also true for women veterans, who are at increased risk for TBI compared to women who have not served in the military." Cite: Amoroso, T., & Iverson, K. M. (2017). Acknowledging the risk for traumatic brain injury in women veterans. The Journal of nervous and mental disease, 205(4), 318-323. — Preceding unsigned comment added by 2601:18B:8200:61D8:DC6A:19FE:92:875D (talk) 23:45, 3 April 2017 (UTC)

Lancet Neurol

Critical care management doi:10.1016/S1474-4422(17)30118-7 JFW | T@lk 11:30, 11 May 2017 (UTC)

Semi-protected edit request on 7 March 2018

Remove or replace picture "Measurement of ICP in a case of TBI" It does not show a external ventricular drainage used for mesurement of ICP but a VP-shunt.

I suggest adding the following under the title Causes "In elderly the most common cause of traumatic brain injury are falls" references HarveyL.A., and CloseJ.C.T. (2012). Traumatic brain injury in older adults: characteristics, causes and consequences. Injury 43, 1821–1826.Crossref, Medline Centers for Disease Control and Prevention (CDC). (2003). Nonfatal fall-related traumatic brain injury among older adults—California, 1996–1999. MMWR Morb. Mortal. Wkly. Rep. 52, 276–278.Medline Samuel Lenell (UU) (talk) 21:33, 7 March 2018 (UTC)

 Not done: The sources provided are, at the least, more than 6 years old, and at the most, 15 years old. Spintendo      21:57, 7 March 2018 (UTC)

Note: regarding the first part of this request, I've removed the image as it was indeed an incorrectly labelled diagram of a VP shunt which is unlikely to be used for acute ICP monitoring. Although there's apparently a role for shunting in the management of posttraumatic hydrocephalus (see https://emedicine.medscape.com/article/326411-overview), it's not really an acute measure where an external ventricular drain is more common. EVDs can easily be hooked up to a transducer and monitored.

On another note, it's nice to see this article still ticking along... I was peripherally involved with it a few years back, though I no longer work in an ICU! Basie (talk) 23:06, 20 May 2018 (UTC)

Excellence in Prehospital Injury Care - Traumatic Brain Injury Project

See Epic and University of Arizona College of Medicine - Tucson and Traumatic_brain_injury#Treatment and this new news https://epic.arizona.edu/more-info/association-statewide-implementation-prehospital-traumatic-brain-injury-treatment and do you thing editors :) thanks

Role of vWF

doi:10.1111/jth.15096 JFW | T@lk 15:55, 25 October 2020 (UTC)

Permanent Brain Damage redirect?

I'm not sure the redirect from Permanent Brain Damage to Traumatic Brain Injury is correct. That's because - according to this article - the cause of a Traumatic Brain Injury is an "external force." However, one can achieve Permanent Brain Damage without application of force. For example, here is the story of a woman who drank a bottle of soy sauce during a failed attempt at body cleansing who achieved permanent brain damage. There was no force required; just internet misinformation.

Jeffrey Walton (talk) 02:55, 2 October 2021 (UTC)

You're quite right, thanks for pointing this out. Redirected to Brain damage. Better late than never! delldot ∇. 12:46, 13 August 2022 (UTC)

Semi-protected edit request on 9 July 2022

The word "pterion" is linked, but not in its first appearance. Please move the link from appearance #2 to appearance #1. 49.198.51.54 (talk) 11:52, 9 July 2022 (UTC)

 Done Nice catch! Gave me a headache trying to figure out which one was blue.Fbifriday (talk) 02:44, 10 July 2022 (UTC)

Outdated article could use a rewrite

The cited sources of this article are quite old, and it appears not to have been updated since its creation There is a surfeit of seemingly copy-pasted how-to, and a lack of secondary or tertiary sources. A full rewrite would take much effort on the part of brave editors.--Quisqualis (talk) 00:12, 11 August 2022 (UTC)

If you have time you are certainly welcome and encouraged to take a crack at it! An entire rewrite is daunting but it'd be a good start to add newer references to the info that's still good (or update it if it's not), and remove the how to and other crud that's accumulated. Thanks for pointing out the need for improvement! delldot ∇. 12:41, 13 August 2022 (UTC)

Risk factors is not old age, but late teen young adult age

The age group at highest risk for TBI is 15-25 due to sports, etc... Not old age 104.192.232.8 (talk) 12:20, 27 November 2022 (UTC)

Wiki Education assignment: English 102

This article was the subject of a Wiki Education Foundation-supported course assignment, between 9 January 2023 and 5 May 2023. Further details are available on the course page. Student editor(s): ZionSmart453, Rbg.coco (article contribs).

— Assignment last updated by Guevarab1 (talk) 19:24, 14 March 2023 (UTC)

Semi-protected edit request on 28 July 2023

In the article "Traumatic Brain Injury", under the topic chronic stage, I wanted to add a portion about occupational therapy and what we do in working with people with TBI.

Chronic stage

Once medically stable, people may be transferred to a subacute rehabilitation unit of the medical center or to an independent rehabilitation hospital.[89] Rehabilitation aims to improve independent functioning at home and in society, and to help adapt to disabilities.[89] Rehabilitation has demonstrated its general effectiveness when conducted by a team of health professionals who specialize in head trauma.[120] As for any person with neurologic deficits, a multidisciplinary approach is key to optimizing outcome. Physiatrists or neurologists are likely to be the key medical staff involved, but depending on the person, doctors of other medical specialties may also be helpful. Allied health professions such as physiotherapy, speech and language therapy, cognitive rehabilitation therapy, and occupational therapy will be essential to assess function and design the rehabilitation activities for each person.[121] Treatment of neuropsychiatric symptoms such as emotional distress and clinical depression may involve mental health professionals such as therapists, psychologists, and psychiatrists, while neuropsychologists can help to evaluate and manage cognitive deficits.[89][122] Social workers, rehabilitation support personnel, nutritionists, therapeutic recreationists, and pharmacists are also important members of the TBI rehabilitation team.[121] After discharge from the inpatient rehabilitation treatment unit, care may be given on an outpatient basis. Community-based rehabilitation will be required for a high proportion of people, including vocational rehabilitation; this supportive employment matches job demands to the worker's abilities.[123] People with TBI who cannot live independently or with family may require care in supported living facilities such as group homes.[123] Respite care, including day centers and leisure facilities for disabled people, offers time off for caregivers, and activities for people with TBI.[123]

Pharmacological treatment can help to manage psychiatric or behavioral problems.[124] Medication is also used to control post-traumatic epilepsy; however the preventive use of anti-epileptics is not recommended.[125] In those cases where the person is bedridden due to a reduction of consciousness, has to remain in a wheelchair because of mobility problems, or has any other problem heavily impacting self-caring capacities, caregiving and nursing are critical. The most effective research documented intervention approach is the activation database guided EEG biofeedback approach, which has shown significant improvements in memory abilities of the TBI subject that are far superior than traditional approaches (strategies, computers, medication intervention). Gains of 2.61 standard deviations have been documented. The TBI's auditory memory ability was superior to the control group after the treatment.[64] Melissa Scotti Alvarado (talk) 20:58, 28 July 2023 (UTC)

The Value of Occupational Therapy in TBI Rehabilitation

The occupational therapy scope of practice is based on the American Occupational Therapy Association (AOTA) documents Occupational Therapy Practice Framework: Domain and Process (1) and the Philosophical Base of Occupational Therapy (2), which states that “the use of occupation to promote individual, family, community, and population health is the core of occupational therapy practice, education, research, and advocacy” (p. 1). Additional information regarding the scope of practice of occupational therapy can be found in https://www.aota.org/practice/practice-essentials/scope-of-practice. Occupational therapists use client-centered approaches to provide meaningful, purposeful goals that empower the client to actively participate in and improve their occupational performance (3).

Occupational therapists working with individuals with TBI would complete an occupational profile and a variety of additional assessments to analyze occupational performance. When considering roles of clinicians in the multidisciplinary team, it is a role of the occupational therapist to assess a patient’s functional cognition and determine the impact of cognitive impairment from TBI on occupational performance (4). While in acute care, Occupational Therapists can assess functional cognition (5), complete cognitive assessments or screens, such as the Montreal Cognitive Assessment (MoCA; 6), and performance- based assessments (7), such as the Menu Task (8) and Assessment of Motor and Process Skills (AMPS; 9). Occupation-based approaches to assessment using performance-based assessments reinforce occupational therapists’ expertise in occupation-based methods, and an occupation-centered perspective (10). The highest levels of cognitively demanding activities such as community IADL, community mobility, and leisure activities (11) can be assessed during home care services, outpatient and / or community-based settings. Some assessments that can be performed in a community-based setting include the Canadian Occupational Performance Measure (COPM; 12), The Community Integration Questionnaire (CIQ; 13) and The Satisfaction With Life Scale (SWLS; 14).

Occupational therapists (OTs) provide interventions to address the physical (17), psychosocial (15) and cognitive (16) impairments after TBI and to support overall wellness (17). “Occupational therapy practitioners can deliver physical activity-based interventions at both the individual and group levels, such as home exercise programs, activity diaries, functional balance tasks, and cardiovascular and strength training” (17) to improve mobility and participation in daily activities. Psychosocial interventions delivered by OTs include emotional regulation skills, social participation strategies, and establishing healthy habits and routines after TBI (15). OTs also provide interventions to address cognitive impairments such as reduced memory, attention or executive functioning through interventions such as analyzing a task and breaking it into smaller, attainable goals, using different learning strategies based on the person’s level of cognitive functioning (i.e. procedural learning and errorless learning strategies) and implementing compensatory strategies within daily activities (16).

Occupational therapists are experts at helping individuals with TBI apply techniques within their daily activities and within their natural environments (i.e. home, work, school, community) (16), which results in improved ability to resume these activities. OTs may obtain additional certifications to work with people who have experienced a TBI (21): Certified Brain Injury Specialist (CBIS) (23), Neuro-Developmental Treatment (NDT) (20), Certified Low Vision Therapist (CLVT) (19,22), Certified Neuro Specialist (CNS) (24) and Certified Driver Rehabilitation Specialist (CDRS) (18,25).

Resources: 1. American Occupational Therapy Association. (2020c). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001 2. American Occupational Therapy Association. (2017). Philosophical base of occupational therapy. American Journal of Occupational Therapy, 71(Suppl. 2), 7112410045. https://doi.org/10.5014/ajot.716S06 3. Pedretti, L. W. (1996). Occupational performance: A model for practice in physical dysfunction. In L. W. Pedretti (Ed.), Occupational therapy: Practice skills for physical dysfunction (4th ed., pp. 3-12). St Louis, MO: Mosby 4. Grieve, J. I., & Maskill, L. (2013). Neuropsychology for occupational therapists: Cognition in occupational performance. John Wiley & Sons 5. Giles, G. M., Edwards, D. F., Morrison, M., Baum, C., & Wolf, T. (2017). Screening for functional cognition in postacute care and the improving medicare post-acute care transformation (IMPACT) act of 2014 (health policy perspectives). American Journal of Occupational Therapy, 71(5), 1–6. https://doi.org/10.5014/ajot.2017.715001 6. Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J. L., & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695–699. 7. Giles, G. M., Wolf, T. J., & Edwards, D. F. (2019). Principles of functional cognitive as-sessment. In T. J. Wolf, D. F. Edwards, & G. M. Giles (Eds.), Functional cognition and occupational therapy: A practical approach to treating individuals with cognitive loss (1st ed., pp. 31–37). American Occupational Therapy Association Inc. 8. Al-Heizan, M. O., Giles, G. M., Wolf, T. J., & Edwards, D. F. (2020). The construct va-lidity of a new screening measure of functional cognitive ability: The menu task. Neuropsychological Rehabilitation, 30(5), 961–972. https://doi.org/10.1080/09602011.2018.1531767 9. Fisher, A. G. (1995). Assessment of motor and process skills administration manual. Department of Occupational Therapy Colorado State University 10. Fisher, A. G. (2013). Occupation-centred, occupation-based, occupation-focused: Same, same or different? Scandinavian Journal of Occupational Therapy, 20(3), 162–173. https://doi.org/10.3109/11038128.2012.754492 11. Beaulieu, C. L., Dijkers, M. P., Barrett, R. S., Horn, S. D., Giuffrida, C. G., Timpson, M. L., Carroll, D. M., Smout, R. J., & Hammond, F. M. (2015). Occupational, Physical, and Speech Therapy Treatment Activities During Inpatient Rehabilitation for Traumatic Brain Injury. Archives of Physical Medicine and Rehabilitation, 96(8), S222-S234.e17. doi: https://doi.org/10.1016/j.apmr.2014.10.028 12. Law, M., Baptiste, S., Carswell, A., McColl, M. A., Polatajko,H., & Pollock, N. (2014). Canadian Occupational 13. Willer, B., Ottenbacher, K. J., & Coad, M. L. (1994). The Community Integration Questionnaire: A comparative examination. American Journal of Physical Medicine and Rehabilitation, 73, 103–111. https://doi.org/10.1097/ 00002060-199404000-00006 14. Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The Satisfaction With Life Scale. Journal of Personality Assessment, 49, 71–75. https://doi.org/10.1207/s15327752jpa4901_13 15. https://www.aota.org/practice/practice-essentials/evidencebased-practiceknowledge-translation/evidence-informed-intervention-ideas-psychosocial-interventions-for-adults-with-traumatic-brain-injury 16. https://www.aota.org/practice/practice-essentials/evidencebased-practiceknowledge-translation/evidence-informed-intervention-ideas-addressing-cognition-for-adults-with-traumatic-brain-injury 17. Beth Fields, Kitsum Li, Adam Kinney, Olivia Condon, Emilio Villavicencio; Physical Activity Interventions That Address Motor and Balance Impairments and Skills for Adults With Traumatic Brain Injury (TBI) (2012–2021). Am J Occup Ther September 2022, Vol. 76(Supplement 2), 7613393190. doi: https://doi.org/10.5014/ajot.2022/76S2019 18. Sherrilene Classen, Charles Levy, Dennis McCarthy, William C. Mann, Desiree Lanford, J. Kay Waid-Ebbs; Traumatic Brain Injury and Driving Assessment: An Evidence-Based Literature Review. Am J Occup Ther September/October 2009, Vol. 63(5), 580–591. doi: https://doi.org/10.5014/ajot.63.5.580 19.Sue Berger, Jennifer Kaldenberg, Romeissa Selmane, Stephanie Carlo; Effectiveness of Interventions to Address Visual and Visual–Perceptual Impairments to Improve Occupational Performance in Adults With Traumatic Brain Injury: A Systematic Review. Am J Occup TherMay/June 2016, Vol. 70(3), 7003180010p1–7003180010p7. doi: https://doi.org/10.5014/ajot.2016.020875 20. https://www.ndta.org/NDT-Certification 21. https://otpotential.com/blog/where-to-go-ot-degree#cndt 22. https://www.acvrep.org/certifications/clvt 23. https://www.biausa.org/professionals/acbis/certified-brain-injury-specialist/cbis-information-eligibility 24. https://www.neurospecialist.org/certification 25. https://www.aded.net/page/220 26. https://www.aota.org/practice/practice-essentials/scope-of-practice.

 Not done for now: please establish a consensus for this alteration before using the {{Edit semi-protected}} template. - FlightTime (open channel) 21:01, 28 July 2023 (UTC)

This is a huge edit and will take some time to transition from academic writing to Wikipedia style. A lot of the resources look to meet WP:MEDRS from my perspective but it could use some tweaking to not sound promotional in nature- i.e "OTs are experts at..." . Would you consider doing a few practice edits on Wikipedia first to get experience and then gradually making edits to this article to improve the OT section? I think you need to make 10 edits over 4 days to get confirmed (see link below). Start by some copy editing on non-protected articles, find a secondary source and practice adding it with the correct template, etc, and it will help you get ready to improve this article. You can also review WP:MEDMOS, wikipedia's medical manual of style for appropriate headings and subheadings for this article. Here is what I found re criteria on how to be a confirmed editor which would allow you to work incrementally on this article and not need permission (just work with the community to improve it and discuss challenges on the talk page) https://wiki.riteme.site/wiki/Wikipedia:User_access_levels#:~:text=Users%20are%20automatically%20promoted%20into,of%20age%20and%20500%20edits. @Melissa Scotti Alvarado: let me know if this makes sense or if I can help in any way! JenOttawa (talk) 23:48, 28 July 2023 (UTC)