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| Division of Occupational Therapy - OT Connect Traumatic Brain Injury
TBI is caused by external forces impacting the brain, which includes injuries with and without skull fractures, that disrupt normal brain functioning. TBI is usually accompanied by a loss of consciousness at the point of injury. Impairments related to the injury may be apparent immediately, or may emerge slowly as increasing demands are placed on the individual. Possible Mechanisms of injury include:
** “Transportation-related incidents are the leading cause of brain injury." (www.biausa.org) Types of TBI's:
Common Symptoms/Course of Disease Depending on severity, a person with TBI can experience changes in physiology, cognition and behavior and may include the following:
Usual Age or common age of presentation: The majority of individuals with TBI become injured between 15 and 24 years of age, (Umphred, 2001) and persons over the age of 65 (NIPC, 2002). Sex Biases: The incidence of TBI is twice as high in males versus females. Cultural Biases: According to the Center for Disease Control website, “African Americans have the highest death rate from TBI (Thurman 1999).” Current Medical Treatment: medications; surgeries; testing, etc. Successful treatment includes early hospitalization to manage possible respiratory difficulties, to monitor cardiovascular changes and inter-cranial pressure as well as to treat other general medical conditions. Several tests may be performed following TBI and include:
In addition to medical testing, a physician will also use pharmacological interventions, or drugs, to help manage a traumatic brain injury. There are four major groups of drugs:
Occupational Therapy Involvement Occupational therapy is involved with treating Traumatic Brain Injury in several phases of recovery and rehabilitation. Occupational therapy may be involved in providing sensory, motor, and positioning supports during periods of coma. As the individual improves and re-gains skill the occupational therapy can smooth the process and re-teach skills from basic self-care, to more complex cognitive skills such as memory and problem solving. Occupational therapy works with persons throughout the lifespan. In addition to traditional medical settings, occupational therapists and may see persons recovering from TBI's in birth-to-three early intervention programs, in the public school environment, as job coaches, and in community mental health. As the health care delivery system changes, new programs are developing that assist brain injured patients in re-entering their community. (Landa-Gonzalez, 2001). References
How OT Makes a Difference: Evidence-Based Practice This article focuses on the importance of Occupational Therapy intervention with clients with acquired brain injuries. The subjects in this study identified personal goals that they would like to accomplish. Three different groups of patients in different regions of the country participated in the study. Upon initiating treatment, patients identified the areas that they would like to work to improve in via three instruments, (COPM-P, COPM-S, and CIQ). These questionnaires were administered again at time of discharge and then again after a two-week no treatment period. The results and statistical analysis of the results show a strong association, “with achievement of self-identified goals and improvement in perception of performance and satisfaction with performance. This study supports’ adults’ participation in outpatient occupational therapy following acquired brain injury. Trombly, C.A., Radomski, M.V., Trexel, C., Burnett-Smith, S.E. (2002). Occupational therapy and achievement of self-identified goals by adults with acquired brain injury:phase II. American Journal of Occupational Therapy, 56, 489-498. “D” received a traumatic brain injury as a result of a motor vehicle accident. In summer of 2000, he lost control of the cement truck he was driving, drove through a ditch and hit a large tree. As a result D was in a coma for 48 days. According to D and a former therapist, he had one of the worst brain injuries in the area, and was,” mostly left for dead.” During that time he received some therapy in the hospital and then was later transferred to a nearby nursing facility, where he “woke up.” At that time he was unable to dress himself or perform other self-care tasks; again he had some therapy here too. D has progressed through the various levels of therapy services, including in-patient rehab, home healthcare and finally community re-entry. With the help of the occupational therapy team, D was able to go back to work in the Fall of 2001. Upon returning to work, D found that his production level was well below the standard requirements. Occupational therapy worked with him to improve his production and as D says, “make my boss happy.” Currently, D is still receiving therapy with a certified occupational therapy assistant (COTA) who works with him daily and a life-skills coach who he works with in the evenings. D’s current goals focus on improving his reading, writing, and memory. When D was asked if his needs are considered, he replies, “Oh ya, I am supposed to be the boss, I tell them what to do.” For D the benefits of occupational therapy have allowed him to live by himself. When asked if he considered occupational therapy a positive experience, D simply replied, “I really do.” Clearly, occupational therapy has helped D rebuild skills from dressing to balancing a checkbook, and D is able to live his life again. Living with Brain Injury: A Guide for Families **One must remember that the symptoms an individual with brain injury experiences will vary, as will the time of recovery. Here are some of the symptoms that you may notice or your family member may complain of:
Helpful Hints for Recovery
This information is adapted from, “Facts About Concussion and Brain Injury,” developed by the CDC and is available on-line at http://www.cdc.gov/ncipc/tbi
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