TRAUMATIC BRAIN INJURY (TBI)1. INTRODUCTION.Traumatic Brain Injury (TBI) is defined as damage to brain tissue caused by an external mechanical force with resultant loss of consciousness, post-traumatic amnesia, skull fracture or objective neurologic findings that can be attributed to the traumatic even on the basic of radiologic findings or physical or mental status examination.Types of Brain Injury1. Non-Traumatic Brain Injury1. Anoxic Brain Injury Aka as hypoxic brain injury/hypoxic encephalopathy Caused by decreasing O2 to the entire brain Major cause is cardiac arrest1. Toxic brain injury Ex: industrial solvent1. Metabolic brain injury

1. Traumatic Brain Injury1. Closed head injury: dura mater remains intact1. Open head injury : dura mater opened1. Penetrating head injury: includes stab wounds, missile wounds and gunshot wounds

1. EPIDEMIOLOGY AND ETIOLOGY

Male > femaleAge predilection: 18-25y/oFall: common cause in children and elderlyMotor vehicular Head Injury: the major direct external cause.

50,000 American die235,000 hospitalized1.1 are treated and released from an emergency dept.

SequelaeIV - B.S. OccupationalOT 5 STR: TBIJanuary 2015 Therapy1. Karen AbinsayJet DuriaSheena Gazzingan2. Neuromuscular Impairments Abnormal tone Sensory impairments Motor function (motor control and learning) impairments Impaired balance Paresis/paralysis

3. Cognitive impairments Altered level of consciousness/alertness Memory loss Altered orientation Attention deficits Impaired insight and safety awareness Problem solving/reasoning awareness Perseveration Impaired executive functioning

4. Behavioral Impairments Disinhibition Impulsiveness Physical and verbal aggressiveness Apathy Lack of concern Sexual inappropriateness Irritability Egocentricity

5. Communication Impairments Receptive aphasia Expressive aphasia Dysarthria Impaired reading, writing and pragmatics

6. Visual-Perceptual Impairments Damage to cranial nerves or the occipital lobe can cause visual impairments Hemianopsia Spatial neglect Apraxia Spatial relations syndrome Right-Left discrimination deficits

7. Swallowing Impairments Dysphagia Damage to cranial nerves Apraxia

8. Indirect Impairments Decreased bone density Muscle Atrophy Decreased endurance Infection Pneumonia

TBI DescriptionSEVERITYGLASGOW COMA SCALELOSS OF CONCIOUSNESSPOST TRAUMATIC AMNESIA

MILD13-1524 hrs>7 days

*GCS score of 8 and below = comatose state

Sequence of recovery of function from comaEye opening Sleep Wake Cycle Follows Commands SpeaksIV. ASSESSMENT:Diagnosis of specific alterations in consciousness and prognostic decision must be researve for physicians and other professionals with experience in neurological assessment of patients with impared consciosness.OT Evaluation;Rancho Los Amigos Levels of Cognitive Functioning ScaleUses behavioral observations to categorized a patients level of cognitive functions. It helps clinicians to communicate abouts patients level of cognitive function among themselves and with families and to develop appropriate rehabilitation strategies.LEVELDESCRIPTION

1No Response; unresponsive to stimuli

2Generalized Response; non-specific, inconsistent, and non- purposeful reaction to stimuli

3Localized Response; response directly related to type of stimulus but still inconsistent or delayed

4Confused, Agitated; response heightened, severely confused, may be agitated

5Cinfused-Inappropriate: some response to simple commands, but confusion with more complex commands; high level of distructability

6Confused-Appropriate: response more goal directed but cues necessary

7Automatic-Appropriate: response roborlike, judgement and problem solving skills

8Purposeful-Appropriate: response adequate to familiar task, subtitle impairments require standby assistance with acknowledging other peoples needs and perspective; modifying plans

9Purposeful-Appropriate: responds effectively to familiar situations but generally needs cues to anticipate problems and adjust performance; low frustration tolerance possible

10Purposeful and Appropriate: responds adequately to multiple task but may need more time or periodic breaks; indipendently employs cognitive compensatory strategies and adjust tasks as needed

Acute Stages of Recovery; Glasgow Coma Scale (GCS)Assesses level of conciousness scale that includes 3 sections scoring eye opening, motor, and verbal responses to vioce command. Western Neuro Sensory Stimulation Profile (WNSSP)Assesses cognitive function in severely impared adults and monitors change in in non-comatose patients who are slow to recover. Coma Recovery ScaleDetects subtle changes in neurobehavioral status.Impatient Rehabilitation; Functional Indipendence Measure (FIM)Measure of disability in performing basic ADL. Functional Assessment Measure (FAM) Assessment of Motor and Process Skills (AMPS)Assesse 16 motor skills and 20 process skills evaluated within the context of client-chosen IADL skills. Loewenstein Occupational Therapy Cognitive Assessment (LOTCA)Provide comprehensive profile of visual perceptual and motor skills and involve both motor-free and constructional functions. Kitchen Task Assessment (KTA)Determines the level of cognitive support that a person needs to complete a cooking task sucessfully.Postacute Rehabilitation; Canadian Occupational Performance Measure (COMP)Clients assessment tool based on clients identification of problems in performance in areas of occupation. Safety Assessment of Function and the Environment for Rehabilitation (SAFER) Interest ChecklistTREATMENT:V. OT INTERVENTIONAcute Stages of Recovery Positioning AROM, AAROM, PROM exercise Sensory Stimulation Splinting and Casting Patient and Family Education and Support

Inpatient Rehabilitation; Optimize gross and fine motor functioning and abilities through meaningful tasks and activities Optimize visual-perceptual functioning and abilities through environmental adaptations, compensatory techniques, and assistive devices such as low-vision aids Maximize cognitive functioning and abilities with compensatory or remedial strategies that optimize the areas of orientation, attention, and memory Increase independence in ADL and IADL Patient and family edecutaion and supportPostacute Rehabilitation; Community reintegration Maximize cognitive abilities in natural environments by teaching compensatory and adaptive cognitive strategies Environmental modifications and adaptive equipment Restore competence in ADL and IADL Participation in previous or new leisure activities Patient and family education and support