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IV - B.S.

Occupational
Therapy

OT 5 STR: TBI

January 2015

TRAUMATIC BRAIN INJURY (TBI)


I

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 Injury

A Non-Traumatic Brain Injury


1 Anoxic Brain Injury
Aka as hypoxic brain injury/hypoxic encephalopathy
Caused by decreasing O2 to the entire brain
Major cause is cardiac arrest
2 Toxic brain injury
Ex: industrial solvent
3 Metabolic brain injury
B Traumatic Brain Injury
1 Closed head injury: dura mater remains intact
2 Open head injury : dura mater opened
3 Penetrating head injury: includes stab wounds, missile wounds and gunshot
wounds
II

EPIDEMIOLOGY AND ETIOLOGY


Male > female
Age predilection: 18-25y/o
Fall: common cause in children and elderly
Motor vehicular Head Injury: the major direct external cause.
50,000 American die
235,000 hospitalized
1.1 are treated and released from an emergency dept.

Karen Abinsay

Jet Duria

Sheena Gazzingan

IV - B.S. Occupational
Therapy

OT 5 STR: TBI

January 2015

Sequelae
1. Neuromuscular Impairments
Abnormal tone
Sensory impairments
Motor function (motor
control and learning)
impairments
Impaired balance
Paresis/paralysis
2.
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.
5. Behavioral Impairments
Disinhibition
Impulsiveness
Physical and verbal
aggressiveness
Apathy
Lack of concern
Sexual inappropriateness
Irritability

Karen Abinsay

Jet Duria

Egocentricity
6.
7. Communication Impairments
Receptive aphasia
Expressive aphasia
Dysarthria
Impaired reading, writing
and pragmatics
8.
9. 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
10.
11. Swallowing Impairments
Dysphagia
Damage to cranial nerves
Apraxia
12.
13. Indirect Impairments
Decreased bone density
Muscle Atrophy
Decreased endurance
Infection
Pneumonia
14.

Sheena Gazzingan

15.
16.
17.
18.
19. TBI Description
20. SEVE
RITY
24. MILD
28. MOD
ERAT
E
32. SEVE
RE

21. GLASGOW
COMA SCALE
25. 13-15
29. 9-12

22. LOSS OF
CONCIOUSN
ESS
26. <20 minutes-1hr
30. 1-24 hrs

23. POST
TRAUMATIC
AMNESIA
27. <24 hrs
31. >24 hrs 7
days

33. 3-8

34. >24 hrs

35. >7 days

36. *GCS score of 8 and below = comatose state


37.
38.

39.
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55. Sequence of recovery of function from coma
56. Eye opening Sleep Wake Cycle Follows Commands Speaks
IV.

ASSESSMENT:

57. 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.
58. OT Evaluation;
59. Rancho Los Amigos Levels of Cognitive Functioning Scale
60. Uses 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.
61. L
E
V
E
L
63. 1
65. 2
67. 3
69. 4
71. 5
73. 6
75. 7
77. 8

79. 9

81. 1
0

62. DESCRIPTION

64. No Response; unresponsive to stimuli


66. Generalized Response; non-specific, inconsistent, and non- purposeful reaction
to stimuli
68. Localized Response; response directly related to type of stimulus but still
inconsistent or delayed
70. Confused, Agitated; response heightened, severely confused, may be agitated
72. Cinfused-Inappropriate: some response to simple commands, but confusion with
more complex commands; high level of distructability
74. Confused-Appropriate: response more goal directed but cues necessary
76. Automatic-Appropriate: response roborlike, judgement and problem solving skills
78. Purposeful-Appropriate: response adequate to familiar task, subtitle impairments
require standby assistance with acknowledging other peoples needs and
perspective; modifying plans
80. Purposeful-Appropriate: responds effectively to familiar situations but generally
needs cues to anticipate problems and adjust performance; low frustration
tolerance possible
82. Purposeful 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

83.
84. Acute Stages of Recovery;

Glasgow Coma Scale (GCS)

85. 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)

86. Assesses cognitive function in severely impared adults and monitors change in in
non-comatose patients who are slow to recover.

Coma Recovery Scale

87. Detects subtle changes in neurobehavioral status.

88. Impatient Rehabilitation;

Functional Indipendence Measure (FIM)

89. Measure of disability in performing basic ADL.

Functional Assessment Measure (FAM)


Assessment of Motor and Process Skills (AMPS)

90. Assesse 16 motor skills and 20 process skills evaluated within the context of
client-chosen IADL skills.

Loewenstein Occupational Therapy Cognitive Assessment (LOTCA)

91. Provide comprehensive profile of visual perceptual and motor skills and involve
both motor-free and constructional functions.

Kitchen Task Assessment (KTA)

92. Determines the level of cognitive support that a person needs to complete a
cooking task sucessfully.
93. Postacute Rehabilitation;

Canadian Occupational Performance Measure (COMP)

94. 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 Checklist

95. TREATMENT:
V.

OT INTERVENTION

96. Acute Stages of Recovery

Positioning
AROM, AAROM, PROM exercise
Sensory Stimulation
Splinting and Casting
Patient and Family Education and Support
97.

98. 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 support

99. Postacute 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

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