Transcript of Episode

3 General Considerations of treating Traumatic Brain Injuries in Outpatient Practice

*Birds Chirping*

*Door opens and closes* 

Don’t you love the beginning of spring?? It’s March! This means it is Traumatic Brain Injury Awareness Month. What better way to honor such an enormous area of practice for occupational therapy than doing a mini-series on the 4 greatest considerations for an OTP in outpatient practice working with clients who have suffered a traumatic brain injury! 

At Buffalo Occupational Therapy we work very often with individuals at all levels of healing after a brain injury. It’s important to note that depending on where you are working in the continuum of care and the level of injury of your patient, your plan of care and treatment continuum will differ. I also am the lead occupational therapist at the national brain injury institute where I do teletherapy for individuals post-traumatic brain injury and perform medical record reviews for life care planning reports. This, along with my research is what has led to my purview on this topic. 

Before we jump into the series, it’s probably best if we lay down some ground principles.Since the weather is so fantastic, I figured we would to a place many of you know…but you will need to wait and be surprised! As an occupational therapist, I am a huge believer in the P-E-O model! For those of you who are knew here, that is the Person-environment-occupation Model! Environment is everything so get your sneakers on and probably a jacket! It’s sunny out there, but it’s still just a bit chilly. Lets go! 

Okay, let’s walk and talk.  We are headed to the subway and don’t want to miss the early train! Don’t worry, in this world everything is safe and social! Although, it is a bit busy out there! People are have SPRING FEVER!!

*Puts on jacket*

*Door opens and closes* 

*Bird singing*

So as we are in walking, I think that the biggest point I need you to know is that- 

  1. This is an invisible diagnosis – your client needs you to understand this. In outpatient, often times our clients have been discharged from the hospital and they are now ready to live their life. As they begin…or….attempt to re-integrate into the community and their former lifestyles, they begin to experience the changes that weren’t noticeable in a full-time clinical setting. For many, they begin to ‘see’ their altered neurocognitive dysfunctions for the first time. Unfortunately, it’s difficult to explain what they are going Q to their friends and family and this becomes a source of frustration! Friends and family are frustrated because their loved one seems to be “milking symptoms” and our client is frustraated because he/she is actually experiencing insurmountable challenges when trying to do meaningful activities they once thought very simple. 
  2. How can you help this? Give your client time to talk about how he or she is feeling! Actually ask the words, “I know you are fine and you are strong and getting through, but how are your spirits? How are you actually feeling about what you are going through and what has happened?” Sometimes, someone is waiting for permission to be raw and honest, take time to give that to them. Occupational therapy is just as much based on psychology principles as it is cognitive-related and physical medicine. 

*Metro Station Sounds*

Ya know, for a lot of our clients with TBI, these sights and sounds are too hard for them! They have things like Hyperacusis and photophobia. They want to be isolated and make get really confused when having to get onto the subway in a hurry like we just did! That’s why it’s so important to ask about those things!!! Most times, we won’t know unless we initiate the asking! 

So, the second point- when it comes to documenting and interviewing your clients diagnoses with traumatic brain injury – 

  1. Take the time to capture all of the data in your evaluations and initial appointments. I can’t stress enough how important it is to gather all necessary information and data in outpatient services. Not only is this important because of the people who may need this information from you – like other medical professionals and law teams – but as an occupational therapy practitioner, you need to ensure you are quantifying every aspect of brain injury recovery in outpatient practice. 
  2. What does this look like? Get your core group of assessments ready to go! If you do the work the FIRST time, every new patient you have who has been diagnosed with a traumatic brain injury will take less time durinig the preparation phase! 
  3. I like to grab several assessments: 
    1. Role Checklist
    2. Executive Function Questionnaire
    3. Traumatic Brain Injury Symptom Checklist 
    4. ABC Perceived Balance Confidence assessment 
    5. SLUMS
    6. STROOP
    7. DUAL tasking 
    8. Then, moving into more physical exams as time allows. – Tandem Walking Screen 
    9. BERG Balance Assessment
    10. 5 times sit to stand
    11. And Timed up and go test 

There is actually much research surrounding these particular assessments as applied to individuals with acquired brain injuries as it relates to reliability and insight on functional performance capacity. 

*Train stops*

Here’s our stop- let’s get off! *subway fades and birds fade in and out*

The library is just around the corner. I feel the anticipation coming off of you! Alright Alright – I will tell you why we are here! The third and final point is BE PREPARED! 

  1. Be prepared to partner your knowledge of physical medicine with your knowledge of social science and learn how to deliver BOTH through patient education and treatment-based application through the lens of your profession–by using the full scope of practice
    1. I won’t sit to long on this SOAP box, but I usually find my way up here at some point during these discussions….
    2. OT does NOT equal activities of daily living and instrumental activities of daily living. I think you and I can both agree that we do many things that are NOT IADLs and ADLs…right? I mean….you don’t just put cup ints cupboards, wash windows, and get dressed all day? Do you?  Hopefully, you said no! So why do so many of feel like our job starts and ends with these occupations? 
    3. In outpatient occupational therapy, many of our clients are INDEPENDENT with all of these things, but I promise you, they still need help traversing life! They still need someone to bring them to their fullest functional and cognitive capacity so that they can live a least restrictive lifestyle! 
    4. Remember that your job is to REMEDIATE FUNCTION –cognitive function, executive function, physical function, social interactive function…..We always work to remediate! Now, we may help our clients compensate while we remediate, but as a functional performance specialist, an occupational therapy practitioner should never leave their client in a state of dysfunction when we have the tools to lead our client on a journey to recovery. 
      1. When working in outpatient occupational therapy with traumatic brain injuries, you must know how to just as many ways to elicit neurological healing as you do how to improve social interactions and self-care. 

I can’t wait to get started on this mini-series with you! Follow the Rethink OT podcast to be alerted to our first episode in the series! Preparing for an evaluation when I see will be seeing a patient diagnosed with Traumatic brain injury. I will talk about what I am feeling now vs my first patients, how I prepare to engage with the client, and what key things to watch and listen for throughout the first interaction in outpatient occupational therapy! 


As always, thank you for listening to the  Rethink OT podcast where we live out our passion to remake OT into a cutting-edge profession.