Rethink OT Podcast
Transcript of Episode
Episode 2 – TBI Oupatient OT Evalutations
*Car door opens and shuts*
Hey! Look at that! We arrived to the cafe at the exact same time! Let’s head in! ! I will grab us some coffees and you grab the table! I wanted to chat with you today about preparing for an evaluation of a client who has had a traumatic brain injury! It looks like there is a bit of a long line, so I will probably be a couple of minutes! xxxxxxxxx
Okay, so i wanted to talk to you today about evaluating someone in outpatient occupational therapy who has had a traumatic brain injury. What’s our role? How do we fit? What do we do?
So the first thing I want you to understand is that there are 8 domains of occupation:
- Activities of daily living (ADLs)
- Instrumental activities of daily living (IADLs)
- Sleep and rest.
- Social participation.
When someone arrives in front of you in outpatient OT, many of your clients will be fairly independent in ADLs and IADLs. Many of your clients will be living independently (with some help for financial management, medication management, and possibly driving). Now, there are exceptions to this. Depending on the cause of your client’s traumatic injury, your client may also have many musculoskeletal impairments, chronic pain, and balance dysfunction. Remember that an event that produces enough force to result in a brain injury will also effect the other parts of the body. Since we are ‘whole-body’ practitioners, we evaluate and treat the whole body. So, you guessed it, you will be addressing BOT cognitive/executive dysfunction and musculoskeletal and mobility-based dysfunction! You need to know this when preparing for your patient! xxxxxxxxx
*crash from the kitchen* Omgosh, that scared me! Hahaha Someone dropped a full tray of food! That’s awful!
Anyways, okay, we established that you need to prepare to treat and evaluate the entire person when your client is in front of you and that you will not necessarily be addressing ADLs or many elements of IADL in your continuum. Outpatient OT works in all domains of occupation! It’s fantastic to have the freedom to use all the information you have learned in school!
I remember my first patient with a traumatic brain injury and I was so nervous! I went in for the evaluation and I had absolutely no idea what to say, what they would know, what they would understand, what I should be aware of, what kind of objective measures I would be collecting, the list goes on! We learn the Glascow Coma Scale (GCS) and Ranchos Los Amigos Levels (both of which can be found in the BOT PORTAL) and that’s about it. What does this even m ean to a new practitioner?! What if I am not in the intensive care unit where my patient is restrained and combative? How do I approach this?! Anyways…needless to say…all of the thoughts were running through my head and the experience was…..*Clears throat*….rough. Flash forward to today and I have done the research, continue to do the research, and have an arsenal of resources I use during my initial evaluation process — which is, you guessed it!, also accessible in The Portal!
It okay that you are nervous when you see your going to be treating a patient with a traumatic brain injury! It’s OKAY to have that little ‘shot of adrenaline’! This is what drives you to be as prepared as possible! This is GOOD thing! Even seasoned OTs feel this before every single evaluation – no matter how long they have been doing it! It means you care! Frankly, I would be worried if you didn’t feel a little uncomfortable before you evaluations!
Okay – i need to move and stretch the legs a little bit! I’m going to go grab us a refill!
I have fuel! Let’s talk about the steps I take to get get prepared for a TBI evaluation in outpatient OT! There aren’t alot of steps! I can break it all down in 3 steps!
- I do my my ‘QD scan’ — I know that sounds like c-u-t-i-e scan but I am actually say Q like quick and D like dirty scan! The quick and dirty scan on the latest EBP for your patient’s specific type of brain injury. Has anything changed in the research databases since I looked last? Do I need to make any changes in my current repertoire of treatment plan protocols for the remediation of certain dynsfunctions?
- First – it fulfills your ethical and professional duty as an autonomous healthcare provider to follow evidence-based and research-inspired approaches to care
- And Second, it gives you the ‘cutting edge’ confidence that you can only have if you know for a fact you know at least a little bit more about their current condition than they do. You don’t need to know everything! You will always be learning! But you do need to ensure you are atLEAST one step ahead!
- This step does two things for you:
- I gather my materials and make a checklist – Okay, you are probably thinking about your practice setting and thinking, there is no way I have time to do this! But I promise you, with just a little bit of practice – you can! I have done this in skilled nursing with 95% productivity requirements, acute care and medical rehab units, and I also do this in outpatient! If you dedicate just a little bit of time to putting together a binder for specific diagnoses, this step is nothing!
- The materials I gather are my laminated assessments for my client to complete, assessments i will complete through interview, and also some assessments for muscle and mobility. All of my favority go-to assessments are in the TBI OT Evaluation packet in The Portal! Specifically, this incudes the Occupational Profile, Executive function Questionairre, TBI symptom questionairre, Roles checklist, SLUMS, Lawton-Brody IADL, KATZ ADL, Time up and go, 5 times sit to stand, and a template to complete for ROM and MMT.
- I then make a fast and simple checklist to follow. Because I love talking and building a relationship and rapport with my client, I like to make sure I am sticking to a plan. I put all of my assessments in order and have a running checklist on the side to ensure I have crossed all of my Ts!
- Finally, and this is probably most important, I figure out how to ‘come correct’ which means I address my current HEADSPACE! As with any occupational therapy evaluation, you need to walk in as though you are a confident leader in the healthcare world! You aren’t ‘just’ an occupational therapy practitioner, you are a powerful functional-performance enhancing brain and body artist! You know more than your client does about this topic, and you have done the research! Your client is depending on you see beyond the surface and ask questions they don’t know they need ask. It is your job to define their needs to you can refine their ability to participate in the world around them. Remember that a TBI is an invisibile disability, your client is depending on you to see what others cant, to recognize the struggle, and to look at them and give them a plan. It is your responsibility to ensure that they can establish and maintain an internal locust of control throughout their lifespan with or without residual symptoms of their traumatic brain injury.
I don’t know about you, but I am ready to get out of here! Let’s walk out to our cars together!
*Cafe music fades to outside sounds/cars*
Thank you for having coffee with me! I hope what I shared gives you a place to begin with your traumatic brain injury evaluations and also some comfort knowing that you don’t need to know everything about everything to be able to show up and be prepared with relevant information to empower your client.
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. See you in the third episode of the TBI mini series where you and I will discuss, in detail, the domains of occupation that may be impacted by a traumatic brain injury at the outpatient level. Good bye for now!
*Car door closes and engine starts*