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Traumatic Brain Injury Rehabilitation

Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.

What is a Traumatic Brain Injury (TBI)

A traumatic brain injury (TBI) can occur after a fall,  sport injury, motor vehicle accident, blunt force trauma, accident at work, or any other occurrence causing the brain to be jolted or damaged in some way. The severity of the injury can range from mild to severe, and you may experience symptoms lasting days, weeks, months, or even years. 

 

Most people will begin the recovery process of a TBI in an inpatient hospitalization setting where you will regain physical, sensory, behavioral, and cognitive function. If you experienced a TBI resulting in concussion, but is not so severe that you require inpatient hospitalization, you should be immediately beginning community-based outpatient occupational therapy. In a more severe case, outpatient occupational therapy will be part of the continuum of care. Making sure you see a therapy team familiar with the symptoms and recovery process of a traumatic brain injury is crucial to maximizing your outcomes. 

Symptoms of

Traumatic Brain Injury (TBI)

Physical Symptoms

  • Headaches and migraines
  • Impaired balance and dizziness
  • Neck and lower back pain
  • Upper body and lower body muscle weakness
  • Loss of coordination
  • Difficulty sleeping and staying asleep

Emotional Symptoms

  • Mood changes
  • Personality changes
  • Increase volatility and short-tempered 
  • Unable to balance emotions 
  • Increased desire to be alone

Cognitive Symptoms

  • Confusion
  • Decreased executive functioning 
  • Short attention span
  • Short term memory deficits
  • Impaired information processing speed
  • Impaired multi-tasking ability
  • Impaired working memory skills
  • Word finding difficulties

Sensory Symptoms

  • Tremors in hands, legs, or feet
  • Neuropathy, paresthesia, numbness, or tingling in hands and feet
  • Depth perception difficulties
  • Visual perceptual deficits 
  • Sensitivity to light and sound
  • Ringing in your ears (tinnitus) 
  • Taste changes or lack of appetite

For more information, check out the Brain Injury Association

Meaningful Activities (Occupations) affected by a Traumatic Brain Injury (TBI) 

ADLs 

  • Bed mobility 
  • Cleanliness and thoroughness while toileting
  • Showering and maintaining safety 
  • Dressing 
  • Mobility (standing tolerance, walking, getting up and down without dizziness)

IADLs

Other Occupations (meaningful activities)

  • Maintaining volunteer roles 
  • Participating in hobbies or extra-curricular activities
  • Going to church 
  • Exercising 

 

 

Why is outpatient occupational therapy imperative for Traumatic Brain Injury 

What are some problems an occupational therapy can help solve? 

References

Altman, I. M., Swick, S., Parrot, D., & Malec, J. F. (2010). Effectiveness of community-based rehabilitation after traumatic brain injury for 489 program completers compared with those precipitously discharged. Archives of Physical Medicine and Rehabilitation, 91, 1697–1704.

Kim, H., & Colantonio, A. (2010). Effectiveness of rehabilitation in enhancing community integration after acute traumatic brain injury: a systematic review. American Journal of Occupational Therapy, 64, 709–719. http://dx.doi.org/10.5014/ajot.2010.09188

Traumatic brain injury. (2019, March 29). Retrieved March 13, 2020, from https://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/symptoms-causes/syc-20378557

Traumatic brain injury. (2019, March 29). Retrieved March 13, 2020, from https://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/symptoms-causes/syc-20378557

 

Helpful Page Definititions

Functional Plateau

What is a functional plateau or functional baseline?

It can be confusing when you are told that you have stopped making progress and no longer qualify for therapy - nobody wants to hear this! A functional plateau label is given when the therapist you are seeing stops seeing progress being made toward the goals he/she set during the evaluation process. It is also considered 'reaching a new functional baseline'. This means they believe you have reached maximum progress or you will not make any measurable gains in the near future. They can no longer justify restorative therapy (therapy to bring back function). 

Remember that there are other therapists with other perspectives! There are specialty therapists for each individual diagnosis and they may see different therapeutic potential! Always get a second opinion before accepting the idea that you or your loved one has reached all of your maximum potential! You may just need another approach! 

 

Neural Plasticity

What is neural plasticity or brain plasticity? 

Neural plasticity or brain plasticity is a concept known by neurological-centered medical professionals. It is your brain's ability to create new pathways to work around injured ones! This is the foundation of rehabilitation (your body's ability to repair itself). Whether you are re-learning to put weight through your joints after surgery or re-learning to open and shut your hand after a stroke -- neural plasticity is involved! If someone has had a stroke, brain injury, diagnosed with Alzheimer's or another form of dementia, multiple sclerosis, etc. ---the body's desire to maintain its ability to function does not disappear it just needs to be guided in a specific way. 

Functional Activities

Occupation-based interventions are the most functional-based approach to rehabilitation. When you are invested in the activity and understand why you are doing something, your brain's ability to heal and re-learn motor patterns improves exponentially! Occupational therapists are functional rehabilitation specialists which means we are experts in translating physical strategies into functional activities! We understand that performing a sit-to-stand in the studio is much different than getting up from your favorite recliner chair! Likewise, re-learning how to move your arm or walk in the studio is much different than feeling confident entering your home or moving about the community! Buffalo Occupational Therapy always bridges this gap and includes these real-life elements as part of our outpatient rehabilitation process!

Activity Analysis

Occupational therapists specialize in activity analysis. Activity analysis is breaking down a task into its basic parts and you master each part of the whole activity in order to enable maximum independence.

Instrumental Activities of Daily Living (IADLs)

Instrumental Activities of Daily Living (IADLs) are essential for independence in life roles and required for aging in place. There are 8 activities core activities for independence including cooking, cleaning, communication, taking and managing medication, handling your personal finances, transportation and community mobility, shopping

Cooking - The ability to follow a recipe and having the stamina to prepare a meal for yourself and/or your family

Cleaning -   The ability to perform light housekeeping including making your bed, doing your laundry, washing the dishes, taking out the trash, vacuuming, sweeping, cleaning your bathroom, etc. 

Communication - The ability to use the telephone, the computer, have conversations with people (familiar and strangers), communicate your needs clearly.

Taking medication - The ability to sort and organize your medication or determine a compensatory method to do so as well as taking the appropriate dosage at the appropriate time. 

Personal Finances - The ability to establish an organization method to understand financial responsibilities and pay your bills on time. 

Transportation - Whether you are driving, calling for a driving service like a taxi or Uber, or taking public education. You must have a defined action plan for community mobility and transportation.

Shopping - The ability to plan transportation, plan a grocery/clothing list of needs for yourself and your home, have the stamina to collect your items at the store, and be able to get them into your house. 

Activities of Daily Living

Occupational therapists are trained in occupations and activity analysis. An occupation is an activity that you believe is important to your life. There are many levels of occupations, but activities of daily living (ADLs) are the most personal activities and are usually the ones people find most important if they were to lose the ability to complete them.  

ADLs include:

  • Bathing and showering
  • Getting dressed
  • Going to the bathroom
  • Walking and getting up and down from a chair or car
  • Eating and swallowing
  • Feeding 
  • Sexual activity 
  • Personal hygiene and grooming
  • Being able to use personal care devices like adaptive equipment and durable medical equipment 
Executive Functions

Your frontal lobe is the chief operating officer of your body; it creates structure and framework so that you can function in an organized manner. When you experience a brain injury or have a neurological condition, executive functions are oftentimes impaired. 

An example of executive functions: 

  • Problem-solving
  • Multitasking
  • Organization
  • Planning
  • Decision-making
  • Beginning or completing tasks
Visual Perception

We incorporate visual perceptual elements into many treatments to enhance perception, balance, safety, cognition, memory, recall and neural excitation. Some areas of visual perception include form constancy, visual discrimination, figure-ground perception, visual closure, visual memory, and visual sequential memory.

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