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The Benefits of Physical Therapy (PT), Occupational Therapy (OT), and
Speech Therapy (ST) after a Brain Injury: Acutely and Throughout the Recovery Process
Kim Ramey, PT Melissa Chang, OTR Diana Lienemann, OTR
Benefits of PT/OT/ST Acutely
Care is Not as EASY as You Think
Kim Ramey, PT
Traumatic Brain Injury (TBI) United States
• TBI in the United States• Traumatic brain injury (TBI) is a serious public health
problem inthe United States.
• Every year, at least 1.7 million TBIs occur either as an isolated injury or along with other injuries.
• TBI is a contributing factor to a 30.5% of all injury-related deaths in the United States.
• About 75% of TBIs that occur each year are concussions or other forms of mild TBI.
Ages of TBIs in the United States• Children aged 0 to 4 years• Older adolescents aged 15 to 19 years• Adults aged 65 years and older are most likely
to sustain a TBI• Adults aged 75 years and older have the
highest rates of TBI-related hospitalization and death
• Almost half a million (473,947) Emergency Department visits for TBI are made annually by children aged 0 to 14 years
Head InjurySt. Anthony Summit Medical Center
• Head injury is the #1 Trauma diagnosis in the SASMC ED
• St. Anthony Summit Medical Center and Summit County clinics (BMC, CMC, KMC) see 2000 TBI patients per year
• Summit County has 17 times more TBIs than the national statistic per capita
Acute Care Evidence Based Practice
• St. Anthony Summit Medical Center• ED• Inpatient Care
• Mountain Clinics
Acute Care Treatment Guidelines: The REAP project
• Reduce
• Educate
• Accommodate • Pace
Acute Care Treatment Guidelines: The REAP project
Symptoms Day #1
Day #2
Day
#3 Day
#4 Day
#5 Day
# 6 Day
# 7 Day
#8 Day
#9 Day
#10 Day #
11 Day
# 12 Day
#13 Day
#14
Headache
Nausea
Vomiting
Balance Problems
Dizziness
Fatigue
Trouble falling asleep
Sleeping more than usual
Sleeping less than usual
Drowsiness
Sensitivity to Light
Sensitivity to Noise
Irritability
Sadness
Nervousness / Anxiety
Feeling more Emotional
Numbness or Tingling
Feeling Slowed Down
Feeling “In a Fog”
Difficulty Concentrating
Difficulty Remembering
Visual Problems
Other Problems
TOTAL
Acute Care Treatment Guidelines: The REAP project
Symptom Scoring
Acute Care Treatment Guidelines: PT/OT/ST
• Evaluation• History of Concussions/TBI’s• MOCA – Montreal Cognitive Assessment• GOAT – Galveston Orientation and AmnesiaTest• Signs and Symptoms• Balance• Coordination• Safety• Mobility
Acute Care Treatment Guidelines: PT/OT/ST
• Treatment• Patient/Family/Caregiver Education• REST• Settling Techiques• Limit Sound and Light• Limit Visitors and Hospital Staff Interuptions• Mobility & ADL Training- Train/Educate on
Safety Needs• Continue Evaluation and Reassesment
• Signs and Symptoms• Repeat the MOCA – if score below a 25
Acute Care Discharge• Education• REST• Discharge Packet
• REAP• Symptom Scoring Tool• Letters – English/Spanish
• To Patient, Parents and/or Caregivers• Supervisor, Principal, and/or School Team Coach• Resource List
• Follow up – 5-7 Days with a Physician• Accommodation• Screening for further evaluation
Acute Care Discharge - Resources• Resource List
Benefits of EARLY Outpatient PT/OT/ST for Post-Acute TBI
• No TBI diagnosis• Recent TBI diagnosis
Melissa Chang, OTR, OTD
Why people don’t go to therapy after a TBI
• No TBI diagnosis• Lack of financial, transportation, and
social resources• Instructed that symptoms will go away
on their own• Not knowing how therapy can help
Benefits of EARLY Outpatient Therapy• Objective Testing
• Get a TBI diagnosis• Justify services
• PT/OT/ST and other allied health interventions
• Insurance coverage• Vocational rehab• School Individualized Education Program
(IEP)• Social and financial support
Benefits of EARLY Outpatient Therapy• Learn how to prevent a another head injury• Develop insight and awareness• Set realistic expectations for recovery• Find hope• Manage symptoms
• Identify triggers • Learn sensory settling techniques• Balance rest with gradual exertion• Make accommodations with family, friends,
school, and employers
Benefits of EARLY Outpatient Therapy• Re-mediative and adaptive training
• Neuromuscular, vestibular-visual-somatosensory integration, cognition, balance, coordination, perceptual, communication, functional skills training
• Help determine readiness to return sport, school, work, and community participation
Long Term Benefits of Neurological Outpatient PT/OT/ST
Diana Horton Lienemann, OTR
Sensory Systems• The Senses
• Vision/Sight • Auditory/Sound • Smell • Taste • Tactile• Proprioception, Position, Movement • Vestibular: Gravity, Head Movement, Balance • Visceral
• Sensory Integration (SI) • Sensory overload, fatigue, headaches • Settling Techniques
Physical Involvement• Postural Control, Body Awareness
• Normal Verses Abnormal Synergy Movement Patterns, Hemiparesis
Cognitive, Perceptual, Language, Communication
• Re-training
• Compensatory
ADL's, Instrumental Living Skills, Home & Community Integration
• Patient and Family Education, • Family Involvement in Treatment
• Community and Supportive
Resources
ReferencesAmerican Association of Neurological Suregons. (2001). Sports-Related Head Injury. http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Sports-Related%20Head%20Injury.aspx
Centers for Disease Control and Prevention - Injury Prevention & Control: Traumatic Brain Injury
Giza, C., Kutcher, J., Ashwal, S. (2013). Summary of evidence-based guideline: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology.
Harmon, K., Drezner, J., Gammons, M., Guskiewicz, K., Halstead, M., Herring, s., Kutcher, J., Pana, A., Putukian, M., & Roberts, W. (2013). American Medical Society for Sports Medicine Position Statement: Concussion in Sport. Clinical Journal of Sports Medicine, 23(1), 1-18.
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(5), 709-719.
McAvoy, K. (2011). Rocky Mountain Youth Sports Medicine Institute. The REAP Project.
Nalder E, Fleming J, Foster M, Cornwell P, Shields C, Khan A. (2012). Identifying Factors Associated With Perceived Success in the Transition From Hospital to Home After Brain Injury. Journal of Head Trauma Rehabilitation, 27(2), 143-153. Neuro Developmental Treatment (NDT) certification course material. Robbins J, Ayres AJ. (2005). Sensory Integration and the Child, Understanding Hidden Sensory Challenges.
St. Anthony Summit Medical Center Trauma Database
Thank You!
THANK YOU!