Occupational Therapy for Traumatic Brain Injury

Welcome to the TBI-HELP Live Chat

Today's topic is: "Occupational Therapy for Traumatic Brain Injury"

Our Guest is: Ms. Patricia Gentile, MS, ORT/L, Jamaica Hospital Medical Center

[18:59:04] Mod: Tonight as our guest speaker we are proud to have with us Ms. Patricia Gentile, MS, ORT/L from Jamaica Hospital Medical Center. Her topic will be Occupational Therapy for Traumatic Brain Injury. Welcome Pat!
[19:00:34] Mod: What role does occupational therapy have with TBI patients who are in Coma?..
[19:04:45] Pat: patients in coma can present very differently, some can't respond at all, others respond to certain stimuli. What the OT would do would vary depending on where the patient is at. At this early stage OT is often geared towards maintaining mobility, preventing skin breakdown and increasing arousal. The OT might perform ROM exercises, moving the joint thru the full available arc of motion provide cushions when the patient is out of bed
Amanda: how can we get splints and braces done before contracture and drop foot sets in when we are in a place that is not TBI and as knowledgeable?
[19:07:57] Pat: Amanda, splints and braces must first be prescribed by a doctor. Then the OT must evaluate the patient to determine exactly what the patient needs Then the splint or brace is ordered or fabricated.
[19:09:13] Mod: Amy: How does the OT go about formulating a plan of therapy for the TBI patient?
[19:09:28] Pat: If insurance is involved this may take time as some items require "prior approval"... Amy, what is most important is that these items meet the criteria for medical necessity.
[19:23:26] Mod: Amanda: OK now we're out of coma and on the way home. Who helps with home modifications , needs advisement and ordering shower chairs etc?..
[19:25:14] pat: Amanda, the OT is usually the person who makes these recommendations. This would include home modifications, rearranging or adaptive equipment...
[19:25:47] Mod: Whey would an occupational therapist do a home visit before the patient is discharged?
[19:26:43] pat: Home visits should ideally be done before discharge to hlep the transition home. During a home visit the OT would typically take measurements to determine accessibility, This is important if someone is returning home in a w/c or using a ambulation aide. The OT would also check general safety and make recommendations for these as well...
[19:30:28] Mod: Jeff: How does the OT help the family so that they can be effective in assisting the patient when the OT is not there?
[19:29:15] pat: Jeff, this is a common question because many persons with TBI having difficulty carrying over what they learn in OT to other contexts. The OT should actively involve the family in training, particularly related to self-care. The OT should teach the family the routine, context, equipment, etc that can help the pt participate..
[19:32:05] Mod: Amanda: Suppose a pt. leaves without additional therapy but has splints or braces. Could they go back for maintenance work if needed?..
[19:32:54] pat: Amanda, it most cases the patient can return to the OT or the orthotist who provided the equipment for repair.
[19:35:07] Mod: Jeff: Sometimes family members are resistive to helping, how can the OT help them to understand?..
[19:35:25] pat: Jeff, in most cases if the family understands why the patient is having difficulty they come around The best way to do this is be involving them in the actual therapy process and providing opportunities for them to ask questions...
[19:36:08] Mod: Rail: Is there a Home Environment checklist that could go home with the family long before discharge to home? It could be in the form of guidelines or such so the OK wouldn't have some many things to recommend?
[19:37:16] pat: There are generic checklists that could be used....
[19:38:33] Mod: Amanda: As more range is gotten can most adaptive devices be redone the same way or only with a drs. rx?..
[19:39:02] pat: Amanda, that depends on the device. Some are able to be modified as the person's range of motions increases. Other devices can't...
[19:40:40] Mod: Al: How does the family begin to modify their home to accommodate the patient... Can the OT help?
[19:41:06] pat: AL, the modifications depend on the patient's needs. For example, if a patient has cognitive problems modification might involve reorganizing the closet to reduce confusion For patients with physical limitations, the OT might recommend equipment to compensate for lost balance. Examples of commonly recommended equipment include tub chairs, grab bars etc..
[19:42:53] Mod: It is often recommended that patients discharged to home be involved in group activity during the day. Why is this important?..
[19:44:02] pat: Sometimes after TBI an individual may have difficulty imitating and planning activities. A structured group program can help with this It also provided social interaction which is very important ..
[19:45:02] Mod: Amanda: In a facility as JHMC there are loads of equipment as tilt tables etc. In another place what should we look for to get the most of therapy?..
[19:45:29] pat: The best cognitive stimuli is often the most simple. Try to engage the person in familiar, routine activities. Then gradually make the activities more complex and difficult. For those who are easily confused, routines are helpful stimuli as they can trigger participation ...
[19:47:01] Mod: Al: For patients with cognitive problems, what type of stimuli would they require at home?..
[19:48:19] pat: Again, it is important to engage the person in activities that are challenging, but not frustrating...
[19:48:55] Mod: Al: With the continuation from cognitive activities, will the brain be able to begin to compensate for the deficit?
[19:49:30] pat: With time it is generally believed that the brain can learn compensatory strategies....
[19:50:45] Mod: Lots of falls and injuries occur in the bathroom. What are some steps that can be taken to improve safety in this room?..
[19:51:16] pat: The first steps to improve safety are simple Remove scatterrugs, improve lightening, place non-skid decals in the tub. If appropriate, use a raised toilet seat and be sure toilet tissue is within reach Use a wall grab bar and a tub chair while bathing. Your OT can recommend the specific piece of equipment that best needs a person's needs It is also helpful to try out the equipment in therapy before purchasing it...
[19:54:43] Mod: Amanda: Mobility and balance go hand in hand with better cognition. Are standing frames commonly used at home too?..
[19:55:15] pat: Amanda, that is a good question. In my experience standing frames are not used that much with adults; they are used more commonly with children who have balance problems There are some special w/cs which can bring a person to standing position, but these don't address the balance problem...
[19:57:09] Mod: Amanda: What use is the big giant balls that people lay over?..
[19:57:48] pat: Amanda, these are used to work on sitting balance and reflexes By placing a person on the ball you are gently challenging them to control their center of gravity and maintain an upright position. It is important that this activity be carried into into something functional....
[19:59:55] Mod: Well, its time for our session to end. We like to take this opportunity to thank Pat for a very informative session, and we welcome her back in the near future. Good night to all and be safe!
[20:00:47] pat: Thank you