kim ramey, pt melissa chang, otr diana lienemann, otr

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

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