OTA - CLINICAL CONDITION & APPLICATION - TRAUMATIC BRAIN INJURY

General categories of malignant tumors

- Gliomas: derive from glial cells within the brain and spinal cord. A fairly common. Sub-categories include: astrocytomas, ependymomas, oligodendrogliomas. - Meningiomas: arise from the meninges, the membranes that surrounding the brain and spinal cord. Growth of the tumor can create pressure on brain/spinal cord tissue or nerve roots. - Germ cells tumors: growths that form from reproductive cells. Can develop in the brain though it is very rare. - Sellar region tumors: these tumors derive from a vast variety of sources. Most commonly these tumors are benign and slow growing . Often involves the pituitary gland (aka skull base tumors)

Psychosocial deficits of TBI

- Impulsivity - Perseveration - Irritability - Poor control of temper - Aggression - Disinhibition - Apathy - Lack of self-awareness

Cognitive deficits of TBI

- Limited memory. - Retrograde (impaired capacity for new learning) and anterograde amnesia (loss of information that was acquired before the onset of amnesia) which affect learning and cognitive rehabilitation. - Difficulties with sustained attention, concentration, memory, comprehension, reasoning, self-monitoring and impulse control , other awareness, and executive function. - Difficulties in performing ADL tasks, sequencing, new learning, new motor routines.

Impact of brain tumors on occupational performance

- Mental functions are likely to decline: mood, initiative, lack of sense of well being, fearfulness. - Diminished movement: due to fatigue, pain, neuromotor deficits. - Vision: performance negatively affects functional performance. - Communication: verbally or otherwise due to vision cognition, fatigue, medication effect, motor skill quality. - Increased pain: either real or perceived, some pain sources can not be addressed by medication, these are very real and can be significantly painful. - Overall ADL's.

Level of severity of a TBI

- Mild: when patient loses consciousness for less than 15mins, memory loss about trauma event, patient feel daze, disoriented and confused. It is often called concussion. - Moderate: patient loses consciousness from 15mins to few hours follow by days or weeks of confusion. - Severe: affects less than 10% of patient & involves in lose of consciousness for 6hrs or longer after injury or after a period of clarity. People who remains on conscious for a very long time maybe in a coma or vegetative or minimal-conscious state.

Stage of consciousness

- Minimally - conscious state: any small, consistently identifiable & deliberate behavior or action by the patient. - Semi-coma (vegetative stage): when patient's eyes are open, but not always aware of themselves or their surrounding. - Coma: a deep state of unconsciousness. The patient can't be aroused (wake up). They're not response to stimulate and can't make voluntary action. A patient in this stage maybe referred to comatose. Coma can be medically endured to give the brain time to heal.

Medical complication of TBI

- Post traumatic hydrocephalus (built up of fluid in the ventricles deep within the brain) is the most common. - Dysautonomia is frequently seen after severe TBI and is characterized by hypertension, tachycardia. increased body temperature and blood pressure, and profuse sweating. - Deep Vein Thrombosis (DVT) from prolonged immobilization. - Loss of consciousness (LOC) - Coma

Chronic Traumatic Encephalopathy (CTE)

- Progressive degenerative disease seen in people with a history of repetitive brain trauma, including symptomatic concussions and subconcussive hits to the head that not cause symptoms. - Symptom: dementia (memory loss, aggression, confusion and depression). Appears years or many decades after the trauma.

Benign tumors

- This type are noncancerous, they do not invade other body tissue or spread to other body parts. - They might become life threatening as they cause increasing deficits with cell growth, because they press upon nearby structures and tissues.

4 visual skills that are evaluated in a vision screening

- Visual attention, visual acuity (near & distant), ocular movement (pursuit and saccades) - Ocular alignment, depth perception (stereopsis) - Visual field function. - Visual dysfunction

Describe the types of care settings available for clients with TBI in the acute, subacute and post-acute stages of rehabilitation.

- Acute rehab: 3 hrs of therapy per day of 2 or more therapies, 5-7 days per week. - Subacute rehab: requires the ability to participate for 0.5-2 hrs each day. - Post-acute rehab: requires at least 6 hrs of therapy a day

What are the goals of a proper wheelchair positioning program?

- Allows clients to interact with their immediate environment in an upright, midline posture. - Facilitates head & trunk control so that clients can see and interact with people and objects in the environment. - Helps prevent skin breakdown & joint contractures, facilitate normal muscle tone, inhibit primitive reflexes, increase sitting tolerance, enhance respiration and swallowing function, and promote function.

Concussion

- An injury to the brain that occurs because of a blow to the head, or because of a fall or blow to another part of the body causes rapid back-and-forth movement of the head. - Symptom: headache, dizziness, blurred vision, memory lapses or loss, alterations in judgment or decision making, or changes in coordination, especially NO CONSCIOUSNESS. Last several days/months/weeks. - Difficult to treat. Rest is the best intervention, refrain from contact sports, avoid strenuous or challenging cognitive activities (exercises & driving). - Repeated concussion have greater effects on the trauma to the brain and require longer recovery times. Long-term effects of concussions can include attention deficits and symptoms of other types of nerve and brain damage.

Tumors of the central nervous system

- Brain tumors are another category of acquired brain injuries which have increased in the past few years. - Tumors are classified as primary or secondary and malignant or benign. - The site of origin for the tumor is considered its primary site, even when the tumors have spread to other parts of the body or brain.

Motor deficit of TBI

- Decerebrate rigidity: result of damage to the brainstem between the vestibular nuclei and the red nucleus. Both UEs and LEs are in a position of spastic extension, adduction, and internal rotation. The wrist and fingers are flexed, the ankles are in plantar flexion with the feet inverted, the trunk extends and the head retracts. - Decorticate rigidity: result when the brainstem is intact despite severe cortical damage.The UEs are in a spastic flexed position with internal rotation and adduction. The LEs are in a spastic extended position but also internally rotated and adducted. - Coordination deficits include tremor (involuntary shaking or movement) and ataxia (impairment of the cerebellum itself leading to movement abnormality characterized by incoordination, impaired sitting and standing balance, or both).

Name 5 types of neuromuscular impairment that maybe present in a client with TBI

- Decorticate rigidity - Decerebrate rigidity - Dystonia (torticollis) - Spasticity - Tremor

Trauma brain injury (TBI)

- Defined by the diagnostic ans statistical manual of mental disorders, as a mild, moderate or severe brain trauma with specific characteristics that include at least one of the following: + Loss of consciousness (LOC) + Post-traumatic amnesia (PTA) + Disorientation and confusion - Involves a complex matrix of physical, cognitive, and neurobehavioral changes that may have a lifetime effect on ADLs and a person's ability to function.

2 components of behavioral management program

- Environmental interventions: alter objects or other environment features to facilitate appropriate behavior, inhibit unwanted behavior, and maintain individual safety. - Interactive interventions: are the approaches staff members and caregivers use to interact with the client.

Signs & symptoms of brain tumors

- Fatigue: falls asleep while active or talking, feels like "I just finished running 20 miles in the desert heat" any time of day. - Sleep disturbance: increased sleep time or decreased sleep time , non-restful sleep. - Pain: systemic, muscle & connective tissue, hypersensitivity which is very painful, hyposensitivity, brain pain. - Mood disorders: impulsive, outbursts, depression, euphoria, lability of mood. - Cognitive dysfunction: diminished memory & word finding, slower processing speed, brain fog. - Visual deficits: double vision, blurry vision, central serous retinopathy, blindness, sensitivity to light.

What are 2 important measurable landmarks of recovery from TBI?

- Glasgow Coma Scale (GSC): to access levels of consciousness after TBI. - Post-traumatic amnesia (PTA): the length of time from the injury to the moment when the individual regains ongoing memory of daily events.

Causes of TBI

3 leading causes: - Falls: the most common cause - Motor vehicle accidents: the most common cause of severe TBI - Violence - Blasts: leading cause of TBI in active duty

Why is it important for a client with TBI to complete an on-road driving assessment?

Because they frequently exhibit deficits that significantly affect their ability to drive

Why is it important to address substance use in individuals with TBI?

Because substance abuse is strongly linked to TBI. Individuals who are hospitalized often are intoxicated at the time of their injury. Individuals who use alcohol or other drugs after sustaining a brain injury so not recover as well as those who don't use alcohol or other drugs.

Describe 3 areas that should be addressed during discharge planning

Components of discharge planning include: - Home safety: if the client is to be discharged home, the therapist should visit the home to recommend modifications for increased safety. - Equipment evaluation & ordering: if the client will be discharged from the acute rehabilitation facility, an evaluation of the equipment needed in the next setting is required. - Family & caregiver education: family member & caregivers should be involved in the client's rehabilitation from the beginning of the treatment and should be considered members of the intervention team. Education includes transfers, wheelchair mobility, ADLs, bed positioning, splint schedules, use of equipment, ROM exercises, self-feeding techniques,...

Malignant tumors

Composed of abnormal cells that multiply rapidly, with the ability to invade or metastasize into other tissues. Brain tumors rarely metastasize beyond the brain.

Signs & symptoms of TBI

People with the TBI experience a wide range of deficits, depending on the location and severity of their injuries. Deficits may include motor deficits, cognitive deficits and psychosocial deficits.

What are the indications for splinting & casting?

Splinting & casting may be indicated when: - Spasticity interferes with functional movement and independence in ADLs. - Joint ROM limitations are present. - Soft tissue contractures are possible.