Kim Ramey, PT
Melissa Chang, OTR
Diana Lienemann, OTR
Care is Not as EASY as You Think
Kim Ramey, PT
• TBI in the United States
•
Traumatic brain injury (TBI) is a serious public health problem in
the 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.
• 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 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
• St. Anthony Summit Medical Center
• ED
• Inpatient Care
• Mountain Clinics
• Reduce
• Educate
• Accommodate
• Pace
Acute Care
Treatment Guidelines: The REAP project
Symptoms
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
Day
Day
#1
#2
Day
Day
Day
Day
Day
Day
Day
Day
Day #
Day #
Day
Day
#3
#4
#5
#6
#7
#8
#9
#10
11
12
#13
#14
Symptom Scoring
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Evaluation
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History of Concussions/TBI’s
MOCA – Montreal Cognitive Assessment
GOAT – Galveston Orientation and AmnesiaTest
Signs and Symptoms
Balance
Coordination
Safety
Mobility
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Treatment
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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
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•
Signs and Symptoms
Repeat the MOCA – if score below a 25
• Education
• REST
• Discharge Packet
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REAP
Symptom Scoring Tool
Letters – English/Spanish
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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
• Resource List
• No TBI diagnosis
• Recent TBI diagnosis
Melissa Chang, OTR, OTD
• 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
• Objective Testing
• Get a TBI diagnosis
• Justify services
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PT/OT/ST and other allied health interventions
Insurance coverage
Vocational rehab
School Individualized Education Program (IEP)
Social and financial support
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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
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Re-mediative and adaptive training
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Neuromuscular, vestibular-visual-somatosensory
integration, cognition, balance, coordination,
perceptual, communication, functional skills training
Help determine readiness to return sport, school,
work, and community participation
Diana Horton Lienemann, OTR
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The Senses
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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
• Postural Control, Body Awareness
• Normal Verses Abnormal Synergy
Movement Patterns, Hemiparesis
• Re-training
• Compensatory
• Patient and Family Education,
•
Family Involvement in Treatment
• Community and Supportive Resources
American 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!