Traumatic Brain Injury (TBI)

What is TBI? TBI stands from Traumatic Brain Injury and can occur when there is direct trauma to the head and/or brain.

  • Keep in mind that patients with brain injury can demonstrate challenges in pragmatics and may demonstrate anger, inappropriate language, attempts to elope from the room, frustration, confusion, agitation, etc. 
  • Patients typically go through 4 stages of recovery including:
    • Period of altered consciousness (Ranchos Los Amigos Scale)
    • Post traumatic amnesia
    • Rapid recovery phase (3-6) months
    • Long term plateau phase
  • Concepts in neuroplasticity are important for understanding patient recovery and treatment
    • Acute phase is critical for recovery as neuroplasticity is most optimal for recovery
    • Neural recovery is dependent on active skilled use of cortical areas effected by the ischemic event. 

How to assess for TBI. Assessment is extremely important in this population as it allows the clinician to establish a baseline and gauge progress as treatment continues.

  • There are a variety of screeners that can be used to assess the patient’s cognitive communication. These assessments are used to determine things as simple as orientation to place/date/circumstance up to being able to participate in social contexts, complete monetary transactions, and plan for future events. 
  • Screeners are typically simple to follow and require the clinician ask the patient a variety of questions or to complete a variety of tasks to assess their comprehension, verbal output, etc. 
  • The MoCA is a simple, quick, and comprehensive assessment that is also available in Armenian in the resource folder. 
  • Scales, including the Ranchos Los Amigos Levels of Cognitive Functioning allow clinicians to assign patients a score based on their levels of arousal. 

Treatment of  TBI

  • Attempt to set goals with the patient. They may likely be aware of their limitations, but if they aren’t they might require additional coaching in order to recognize the changes in their cognition. 
  • If patients are unable to communicate verbally, alternative and augmentative communication should be established. This includes eye communication boards, pointing, writing, etc. to accommodate the patient’s needs and abilities. Begin by establishing a simple, reliable means of communication and increase from there when possible. 
  • Areas of treatment include
    • Attention
      • Types include: focused, sustained, selective alternating, and divided
      • Use metacognitive strategies, external supports (reminders, signs, lists), repetitions, functional strategies
    • Memory
      • Types include: declarative, non-declarative, working
      • Use external aids (acquisition, application, adaptation) , teach internal strategies to improve encoding and retrieval, errorless learning, spaced retrieval, memory book
    • Cognitive Communication
      • Linguistic (discourse, word finding, story grammar), extralinguistic (non-verbal communication), paralinguistic (intonation, cadence, etc.)  behaviors 
    • Right hemisphere damage (less related to speech and communication)
    • Consciousness
      • Glasgow Coma Scale, following comments, yes/no responses, intelligibile verbalization, purposeful behavior
    • Executive Functioning 
  • Treatment should always focus on the needs and abilities of patients.
    • There are a variety of activities, cognitive workbooks, visual stimuli, and skill workbooks available in the resource folder. 

Helpful links:

  • BrainLine is a national multimedia project offering information and resources about preventing, treating, and living with TBI. BrainLine includes a series of webcasts, an electronic newsletter, and an extensive outreach campaign in partnership with national organizations concerned about traumatic brain injury.
  • OT Guidelines for TBI
  • Free Course for Brain Injury Treatment
  • Links to websites of groups that study or provide information about TBI (both for patients and healthcare providers)
  • TBI General Information

Helpful Videos:

Resources for Patients and Families

Evaluation

Treatment

Clinical Resources

Patient Education

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