OTA 2: Lecture 6 Mental Health Traumatic Brain Injury Stroke

1. July 3, 2012 OTA 2: Lecture 6Mental HealthTraumatic Brain InjuryStroke

2. Mental Health, TBI & Stroke • Brain-based, but distinct from one another • 1st half of class: Mental health • Mental health: can be psychologically based or physically/biologically based • 2nd half of class: Intro to TBI and Stroke • Biologically or physiologically based

3. Mental Health: Occupational Therapy and OTA Role • Occupational therapists address barriers to mental health by creating home, work and community environments that facilitate meaningful occupation • (CAOT Position Statement) • Under the direction of the OT, the OTA assists the OT in the application of research, best practices, the recovery model, and demonstration of outcomes.

4. Source: http://www.providencecare.ca/objects/content_revision/download.cfm/revision_id.205934/workspace_id.-4/Occupational%20Therapy%20-%20Mental%20Health%20Services.pdf/

5. Mental Health and OT • Found in: • Community OT • Mental Health facilities • Community facilities • Long-term Care facilities • Forensic systems (Prisons) • Everyday client populations dealing with physical dysfunction

6. Psychosocial Aspects of Physical Disability • Chapter 3 (Early Text) • Experience of loss can be profound • Especially in relation to ROLE LOSS • Effects both: • Client • Client’s family & friends

7. Key Factors Influencing Psychosocial Effect of Disabilty • Time of life and developmental stage • Extent and location of deficit • Is deficit obvious? • Social definition of the deficit • Attitudes of family/loved ones • Extent to which disability affects functioning • Disruption of valued goals ** visit these factors in your regular interactions and conversations with clients**

8. Consider the Model of Human Occupation (MOHO) • What skills, habits, and roles has this person lost or reduced as a result of the disability? • What is the person’s sense of personal causation? • What values and interests does this person have? • What is the person’s social and object environment? • What interventions will increase the person’s sense of personal causation and put the environment more within his/her control?

9. Role Checklist: Homework • Oakley, 2006 • Based on the MOHO • Review the instructions and complete the checklist for yourself. • I do not want a copy of the results, but I would like you to hand in a paragraph reflecting on what you thought of the results.

10. Psychosocial Consequences of Acquired Physical Dysfunction • Different from congenital dysfunction. • Both are equally valid and may surface during treatment, but more likely to surface with OT with acquired injuries • Affected by: • Personal reactions: Feelings of self-worth, Acceptance of disability • Address with: personalized approaches to golas and treatment objectives • Societal reactions: Attitudes, Appearances, (own) vulnerability • Address with: education, collaboration, advocacy

11. Barriers to Healthy Adjustment • Non-acceptance • Person with disability not accepted into society: no place • Examples? • Spread factor • Evaluation of the visible disability is spread to other characteristics not affected • Examples? • Labelling/Stigmatization • Language: retard, crip, psycho, quad…

12. Adjustment to Disability: Kerr • Coping mechanisms and response patterns • Analogous to Kubler-Ross grief processes • SHOCK: “this isn’t me!” • EXPECTANCY: “I’m sick, but I’ll get well” • MOURNING: “All is lost” • DEFENSIVE: • Healthy: “I’ll go on in spite of ___” • Pathological: marked use of defense to deny the effects of the disablity • ADJUSTMENT: “It’s different, but not bad”

13. How do these stages of adjustment play out? • You may see a variety of coping mechanisms in practice. • The same coping mechanism that is helpful or healthy in one client may be harmful to another. • The OT will guide how these coping mechanisms are addressed in treatment

14. Coping Strategies • Projection • Displacement • Sublimation • Aggression • Dependency • Regression • Compensation • Fantasy • Passing

15. Key: Self Acceptance and the Recovery Model • Recovery is the personal process that people with mental illness go through in gaining control, meaning and purpose in their lives. • Recovery involves different things for different people. • For some, recovery means the complete absence of the symptoms of mental illness. • For others, recovery means living a full life in the community while learning to live with ongoing symptoms. • Recovery involves changes in the way individuals with mental illness think, act and feel about themselves and the possibilities in their lives (CAMH, 2012).

16. Exercise: • This lunchtime, wear something embarrassing or use an aid in public while you have your lunch break. When we return, discuss: • What coping mechanisms you used to deal with this small change? • What though processes did you go through?

17. Break: • See you all at 12:00

18. Stroke: Cerebrovascular Accident (CVA) • Leading cause of serious long-term adult disability • Caused by a sudden loss of blood supply to the brain • Blood loss/loss of oxygen leads to damage and death of brain cells • Results in deficits relating to these areas of the brain • Remember: stroke to one side of the brain results in deficits in the opposite side of the body

19. Dysfunction: • Immediately after stroke: • Flaccid paralysis • Hypotonicity (low muscle tone) • Impaired posture control • Sensory deficits • Visual impairments • Perceptual dysfunction • Cognitive dysfunction • Behavioral and personality changes • Impaired speech and language

20. Recovery • Outcome depends on many personal, environmental, and health-related factors • Spontaneous recovery of motor function occurs primarily in first 3 months, but can occur up to one year • Improvements in functional ability continually improve with treatment and adjustment

21. Role of Occupational Therapy • Improving the motor function of the affected side • Integrating sensory, visual-perceptual, and cognitive functions • Facilitating maximal level of functional independence • Encouraging return to life roles

22. Goals of Occupational Therapy For Clients with Stroke • Consider the goals for OT on page 468 • Go through your text and find a treatment strategy that will address each of these for a client with stroke. • For this exercise, it need not be something that the OTA will implement, you can consider yourself to be working in collaboration with the OT guiding you for each goal.

23. Traumatic Brain Injury (TBI) • Results from a penetrating or non-penetrating injury to the brain • A spectrum of disability • No two clients are the same, despite the injury • TBI is a life-altering experience that causes physical, cognitive, behavioral, and emotional changes. • Difficult on both clients and families

24. Levels of Cognitive Functioning:Rancho Los Amigos Scale of Cognitive Functioning • No response: Total Assistance • Generalized Response: Total Assistance • Localized Response: Total Assistance • Confused-Agitated: Maximal Assistance • Confused-Inappropriate, Nonagitated: Maximal Assistance • Confused-Appropriate: Moderate Assistance • Automatic-Appropriate: Minimal Assistance for Daily Living Skills • Purposeful and Appropriate: Standby Assistance • Purposeful and Appropriate: Standby Assistance on Request • Purposeful and Appropriate: Modified Independence

25. Damage • Primary Damage • Occurs at the time of trauma • Secondary Damage • Can occur immediately after the injury, or hours-days later • Can be life-threatening • Can result in widespread damage

26. OT in the ICU • Establishing a bed and wheelchair positioning program • Establishing and implementing a sitting program if possible • Preventing contractures • Increasing endurance • Establishing a baseline cognitive status • Educating the family • Facilitating client participation in basic ADLs

27. Clinical Picture of a Client with TBI • Neuromuscular changes • Deficits in: • Primitive reflexes • Muscle tone • Postural stability • Motor control • ROM • Strength • Sensation • Endurance

28. Clinical Picture: • Reduced Attention and Concentration • Impaired initiation • Impaired memory • Decreased safety awareness • Delayed processing of information • Impaired executive functioning and abstract reasoning • Changes in behavior • Psychosocial changes

29. Treatment • Client-centred (always) • Consider the impact of the changes to personality • To the client themselves (are they even aware?) • To the family • Depends on severity of the injury • Refer to your text, there are good ideas there • Role of education • +++ helpful to clients and families