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 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.

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 diagnosisin 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 TBIsthan 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

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

References 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! Thank You!

Kim Ramey, PT Melissa Chang, OTR Diana Lienemann , OTR