week 7 Brain inury

Question 1

what is ABI caused by /defined

Answer 1

damage to the brain that occurs after birth and is not related to a congenital disorder or degenerative disease

Question 2

what are the 3 classification areas of brain injury

Answer 2

primary/secondary

• primary = occurs at the time of the injury
• secondary = pathological process that occurs after injury and consequences associated

open v closed
open = skull has been pushed into brain (broken)
closed = injury doesn’t breach skull but causes injury brain

focal/diffuse
focal = confined to one part of the brain
laceration/contusion
diffuse = involves more than one area of the brain
diffuse axonal injury
hypoxic brain injury

Question 3

what is the Glasgow coma scale

Answer 3

measures degree of responsiveness
eye-opening 1 = no response 4 being responsive
verbal response 1-5
motor response 1-6

mild = 13-14
moderate 8-12
severe 8 and below

Question 4

what things indicate severe it of PTA of TBI

Answer 4

length of coma
3 weeks or more = poor progonsis
3 months indicates little chanceof functional ability

24hr of less = mild TBI/concussion
1-7days = moderate TBI
7 days onwards = severe TBI

Question 5

how does the person present if they have PTA

Answer 5

decreased information processing
poor cooperation
drowsy or agitated
disorientated

Question 6

what is the Westmead PTA scale

Answer 6

7 orientation questions 
55 new learning questions 
need to get 12/12 for 3 days 
questions such as whats you name how old are you what day is it 
remember 3 pictures

Question 7

what occupational performance deficits do we look for after brain damage

Answer 7

physical (fatigue, abnormal muscle tone, loss of joint ROM)
cognitive (disorientation, memory and new learning)
perceptual (visual processing, agnosias inability to identify objects)
language and communication (dysarthria = slurred speech, aphasia = doesn’t know the words)
behavioural and emotional (agitation, self-monitoring)

Question 8

what are the impacts of TBI on occupational perofrmance

Answer 8

• personal and domestic self-care tasks
• community acitivites
• transport
• work/study
• liesure and social activities

Question 9

inpatient rehab

Answer 9

achieve significant functional gains in preparation for
discharge to a home environment and resumption of meaningful life roles/occupations
- intense rehab in hospital environment by a multidisciplinary team
- family involvement

roles of OT
goal setting
basic cognitive assessment and intervention
ADl and IADL assessment and intervention
equipment prescription and training
family eduction

Question 10

the acute care phase
things often happening
Ot management
and interventions

Answer 10

concussion for mild cases discharge home
moderate to severe may have a neurosurgery
OT treatment of a low level client
- activities of daily living
- family/carer education support
control sensory modulation related to interests

OT treatment treatment goals
- monitor orientation and memory
- reduce confusion 
encourage purposeful and goal-directed activity
-educate family

interventions

• memory activities (puzzles)
• orientation activities eg what’s been going on in the world, talk about days etc
• perceptual activities

Question 11

the rehab phase

treatment approaches

Answer 11

– active inpatient rehab
—Discharge Planning/Transition
 Outpatient rehabilitation/Day Hospital
 Community-based rehabilitation
 Vocational rehabilitation
–

restoration
compensatory
dependent on goals of client

Question 12

the transition/discharge phase

what is services prodied during this phase

Answer 12

bridging gap between hospital and home

QLD ABI transitional rehab service
3-4days a week 12 weeks post discharge
aim to address client centred goals through a multidisciplinary team

Question 13

vocational rehab services aim to

Answer 13

graded return to work
assist people who have an injury, disability or
health condition to work independently in the
open labour market
assist the job
seeker to understand, compensate for or manage
their injury, disability or health condition

Question 14

community rehab

Answer 14

clientred centred goals
community living retraning
trying to provided structure back to there life through routines and home programs

Question 15

what is the goal of ABIOS

Answer 15

training and consultancy on ABI issues
build services and social support
professional service
coordinate existing services ad personal supports

Question 16

[A] (i) Post-traumatic amnesia (PTA) is a recognised phase in the continuum of recovery from traumatic brain injury. Define the term ‘post-traumatic amnesia’ and describe three [3] treatment goals for the occupational therapy management of PTA. [5 marks]

Answer 16

post-traumatic amnesia refers to the state of confusion or disorientation after TBI

Question 17

[B] (i) Describe four [4] common behavioural issues following a traumatic brain injury. [4 marks] (ii) Describe five [5] components of the role of occupational therapy with clients following TBI in inpatient rehabilitation. [5 marks]

Answer 17

agitiation
disinhibition poor impulse control
social inappropriateness
poor self-monitoring

– active inpatient rehab
—Discharge Planning/Transition
 Outpatient rehabilitation/Day Hospital
 Community-based rehabilitation
 Vocational rehabilitation

Question 18

[A] The severity of a traumatic brain injury can be determined using length of post-traumatic amnesia or initial lowest Glasgow Coma Score. (i) Define a severe brain injury using both methods. (2 marks)

(ii) Describe the clinical characteristics of a client in post-traumatic amnesia. (2 marks)
(iii) Describe six [5] goals of occupational therapy management of clients in post-traumatic amnesia. (6 marks)

Answer 18

i state of disorientation and confusion after TBI
<24hrs - mild
1-7 days moderate
7 days on severe

the initial lowest GCS in first 24hrs
13-14 mild
8-12 moderate
8 and below severe

ii state of disorientation and confusion after TBI
they may struggle to remember things poor cooperation drowsy or agitiated

iii - monitor orientation and memory function

    - reduce the external influence on confusion 
   - encourage initiation of ADL  
 - educate family 
 - decrease inappropriate behaviour and vebalisations

Question 19

Name and describe four [4] common psychosocial issues following a traumatic brain injury. (8 marks)

Answer 19

personal relationships = relationship breakdown
social particpation = social isolation
employment and financial issues
dual diagnosis = condition plus depression