Occupational therapy important for recovery in patients with brain injuries.

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deanna 2013In acknowledgement of National Brain awareness week, we spoke with Occupational Therapist Deanna Slaney, BAHKin, MScOT Reg (NS), who often works with patients recovering from brain injuries. Deanna has been a member of the pt Health clinical team since October of 2010 and practices in Nova Scotia.

What kind of patients do you typically see?

I typically work with clients who have been involved in motor vehicle accidents and have been diagnosed post-concussion syndrome. However, OTs can work with patients with acquired and/or traumatic brain injuries as well as post-stroke patients.

What is involved in the assessment of a patient with a brain injury?

There are numerous cognitive assessments that can be used for patients with a brain injury. These assessments can be done in clinic or in the home. Typically, an interview is conducted including the following sections: patient history, self-care information, work information, leisure information, obtain their goals, and then complete screening activities to assess their cognitive function (e.g. ability to follow instructions, carry on a conversation, concentration, attention span, decision-making ability, memory, ability to finish a task). Standardized and non-standardized assessments and activities would be completed.

Once you’ve finished an assessment, how do you create a treatment plan for an individual patient’s rehabilitation?

The treatment plan would be developed after review of the initial assessment. From this assessment a home visit or job site visit was be recommended.

Compensatory techniques would be developed based on a patient’s abilities and goals. These techniques would change and progress as the patient’s cognitive function begins to improve. Home activities for memory, concentration, and attention may be provided.

A home assessment may involve: observation and tour of the home, ADL assessment that would involve observing a client completing daily tasks such as showering/bathing, donning and doffing clothing, preparing meals, completing house work, ascending and descending stairs, medication management, money management. Suggestions would then be developed on how to assist with completing these tasks in a safe and productive manner (modifications, compensatory techniques, assistive devices)

A job site assessment may involve: observation and tour of the workplace, ergonomic assessment of the work station, observing clients completing work tasks, assisting in identifying modified duties as the clients return to work, identification of any cognitive factors that may influence safety and productivity at work (e.g. noise level, concentration and attention span, order of work tasks-if they are an electrician making sure they know to turn the power off before starting to work on electric panels, etc). Return to work planning would be determined. Modifications, compensatory, assistive devices, and job coaching would be identified. A cognitive work hardening program may be recommended where the clients participate in an in clinic program to improve their function (working with a treatment team).

Typically, do you work with other clinicians at your clinic to help the patient? How does working together help to improve outcomes?

Based on the client and their needs the patient would work with other clinicians. Typically, the clients are referred to OT by another clinician if they are not referred directly from a physician.

Working together allows the client to receive the best care where each individual clinician can focus on their speciality and provide a holistic approach to rehabilitation services.

What kind of results have you seen from some of your past patients?

– Clients have returned to work on a modified return to work plan or full work duties with modifications and/or assistive devices  to assist with their safety and success rate

-Clients have been able to progress in their ability to complete cognitive tasks such as reading and using the computer.

-Clients have been able to complete home activities safely and independently.

-Improved concentration and attention.

If patients seek rehabilitation for a neurological issue quickly, do you find that outcomes are generally better? What is the difference?

Although we have not tracked all of our data to date, my personal belief is that providing early intervention for any patient seeking rehabilitation cognitively or physically is a positive thing. The goal around intervention for any occupational therapy service is to create independence and enable the return to the client’s daily personal or work routine. I think we all can agree that identifying the client’s difficulties and limitations earlier on, whether physical or cognitive, will also aid in setting out realistic goals for the family and client to achieve.

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