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Libby

Traumatic Brain Injury


20 Years Old
CHELSEA TOWNSEND
SHAWNA SOILEAU
OLIVIA HERNANDEZ

Libbys Occupational Profile


20 year-old female
Attends Texas A&M University- majoring in Accounting
Enjoys exercising and staying active
Was in car accident and experienced a closed head injury
of moderate severity
First sent to Memorial Hermann hospital where she
underwent immediate surgery
After a week in acute care, Libby was sent to TIRR
inpatient hospital for occupational, physical, and speech
therapy
After discharge from the hospital she was referred to the
TIRR outpatient rehabilitation

Traumatic Brain Injury (TBI)


A change in brain function
Impairment of cognitive abilities or physical functioning
Problems with behavioral, sensory, and emotional function
May be temporary or permanent

Mild
Moderate
Severe

Estimated 1.4 million Americans sustain a TBI each year


Primary Causes

Falls
Motor vehicle accidents
Assaults

TIRR Memorial Hermann


Outpatient Rehabilitation
Different Level of Care
Team of Professionals

Patients who have had catastrophic injuries or

illnesses often need lifelong follow up through


outpatient rehabilitation to detect and prevent
complications.
Hours: Mon-Sat
7:00 am- 6:00 pm
Open Gym
3:00 pm- 8:00 pm

The Work Environment

Occupational Therapy
Physical Therapy
Speech Therapy
Gyms
Advanced technology
Client Centered Rooms
Visual Assessments
Electronic Charting
TIRR Memorial Hermann Outpatient Rehabilitation- Kirby Glen
2455 S Braeswood Houston, TX 77030
Gerald Virtanen, OTR

Occupational Therapy Services at TIRR


Person, Environment,

Occupation (PEO) Model


Client Centered

Daily activities to regain


the skills to return to the
community and school.
Individual goals

Lymphedema

management
Casting and Splinting
Sensory integration
Visual Assessments

Challenge Program
Strength Unlimited

Program

Intake/Screening
Review of physicians

documentation
Medical history- No prior medical
history
Current medications

Baclofen
Topiramate, neurontonin (anticonvulsants)
Citalopran (anti-depressant)
Acetaminophen, ibuprofen (pain
management)

Level of functioning

Prior: completely independent in all


areas of functioning
Current: independent in grooming
and UE dressing; assistance needed
in LE dressing, transfers, and
ambulation

Home environment

Prior to accident- college


dormitory
When discharged- parents onestory home with mom, dad, and
brother

Adaptive equipment

Manual wheelchair
Walker

Driving status

Prior to accident was driving


daily, but now unsafe to do so

Employment

Full time student at Texas A&M

Hobbies/interests

Exercising
Cooking

Evaluation/Assessment
Functional Tests
Orientation questions
What is your name? What is
todays date? Where are you?
Why are you here?
Libby was able to answer
these questions correctly
Range of Motion
Shoulder flexion below
normal range
Libby is able to fully flex her
elbow; however, spasticity is
limiting elbow extension
Forearm, fingers, and thumb
measurements within normal
range

Manual Muscle Testing


Libby has tone in her upper
extremities, so she is able to
withstand resistance
temporarily, but then muscle
gives (MMT grade 3+)
High tone in shoulder
internal rotators and
abductors
Elbow flexors have normal
muscle tone, but elbow
extensors cannot move
against gravity
Forearm, wrist, fingers, and
thumb muscles have normal
muscle tone

Evaluation/Assessment Cont

Hand and pinch strength


Grip strength tested using
dynamometer
Less than average grip
strength in both dominant
and non-dominant hand
Tip to tip pinch, lateral pinch,
and tripod pinch strength
tested using a pinch gauge
Less than normal in both
hands
Coordination
9 hole peg test
30 seconds for her dominant
hand and 33 seconds for her
non-dominant hand (Average
is 15 seconds in dominant
and 17 seconds in nondominant)

Sensation
Proprioception deficits
Libby presents difficulty
distinguishing between light
touch
Vision assessment
Libby wears
contacts/glasses
She does not have cataracts,
glaucoma, nor nystagmus
Presents field cuts, tracking
deficits, and possible
hemianopsia in both eyes
Cognitive assessment

Ranchos los Amigos Scale


Libby scored a level VI

Intervention
Short term goals

Activities and Exercises

Increase right UE shoulder flexion


AROM greater than 90 degrees
Will perform transfers
independently 100% of the time at
home and at therapy
Demonstrate the ability to safely
complete LE dressing

AROM exercises- Dow

Long term goals

Return back to school

Complete ADLs independently

Strengthening exercises- Thera

band
Balance, coordination, visual
acuity Letter toss game
Cognition and sequencing- bread
in a bag
Practicing transfer techniques
Typing on the computer

TIRR Memorial Hermann


Challenge Program
Libby was a admitted in the

Challenge Program
This program assist her in
returning to school and to
gain a higher level of
independence.
Education services prepared
her to succeed in an education
environment.
The therapy staff consulted
with the school personnel
about the appropriate
accommodations in the
academic setting.

Strength Unlimited
Program
Strength Unlimited is a

community wellness program at


TIRR Memorial Hermann they
have professional trainers, an
open gym and classes for those
who can benefit from a wellness
program after outpatient
therapy.

Open Gym
Monday: 4:00 pm to 8:00 pm
Tuesday: closed
Wednesday: 4:00 pm to 8:00 pm
Thursday: closed
Friday: 3:00 pm to 7:00 pm
Saturday: 9:00 am to 1:00 pm

Discharge
2-3 times per week for 4 months
Reason for discharge

Met most of her goals


Still working toward long term goal of returning to
college
Discharge Plan
Home exercise program
Challenge Program
Strength Unlimited

Its a very flexible career

Occupational
Therapy

There are a wide variety of

services that Occupational


Therapist can apply

What we learned
about OT as a
result of visiting
TIRR

Lymphedema Management
Splints
Sensory Integration

Working with TBI patients can be


challenging because every case is
different and one needs to adapt to
individual needs

References
Schell, B.A.B., Gillen, G., & Scaffa, M. E. (Eds.).

(2014) Common Conditions, Resources, and


Evidence. Willard and Spackmans
Occupational Therapy (12th ed.) (pp. 11841185). Philadelphia: Lippincott Williams &
Wilkins.
TIRR Memorial Hermanns website:
http://tirr.memorialhermann.org/patientresources/