It is important for individuals with traumatic brain injury and their family members to recognize that even a mild brain injury may have significant health consequences. Most people with a mild brain injury have a good prognosis, although the process of recovery may take many months. People with moderate to severe brain injury may take years to recover, and many associated problems become lifelong consequences of the injury. Rehabilitation programs focus on evaluating and treating cognitive, language, and behavioral problems that interfere with the individual's return to the community. A program based on functional activity that teaches clients how to translate skills learned in the clinic into their real life setting holds the best potential for long-term success.

Occupational therapists have an important role in the rehabilitation of individuals with traumatic brain injury. The numerous problems discussed above have an enormous impact on a person's ability to perform their daily work, self-care, and leisure activities. Through skill acquisition, purposeful activity, and environmental modification, occupational therapists provide the opportunity for people with brain injury to accomplish necessary and meaningful tasks and maximize their potential for being as independent as possible.

COMMON PROBLEMS ADDRESSED BY OCCUPATIONAL THERAPISTS:

Confusion  

Early in recovery the individual may be confused or disoriented. Help a confused person by reassurance, reorientation, and redirection. Reassure the person that he or she is in a safe place. Reorient the person by reminding them where they are, what time it is, what has happened to them, and what day it is. Occupational therapists recommend signs or visual reminders like calendars and clocks to reorient the person. When the confused person with brain injury is agitated, redirect them to another subject or activity rather then attempting to persuade them out of being agitated. Restructuring the person's surroundings to reduce noise level and visual stimulation is often helpful.

Sensory Disturbances

A person with a brain injury may lose sensation in parts of the body or may be more sensitive to certain sensations, such as heat, cold, light pressure, deep pressure, sharp, and dull . Occupational therapists recommend environmental modifications to promote safety such as wearing heat-resistant gloves and aprons when cooking, using safety scissors and other utensils, and using thermometers to determine the temperature of bath or dishwater.

Visual problems may include double vision, inability to see things on one side of the body, inability to perceive the distance between objects, inability to scan the environment, or lack of visual acuity. Occupational therapists are skilled in prescribing activities that enhance the awareness of the visual problem, compensate for losses and increase ability to functionally use vision. Some occupational therapists work closely with ophthalmologists and optometrists to improve visual deficits.

Loss of smell and taste are common consequences of severe brain injury. Those with brain injury often complain about the taste of food and may refuse to eat. Safety education, such as checking the expiration date and temperature of food before eating, is provided by occupational therapists.

Upper Extremity Movement

Many people with moderate or severe brain injury lose the ability to move one or both of their arms or have severely decreased muscle strength and endurance. Some people can still move their arms, but the movement is jerky and difficult to control. Occupational therapists provide special techniques for facilitating movement in the arms and recommend special equipment to promote independence in controlling movement.

Memory Problems

The difficulty people with brain injury have in remembering new information for more than a few minutes requires the use of memory aids recommended by occupational therapists, such as day planners and organizers, alarm cueing devices, data cards, and medication-alarm containers. Living arrangements can be modified to reduce demand upon the impaired memory.

Psychiatric Disorders

Anxiety and depression may accompany brain injury. In addition, changes in the chemical makeup of certain parts of the brain following trauma may increase the chance of developing other psychiatric disorders such as psychosis, obsessionality, mania, and paranoia. Occupational therapists recommend assistance from a psychiatrist with experience in treating people with brain injury.

Denial Of Symptoms

People with traumatic brain injury often deny that their injury has caused any personal changes. It is important to recognize that denial is not "stubbornness", but a result of the brain damage itself. To cope with denial, let the person with the injury try activities to see if they can perform them safely and effectively. Give immediate feedback. Do not expect the person to draw the same conclusions you do. Discuss limitations in the context of brain injury and recovery.

Personality Change

Personality change often causes a person to become self-centered and lose the ability to provide the caring and nurturing required for a loving relationship. People who have brain injury may become emotionally reactive, anxious and demanding. Occupational therapists recommend that families and caregivers need to set rules for themselves and the person with the injury and stick to them. A support group can help the person with the injury to get impartial feedback on behavior and its impact on others.

Behavior Disorder

In the early stages of recovery, a person with brain injury may be verbally and physically aggressive, irritable and may become angry at imaginary or real situations. This behavior often continues when the person goes home. Occupational therapists recommend effective coping strategies such as getting help immediately if the situation appears dangerous. Avoid taking anger personally. Be specific and concrete about expectations. Get assistance and counseling for the injured person and the family.

Planning and Self Control

An individual with a brain injury may have impaired judgment. They may know they have an appointment, but be unable to arrange to get there. They may know they have to pay rent, but spend all their money needlessly. People with severely impaired judgment may require 24-hour supervision and may not be able to live independently. Environmental cues recommended by occupational therapists and ongoing case management can allow those with impaired judgment to live more independently.

RESOURCES

National Head Injury Foundation                               The American Occupational Therapy Association, Inc.    
1776 Massachusetts Ave. NW                                      4720 Montgomery Lane
Suite 100                                                                     PO Box 31220
Washington, DC 20036-1904                                        Bethesda, MD 20824-1220
202-296-6443 voice
202-296-8850 fax                                                                  

Information based on "Coping with Brain Injury: A Guide for Family and Friends, by Gordon Muir Giles.