Occupational Therapy for Brain Injury - Part 2: OT Process

These flashcards include key terms and definitions related to the process of occupational therapy for individuals with brain injuries, addressing assessment methods, recovery levels, therapeutic interventions, and the importance of family involvement.

What is a brain injury?

Any damage to the brain that disrupts normal function. It may be traumatic (from external force) or non-traumatic (from internal causes like stroke or oxygen loss).

What is a Traumatic Brain Injury (TBI)?

Brain damage from an external mechanical force (e.g., fall, vehicle accident, blow to head). Can cause bruising, bleeding, or shearing and lead to temporary or permanent changes in thinking or behavior.

What is a Non-Traumatic (Acquired) Brain Injury (ABI)?

Occurs from internal causes such as stroke, tumor, infection, or oxygen deprivation (anoxia/hypoxia); no external force is involved.

What is a Focal Brain Injury?

Localized damage to one area of the brain, often from a direct blow or penetrating injury.

What is a Diffuse Brain Injury?

Widespread damage to axons throughout multiple brain areas, commonly from acceleration or rotational forces (e.g., diffuse axonal injury).

What is the difference between focal and diffuse brain injuries?

Focal = localized to one region. Diffuse = widespread across several regions. 🧩 Focal → “one spot”; Diffuse → “many connections.”

What is Diffuse Axonal Injury (DAI)?

Widespread tearing of axons caused by rapid acceleration/deceleration, leading to coma and severe long-term motor and cognitive deficits.

What is the Glasgow Coma Scale (GCS) used for?

To measure a person’s level of consciousness after brain injury based on eye, verbal, and motor responses (3 = severe, 15 = normal).

What is aphasia?

Loss of ability to understand or express language due to damage to language centers (usually left hemisphere).

What is dysarthria?

Slurred or slow speech caused by weakness or poor coordination of speech muscles.

What is photophobia?

Sensitivity to light, often increased after brain injury.

What is diplopia?

Double vision resulting from misalignment of the eyes or impaired ocular muscle control.

What is accommodative dysfunction?

Difficulty adjusting eye focus for near and far objects, causing blurry vision.

What is nystagmus?

Involuntary eye movements that create shaky or unstable vision.

What is ptosis?

Drooping of the upper eyelid, often due to cranial nerve III damage.

What is oculomotor dysfunction?

Impaired eye movement control due to cranial nerve damage, causing tracking and scanning difficulty.

What are perceptual deficits?

Problems interpreting visual information (e.g., depth perception issues, spatial neglect, visual field loss).

What is spasticity?

Abnormally high muscle tone causing stiffness and limited movement from upper motor neuron damage.

What is flaccidity?

Reduced or absent muscle tone that makes limbs appear limp and heavy.

What is ataxia?

Poor coordination of voluntary movement leading to unsteady motion, often from cerebellar damage.

What are postural impairments after brain injury?

Abnormal alignment from muscle imbalance (e.g., posterior pelvic tilt, head flexion, scapular retraction).

What is dysphagia?

Difficulty swallowing caused by weak or uncoordinated muscles used for eating.

What is proprioception?

The sense of body position and movement without visual input.

What is kinesthesia?

The sense of body movement, allowing awareness of motion while it occurs.

Which sensory functions are often affected after brain injury?

Light touch, pain, temperature, proprioception, and kinesthesia may be reduced or lost.

What is the best initial step for a patient hypersensitive to sensory input?

Reduce environmental stimulation by dimming lights and lowering noise to prevent overload.

What is attention in cognition?

The ability to focus mental effort on a task or stimulus — includes alertness, selective, sustained, alternating, and divided attention.

What is alertness?

A basic state of readiness to notice and respond to stimuli.

What is selective attention?

Focusing on one stimulus while ignoring distractions.

What is sustained attention?

Maintaining concentration on one activity for an extended period.

What is alternating attention?

Switching focus back and forth between different tasks or stimuli.

What is divided attention?

Managing two or more tasks at once, such as walking while talking.

What is Short-Term Memory (STM)?

Temporarily holds information for seconds to minutes (e.g., remembering a phone number to dial it).

What is Working Memory?

Actively holds and manipulates information for tasks like mental math or following multi-step instructions.

What is Long-Term Memory (LTM)?

Stores information for hours to a lifetime and supports learning, skills, and personal history.

What is Declarative Memory?

A type of long-term memory for facts and events that can be consciously recalled (e.g., names, dates).

What is Procedural Memory?

A type of long-term memory for learned skills and habits (e.g., riding a bike, typing), often preserved even when other memory systems are impaired.

What is executive function?

Cognitive skills for goal-directed behavior — planning, organization, sequencing, initiation, and judgment.

What is impaired judgment?

Inability to make realistic or safe decisions, often leading to safety risks.

What is cognitive fatigue?

Mental exhaustion from sustained effort; patients need frequent rest breaks and paced tasks.

What is apathy after brain injury?

Lack of emotion or motivation, causing reduced engagement with surroundings.

What is impulsivity?

Acting without thinking, which may result in unsafe or inappropriate behavior.

What is disinhibition?

Loss of social restraint or self-control, leading to inappropriate language or actions.

What psychosocial changes are common after brain injury?

Altered personality, emotional instability, grief, anxiety, depression, and role loss.

Which factors support recovery after brain injury?

Mild injury severity, deficit awareness, social support, education, emotional stability, and consistent therapy.

What is a key OT strategy for clients with memory or cognitive deficits?

Use structured tasks, external aids, clear step-by-step directions, and feedback to improve carry-over and performance.

What are common OT assessment tools for brain injury?

COPM, Section GG/FIM, ROM and strength tests, tone assessment, Rancho Los Amigos scale, Mini-Mental Status Exam or cognitive battery, and vision/visual-perceptual assessments.

What is the Rancho Los Amigos (RLA) Scale?

A 10-level scale describing cognitive, behavioral, and functional recovery after brain injury. Progression is not always linear.

What happens at Rancho Level I – No Response?

The person shows no observable response to stimuli and appears in deep coma. OT focuses on positioning, sensory stimulation, and family education.

What happens at Rancho Level II – Generalized Response?

The person reacts inconsistently and non-purposefully to stimuli. OT uses structured sensory stimulation and tracks emerging responses.

What happens at Rancho Level III – Localized Response?

The person reacts specifically but inconsistently to stimuli and may begin to follow simple commands. OT focuses on sensory stimulation and basic motor tasks.

What happens at Rancho Level IV – Confused–Agitated?

The person is alert, confused, and may be aggressive or restless. OT provides a structured, low-stimulation environment and focuses on safety and simple ADLs.

What happens at Rancho Level V – Confused, Non-Agitated, Inappropriate?

The person is more alert but still confused, may wander, and follows one-step commands inconsistently. OT provides structure, cues, and simple tasks.

What happens at Rancho Level VI – Confused, Appropriate?

The person shows goal-directed behavior with external cues, improved attention, and limited new learning. OT uses repetition, memory aids, and structured routines.

What happens at Rancho Level VII – Automatic, Appropriate?

The person performs routine daily tasks automatically but lacks insight and judgment. OT focuses on higher-level ADLs, safety, and community reintegration.

What happens at Rancho Level VIII – Purposeful, Appropriate?

The person is consistently oriented and purposeful with carry-over for new learning. OT emphasizes independence, coping, and fatigue management.

What happens at Rancho Level IX – Purposeful, Appropriate, SBA on Request?

The person can shift attention, use memory devices, and ask for help when needed but may need assistance in new situations. OT focuses on problem-solving and self-monitoring.

What happens at Rancho Level X – Purposeful, Appropriate, Modified Independent?

The person is independent with tasks and memory aids but may need extra time or breaks. OT supports work and community reintegration and coping strategies.

What is the OT focus for individuals at RLA Levels I–III (low levels)?

Increase arousal and awareness through sensory stimulation, positioning, splinting, dysphagia management, basic ADLs (hand-over-hand), and family education.

What is sensory stimulation (coma stimulation)?

A structured presentation of visual, auditory, tactile, olfactory, gustatory, and movement input to increase alertness and awareness in low-level clients.

What are key guidelines for sensory stimulation?

Present one stimulus at a time, monitor vital signs, assume comprehension, use normal tone, and be consistent in approach.

What is the goal of bed positioning in acute brain injury?

Prevent pressure sores, maintain ROM, and support respiration and comfort. Patients are repositioned about every two hours.

What are the goals of splinting and casting in brain injury?

Decrease abnormal tone, prevent contractures, and improve movement. Splints are used for positioning; casting manages severe spasticity.

What is the purpose of wheelchair positioning?

Supports upright posture, prevents skin breakdown, enhances respiration and swallowing, and increases interaction with the environment.

Why is family and caregiver education important?

Families assist with eliciting responses, sensory programs, and positioning. Education begins immediately and continues through all stages of recovery.

What is the OT focus at RLA Levels IV–VIII (intermediate to higher levels)?

Address motor and cognitive impairments, facilitate ADLs/IADLs, manage behavior, and prepare for community reintegration and discharge.

What are examples of neuromuscular interventions in brain injury rehab?

NDT, PNF, NMES, weight-bearing, and bilateral integration to improve tone, coordination, and carry-over.

What are key behavior management strategies for brain injury?

Modify the environment, maintain team consistency, use calm and direct communication, and reinforce positive behavior.

What is the purpose of discharge planning in brain injury rehab?

Ensure a safe transition home through home safety evaluations, caregiver training, and planning for equipment, driving, or school/work return.

What are general OT approaches for clients with brain injury?

Provide a clear rationale, maintain structure and repetition, use cognitive supports, ensure team consistency, and educate clients and families.