Traumatic Brain Injury (TBI): Treatment Techniques and Rehabilitation Strategies

What is the primary goal of sensory stimulation in TBI treatment?

To increase arousal, improve awareness of self and environment, and facilitate neurologic responsiveness in early recovery.

What are the key sensory modalities recognized by OTs for stimulation?

Tactile, auditory, visual, olfactory, gustatory, and vestibular.

What should OTs avoid in sensory stimulation?

Sensory input that causes withdrawal responses, pain, nausea, seizure activity, or excessive vestibular stimulation.

What is the critical rule regarding sensory input in TBI treatment?

Sensory input must be structured and controlled, not random.

What does PROM stand for in TBI treatment?

Passive Range of Motion.

How should OTs modify PROM in the presence of hypertonicity?

By avoiding sudden stretch and inappropriate or excessive stimulation, and preparing proximal joints before distal movement.

What is a key example of preparing movement in PROM for TBI?

Scapular mobilization before upper-extremity PROM to support normal shoulder mechanics.

What is the focus of OT intervention when severe hypertonicity limits movement?

To use additional medical and mechanical supports and teach self-ROM exercises as appropriate.

Why is facial and oral motor control important in TBI treatment?

It supports communication, feeding, and swallowing safety.

What activities may be included in facial and oral motor control therapy?

Blowing, sucking, facial expression exercises, and sensory stimulation to encourage movement.

What are key safety principles regarding feeding in TBI patients?

Feeding is delayed until swallowing safety is established, especially for patients at risk for aspiration.

What types of food textures are introduced during early intake for TBI patients?

Smooth, puréed textures and then gradually progressing to thick liquids and soft, moist foods.

What is the core focus of OT in increasing independence in ADLs?

Bathing, dressing, feeding, hygiene, and grooming.

What approaches are used to increase independence in ADLs?

Neurodevelopmental techniques, repetition, energy conservation, work simplification, and compensation strategies.

What are the two categories of cognitive intervention in TBI treatment?

Cognitive remediation and cognitive rehabilitation.

What are the early treatment principles for cognitive intervention?

Encourage response to verbal commands, observe motor responses, and structure tasks to the patient's cognitive level.

What cognitive skills are targeted in TBI treatment?

Attention span, orientation, sequencing, problem solving, error recognition, memory, and executive function.

What is the purpose of cognitive remediation?

To provide patients with the behavioral repertoire needed to solve problems or perform difficult tasks.

What is the focus of cognitive rehabilitation?

To ameliorate deficiencies across the cognitive system continuum using an information-processing perspective.

What is essential for supporting higher cortical functioning in TBI patients?

Good body alignment and stable positioning.

What should be done to manage agitation in TBI patients?

Not all patients experience agitation; management strategies should be tailored to individual needs.

What is the clinical takeaway regarding sensory stimulation?

More stimulation is not better; OT intervention stops when the response is negative.

What is the goal of OT when addressing swallowing safety?

To ensure that feeding is only initiated when swallowing safety is established.

What is the significance of using both upper extremities in ADLs?

To encourage functional independence and use the involved side for weight-bearing and stabilization.

What role does OT play in collaboration with speech pathologists?

OT collaborates closely to ensure safe feeding practices and address swallowing deficits.

What is the importance of graded cueing in cognitive intervention?

To assist patients in progressing from simple to complex tasks and reduce reliance on adaptation.

What should be monitored during the progression of oral intake?

Bolus control, oral structure function, and coordination of the suck-swallow pattern.

What is the aim of using transfer of training techniques in cognitive rehabilitation?

To ensure improvements in cognitive tasks transfer to ADLs requiring the same skills.

What is the duration range for agitation in TBI patients?

Agitation may last as short as 3 days to as long as 4 weeks.

What communication style should be used with agitated TBI patients?

Use a calm, controlled voice that is not condescending.

What are some inhibitory techniques to decrease agitation?

Warmth, sustained touch, slow rocking, and slow vestibular stimulation.

What is the focus of perceptual interventions in TBI treatment?

Adaptation to the environment and capitalizing on intact perceptual skills.

What should be the initial environment for perceptual intervention?

A distraction-free environment.

What is the goal of the adaptive (functional) perceptual approach?

To provide training in ADL behaviors rather than isolated perceptual skills.

What does the remedial perceptual approach aim to achieve?

Advance recovery or reorganization of impaired CNS functions.

What types of sensory stimulation are included in the remedial approach?

Vestibular, tactile, proprioceptive, and kinesthetic input.

What is the importance of graded cueing in perceptual tasks?

Tasks requiring 50% or greater cueing are too advanced and should be graded down.

What are primary perceptual targets in TBI treatment?

Figure-ground discrimination, position in space, right/left discrimination, spatial relations, topographical orientation, and praxis.

What is the clinical emphasis when using both remedial and information-processing approaches?

Activities must relate to function, not isolated drills.

How should visual scanning tasks be integrated into therapy?

Using functional scanning tasks, not abstract drills.

What should be the focus when teaching compensation for visual-perceptual deficits?

Safety, functional independence, and carryover into daily routines.

What is the goal of tactile sensation and sensory re-education interventions?

Improve functional performance and reduce safety risk due to sensory loss.

What strategies are used for pain management in TBI?

Teach relaxation techniques, reduce muscle tension, and monitor pain intensity.

What is the foundational assumption of OT intervention based on neuroplasticity?

The CNS is capable of change after injury.

What is the key principle when addressing voluntary movement in TBI patients?

Voluntary movement is addressed alongside trunk control and positioning.

When is strengthening introduced in TBI rehabilitation?

Only when tone and motor control allow.

What is the clinical goal for increasing endurance and activity tolerance?

Sustained participation in function.

What role does OT play in leisure and avocational participation?

Explore interests and assess adaptations for meaningful leisure roles.

What are OT's responsibilities in ensuring home safety before discharge?

Assess home safety, conduct home visits, and recommend modifications.

What interventions promote community mobility and accessibility?

Supervised outings, curb management, and training on uneven surfaces.

What is the clinical outcome of promoting independence in community mobility?

Independent and confident community mobility.