Treatment Plan: TBI Patient

Lauren Owens

Patients with traumatic brain injuries often face a very frustrating and very
difficult road to recovery. No two patients will have all of the same deficits and
treatment must be individualized to fit their needs. The severity of cognitive deficits
will also be different for each patient. This will depend on what stage of recovery
they are in, how severe the injury was, how long they may have been in a coma,
and where the injury took place. Some of the deficits that a Traumatic Brain Injury
patient will face are disorientation, initiation, an inability to process information in
an accurate manner, impaired memory, and decreased level of attention.
Interventions for these patients can be approached in many ways, depending on
what the deficits are and their severity.
One of the most common deficits seen in TBI patients is memory. Memory can
affect many aspects of their daily life, including money management, cooking, and
arriving on time to appointments, school, work, among other things. Some clients
may forget what happened during their last treatment session (short term memory),
or maybe a vacation they went on a few years ago (long term memory), or
sometimes even what the therapist just told them! Getting family involved as soon
as possible is very important because they can verify personal information that the
patient may have trouble recalling and can also help with orientation. They can also
help establish a meaningful cueing system for the patient.
Internalizing as many verbal cues as possible is ideal, but sometimes the use
of adaptive equipment is needed. A checklist can be used for chores or a schedule
for appointments, and the patient can check off each task as they do them. This can

also apply to a school setting if the patient is younger. Homework can be put on a
check list and books and supplies needed for the task can also be listed. The
patient can check them off as they are done. If the patient has a smart phone, they
can also program reminders into their phone and they will be reminded of
appointments, bills due, etc. on their phone.
Another common deficit in TBI patients decreased level of attention.
Inattention to task can be caused by internal and external factors. Internal factors
may be associated with catheters or intravenous tubing, pain, or urinary urges while
external factors may something like a loud environment. Familiar activities of high
interest will help the patient maximize their attention and concentration because
the patient will be more inclined to complete tasks they are interested in. It also
helps to complete the activity in a quiet environment because some patients may
have issues blocking out irrelevant sound or visual stimuli.
There are a large variety of adaptive equipment options for patients with
attention span issues. If a patient wants to cook, there is a device called a Boil Alert
that is placed under the kettle and rattles when the water is boiled. There is also a
stove power controller that can be set on a timer to automatically shut off at 15, 30,
or 60 minute intervals for those who may forget to turn off their electric stove. For a
patient who may be a student, index tabs and color coded folders may help with
school related tasks because they will not have to spend as much time trying to find
a certain chapter or subject.
Another common problem with TBI patients is delayed information
processing. This delay can be seen with any kind of visual, auditory, or other
sensory information and last from a few seconds to a few minutes or more. The OT

practitioner should give the patient sufficient time to respond during therapy.
Intervention for these patients will depend on what kind of information they have
trouble processing. Some may benefit best from verbal and tactile cues, while
others may benefit from having information presented sequentially one at a time.
Adaptive equipment for delayed information processing will also vary
depending on what problems were defined and what needs to be compensated for.
For a patient with visual deficits the technology needed may be as simple as
reading glasses or an eye patch to treat impaired vision or diplopia. Another option
would be speech output reading machines to translate text into speech and there
are a variety of iPhone apps that read eBooks. These would be ideal for students.
For auditory information processors, portable note takers or voice recognition
technology could be used to translate spoken word into text. iPhones also have an
app already built in called Voice Memos that allows you to record sounds, this would
be ideal for a student with auditory processing deficits because they could listen to
lectures as many times as they needed to.
Assistive Technology is a very important tool to OT practice. Increasing
function is the goal of our practice, and adaptive equipment is a very successful
compensatory strategy to help a patient increase their function and hopefully regain
their independence. For Traumatic Brain Injury patients, this can be a helpful tool in
helping them meet that goal.

References
1. "Using External Aids to Compensate for Memory and Organizational Problems
Post-TBI." Using External Aids to Compensate for Memory and Organizational
Problems Post-TBI. Teaching Research Institute, Western Oregon University,
2013. Web. 08 Nov. 2013. <http://www.brainline.org/content/2011/04/usingexternal-aids-to-compensate-for-memory-and-organizational-problems-posttbi.html>.
2. Gordon, Wayne, PhD. "Simple Ways to Help Your Child Succeed in School After
a TBI." Simple Ways to Help Your Child Succeed in School After a TBI. WETA,
2013. Web. 08 Nov. 2013. <http://www.brainline.org/content/multimedia.php?
id=4642>.
3. "Assistive Technology for Individuals with Traumatic Brain Injury." Assistive
Technology for Individuals with Traumatic Brain Injury. Disability Rights New
Jersey, 2013. Web. 08 Nov. 2013.
<http://www.brainline.org/content/2011/04/assistive-technology-forindividuals-with-traumatic-brain-injury-tbi.html>.
4. Early, Mary Beth. "Traumatic Brain Injury." Physical Dysfunction Practice Skills
for the Occupational Therapy Assistant. 3rd ed. St. Louis, MO: Elsevier/Mosby,
2013. 491-514. Print.
5. Cook, Albert M., and Jan Miller. Polgar. "Sensory Aids for Persons with Visual
Impairments." Essentials of Assistive Technologies. St. Louis, MO: Mosby,
2012. 153-82. Print.
6. Cook, Albert M., and Jan Miller. Polgar. "Sensory Aids for Persons with Auditory
Impairments." Essentials of Assistive Technologies. St. Louis, MO: Mosby,
2012. 182-96. Print.