Unlocking Independence: Occupational Therapy and Brain Injury
Author: Rickey Hickman (Snr Occupational Therapist)
Introduction
Getting back to your daily activities after a brain injury can be like climbing Mount Everest, you see where you want to go, but getting there is easier said than done. The journey may seem daunting, but occupational therapy can play a pivotal role in helping you or your loved one to a better life. Calling on their specialised training an OT will support you in regaining function and gaining independence.
In this article we will explore Brain Injuries and their impact and the occupational therapy role in Brain Injury Rehab.
Let's find out more, shall we.
Understanding Brain Injury and Its Impact
What is Brain Injury?
A brain injury happens when damage to the brain disrupts its normal function, whether from external or internal causes. For example, a Traumatic Brain Injury (TBI) occurs when a blow or jolt to the head directly harms the brain tissue. Conversely, an Acquired Brain Injury (ABI) results from internal factors like strokes, tumours, infections, or a lack of oxygen that affect brain health. Both TBI and ABI can impact various aspects of brain function, including cognitive, sensory, physical, emotional, and behavioural abilities.
Common Effects on Functional Capacity
Brain injury can impact all functions of the body, the specific symptoms and their severity depend on the location of the injury and the extent of the damage—generally, more significant damage leads to more noticeable impairment.
Physical Impairments: Following a brain injury, individuals may experience a variety of physical impairments which include:
- Hemiparesis: Weakness on one side of the body, typically affecting the arm and leg on the same side.
- Hemiplegia: Complete paralysis on one side of the body.
- Dysphagia: Difficulty swallowing due to impaired motor control in the muscles of the throat and mouth.
- Spasticity: Abnormal increase in muscle tone or stiffness that can hinder movement and coordination.
- Ataxia: Lack of voluntary coordination of muscle movements, affecting balance and coordination.
- Contractures: Permanent shortening of muscles or tendons that can restrict joint movement, often resulting from prolonged immobility or spasticity.
- Fatigue: Persistent tiredness or lack of energy in not uncommon in people who have a brain injury, impacting a person’s ability to engage in daily activities.
- Seizures: Following a brain injury a person may experience seizures due to changes in the structures of the brain, which can alter typical functions and cause chemical imbalances.
Cognitive Impairments: The cognitive effects of a brain injury vary widely, but can impact any cognitive function. Some of the most prominent and challenging cognitive impairments include damage to regions of the brain responsible for attention, memory and executive functions. Challenges in these cognitive functions can have a significant impact on a persons independence in daily life. Here are some of the common challenges people can experience after a brain injury:
- Attention/Concertation: Is the cognitive process of focusing effort on specific stimuli or tasks while filtering out distractions to effectively perform and achieve goals.
- Memory: Is the cognitive process of encoding, storing, and retrieving information and experiences, allowing individuals to recall past events and knowledge.
- Planning: Is the ability to organise and outline the steps required to achieve a specific task or goal that involves anticipating future needs or challenges.
- Problem-solving: Is the ability to identify, analyse and resolve obstacles and challenges.
- Decision-making: Is the ability to evaluate options based on desired outcomes and different contexts to select the most suitable decision.
Sensory Impairments
Your brain processes all the sensory information from the world around you, such as sight, sound, taste, touch, and your sense of where your body is in space (proprioception). When the brain is injured, it can affect how you experience these sensations. Sensory challenges resulting from brain injuries can make everyday activities more difficult and impact your independence.
Emotional and Psychological Impact: Brain injuries can often lead to emotional and psychological challenges. People might notice changes in their mood, such as feeling more irritable, experiencing depression, or struggling with anxiety. Additionally, the injury may affect personality, leading to shifts in behaviour and how one interacts with others.
Role of Occupational Therapy in Brain Injury Rehab
What is Occupational Therapy?
Occupational therapy (OT) is all about helping people lead full, meaningful lives by addressing challenges in performing daily living activities. OTs implement a combination of person, environment and task based approaches aiding individuals to overcome barriers to their independence and enhance their quality of life.
Occupational Therapy Role in Brain Injury?
In Brain Injury Rehab, occupational therapy helps people get regain functional capacity and get back to doing their meaningful daily living activities. They achieve this by addressing physical, cognitive and emotional challenges. Using evidence-based and practical strategies OTs create individualised therapy plans and implement them in collaboration with the client to achieve their goals.
OT Core Techniques and Strategies in Brain Injury Rehab
- Task Adaption: Occupational therapy assessments take a close look at the tasks you find tricky in your daily life. Then we figure out what’s causing the most trouble and adjust those parts to make things easier for you. This way, you can manage your daily activities with more independence.
- Physical Rehabilitation: OTs create personalised exercises to help rebuild your strength, coordination, and range of motion. This not only helps you get back to doing the things you love but also makes daily activities feel more manageable.
- Assistive Technology: OTs might suggest some handy tools to help you out. This could be a four-wheeled walker or wheelchair to help you get around, or a button hook and dressing stick to make dressing easier. These aids are all about boosting your independence.
- Home Modification: To make your home safer and more accessible, OTs might recommend minor or complex home modifications, like adding grabrails or installing a ramp. These tweaks help you move around more comfortably and tackle everyday tasks with greater ease.
- Cognitive Rehabilitation: OTs use specific exercises to help improve your memory and thinking skills. Their aim is to make everyday challenges less of a hassle and help you manage cognitive difficulties more effectively.
- Cognitive Strategies: OTs teach practical strategies to help you cope with mental challenges. For example, they might introduce mindfulness techniques to help you manage stress and feel more balanced in your daily life.
Occupational Therapy for Brain Injury - Gold Coast
Constraint-induced movement therapy (CIMT) is an exciting method for recovery after Brain Injury, with clinical literature showing significant improvements following short, intense bouts of the technique (Shaw et al, 2005). This strategy works by temporarily restricting the use of the unaffected arm, which pushes the client to rely on and strengthen the affected arm through lots of practice. CIMT can be really effective in boosting motor function and making daily tasks easier by encouraging the brain to adapt and reorganize. The draw backs are that it can be quite demanding and requires a strong commitment from clients, and some may find the intensity challenging or frustrating.
Virtual reality (VR) therapy is a cutting-edge method for recovery after brain injury that immerses patients in digital worlds to help them get better. By using interactive VR simulations, therapists can design customised exercises that focus on improving the specific motor skills and cognitive functions affected by a brain injury. Calderone et al (2023) completed a systematic review finding that VR is effective for improving motor and cognitive skills in people with a brain injury. The great thing about VR therapy is that it’s engaging and can be tailored to fit individual needs, potentially speeding up and boosting recovery.
Task Specific Training (TST) in brain injury rehab focuses on improving motor skills by practicing specific, meaningful movements. This method involves repeatedly performing functional movements like walking, standing from sitting, putting food away, buckling a seatbelt or hitting/kicking a ball. Hubbard et al (2009) highlighted that evidence supports task specific training for brain injury. By practicing specific tasks improvements in motor control, coordination and strength could be achieved and ultimately lead to enhanced daily activity performance. The best part about Task Specific Training is that it is a highly motivating therapy strategy, what is more motivating than practicing the task you want to improve in.
Mirror therapy is a fascinating and promising method for stroke rehab that uses visual feedback to help improve motor function. In this approach, a mirror is placed between the patient’s two arms, hiding the affected limb and showcasing the unaffected one. As the patient moves their unaffected arm, the mirror creates the illusion that the affected arm is moving too, which can help stimulate the brain’s motor pathways and encourage recovery. Gandhi et al (2020) established that Mirror Therapy is a feasible method for motor, sensory and perceptual deficits in acute, sub-acute and chronic phases of stroke, as brain injury occurs after a stroke it is practical to assume that similar improvements would be seen for those with a acquired or traumatic brain injury.
Your Tailored Brain Injury Rehab Plan
Assessment and Goal Setting
The occupational therapy process starts with a detailed assessment to get a clear picture of your unique abilities and challenges. By understanding the specifics of your stroke and how it affects you, we can set realistic and achievable recovery goals.
From there, your occupational therapy will work with you to establish both short-term and long-term goals that are meaningful to you! These goals are tailored to your individual needs and recovery hopes, giving you a clear roadmap for moving forward.
Therapy Planning
Once we’ve completed the assessment and set your goals, your occupational therapy team will create a personalised plan to help you achieve them. They’ll use their clinical experience and the latest evidence-based practices to select the most suitable brain injury therapy and strategies for your needs and objectives.
Collaborative Approach
Once we have a plan set up, your OT will work closely with you and your family to put it into action. During this phase, collaboration is crucial—working together and keeping the lines of communication open can really make a difference in reaching your goals.
Your OT will keep an eye on how things are going and, if necessary, will adjust the plan to make sure you're on track to achieve your objectives.
Success Stories
With our focus on neurological conditions we have seen many clients with brain injuries and have had the privilege of achieving great outcomes.
Mr. Man was discharged from hospital after 6 months of inpatient therapy, he had made great progress in that time but continued to have challenges. Most importantly to him was being independence with his toileting. Because of his hemiparesis he struggled with getting on and off the toilet and wiping. Working together we had installed grabrails in the bathroom, completed tasks specific training and obtained a wiping aid. This combination of intervention and Mr. Man's dedication was the perfect combination and HE DID IT! Mr. Man achieved his goal and the sense of joy it brought him was priceless!
Occupational therapy can be a powerful service in your stroke rehab, but It's important to remember that each person's recovery journey is unique, and outcomes will vary. While we cannot guarantee specific results, our focus is on working together to achieve the best possible progress for each person.
Conclusion
Living with a brain injury presents unique challenges, but Occupational Therapy offers valuable support in achieving a more independent and fulfilling life. Through personalised approaches and dedicated therapy, you can make significant progress in managing your condition. While recovery may be gradual, each step forward is a testament to your resilience and determination. Embrace the resources available, stay committed to your therapy, and continue striving towards your goals. Your journey to greater independence starts now.
References
- Calderone A, Carta D, Cardile D, Quartarone A, Rifici C, Calabrò RS, Corallo F. Use of Virtual Reality in Patients with Acquired Brain Injury: A Systematic Review. J Clin Med. 2023 Dec 14;12(24):7680. https://doi:10.3390/jcm12247680.
- Gandhi DB, Sterba A, Khatter H, Pandian JD. Mirror Therapy in Stroke Rehabilitation: Current Perspectives. Ther Clin Risk Manag. 2020 Feb 7;16:75-85. https://doi:10.2147/TCRM.S206883.
- Hubbard, I. J., Parsons, M. W., Neilson, C., & Carey, L. M. (2009). Task‐specific training: Evidence for and translation to clinical practice. Occupational Therapy International, 16(3-4), 175-189. https://doi.org/10.1002/oti.275
- Shaw SE, Morris DM, Uswatte G, McKay S, Meythaler JM, Taub E. Constraint-induced movement therapy for recovery of upper-limb function following traumatic brain injury. J Rehabil Res Dev. 2005 Nov-Dec;42(6):769-78. https://doi:10.1682/jrrd.2005.06.0094.
Additional Resources
- Brain Injury Australia are an incredible resource with definitions, fact sheets, success stories and more! Check them out - https://www.braininjuryaustralia.org.au/
- Want to learn more about Traumatic Brain Injuries? Consider signing up for this FREE online course - https://mooc.utas.edu.au/landing/tbiwp If you missed the sign-up date, check in at a later time.
- Have a specific question? Check out our Instagram page where every Friday we answer your questions or call and talk to one of our helpful team members.
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