Chapter 31: Trauma-Induced Conditions Flashcards
Intensive Care Unit: Preparatory Methods
Positioning ROM Custom orthosis fabrication Soft tissue mobility Wound care Medical consultation regarding medication for pain and arousal
ICU: Purposeful Activities and Occupation-Based Interventions
Promote sleep/rest (e.g., use strategies such as low-stimulation environment, allow child uninterrupted sleep/rest, limit noise)
Self-care (e.g., work on positioning so child may engage in self-feeding or eating, facilitate lip closure or suck-swallow-breathe pattern)
Facilitate prerequisites for play to provide child with opportunities to engage in cognitive, social, pleasurable activities (e.g., playing peek-a-boo, silly songs, interacting with others by laughing and smiling)
Promote learning and cognition (e.g., orientation to person, place and time; games to remember, reading and writing; cause and effect games)
Promote early functional mobility (e.g., postural control for sitting, crawling, standing, walking)
Intensive Care Unit: Education
Education on diagnosis, precautions, progression, expectations
Education on role of occupational therapist and team members, including role of family
Hands-on education on caring for child
Intensive Care UnitL Safety Notes
Education on diagnosis, precautions, progression, expectations
Education on role of occupational therapist and team members, including role of family
Hands-on education on caring for child
Acute care: Preparatory Methods
Positioning ROM Custom orthosis fabrication Soft tissue mobility Wound care Sensory stimulation Scar massage Pressure therapy Medical consultation regarding medication for pain, arousal, and
Acute care: Purposeful Activities and Occupation-Based Interventions
Trunk control to engage in self-care (e.g., sitting to eat, mobility to get to bathroom)
ADL participation (e.g., muscle strength and endurance to complete morning hygiene, adaptive equipment training)
Neuromuscular reeducation to coordinate motor movements for ADLs, play, academics and functional mobility
Sleep/rest (e.g., establishing routines, relaxation techniques)
Acute care: Education
Education on deep vein thrombosis (DVT) and orthostatic hypotension prevention
Education on exercises to promote the child’s performance in daily living
Education on therapeutic equipment/ strategies
Acute Care: Safety Notes
Precautions
Monitoring vitals
Prevention of orthostatic hypotension
Inpatient Rehabilitation: Preparatory Methods
Positioning ROM Custom orthosis fabrication Soft tissue mobility Sensory stimulation Scar massage Pressure therapy Medical consultation regarding medication for pain, arousal, and spasticity
Inpatient Rehab: Purposeful Activities and Occupation-Based Interventions
Strengthening for ADL independence
Activity tolerance for extended ADL
Neuromuscular reeducation with or without electrical stimulation to coordinate ADL movements
Adaptive equipment training to engage in ADL despite changes in skills
Adaptive equipment training to engage in ADLs despite changes in skills
Self-care rehearsal
IADL rehearsal
Standardized assessment of ADL independence and performance skills
Home evaluation for modification as needed to promote ADL independence
Community reentry outing
Coping strategies for emotionally difficult changes
Social skills training
Memory, attention, awareness retraining for ADL performance and school reentry
Visual skill training for safety and school participation
Consultation with social worker/psychologist regarding readiness for return home
Inpatient Rehab: Education
Hands-on education for care of all functional needs
Hands-on education for use of therapeutic equipment/strategies
Hands-on education on home programming
Education on importance of home programming
Education on results of standardized assessments
Inpatient Rehab: Safety Notes
Precautions
Prevention of orthostatic hypotension
Community reintegration/Outpatient Rehabilitation:Preparatory Methods
Positioning ROM Custom orthosis fabrication Soft tissue mobility Sensory stimulation Scar massage Pressure therapy Medical consultation regarding medication for pain, arousal, and spasticity
Community reintegration/Outpatient Rehabilitation: Purposeful Activities and Occupation-Based Interventions
ADL independence (e.g., motor control an motor learning, muscle strength and endurance, neuromuscular reeducation, adaptive equipment)
IADLs (e.g., practice sequencing steps, organizing, and completing IADLs)
Standardized assessment of ADL independence and performance skills
Play (e.g., promoting play and playfulness in therapy to allow child to engage in pleasurable activities, foster problem-solving, cognition and motor skill development in play, engage with others)
Home evaluation for modifications as needed to promote ADL independence
Community reentry
Coping and social skills training
Memory, attention, awareness retraining for ADL performance and school reentry
Visual skill training for safety and school participation
Consultation with social worker/psychologist regarding readiness for return home
Consultation with school regarding necessary accommodations
Referral to community resources for supports and recreational opportunities
Referral to other disciplines like counseling, certified driver rehabilitation specialist
Community reintegration/Outpatient Rehabilitation: Education
Hands-on education for use of therapeutic equipment/strategies
Hands-on education on home programming and its importance
Education on results of standardized assessments
Education on problem-solving barriers to participation
Community reintegration/Outpatient Rehabilitation: Safety Notes
Precautions
ASIA International Standards for Neurological Classification of SCI
Classification of injuries based on motor exam of 10 muscle groups and sensory exam of 28 sensory points
Autonomic dysreflexia
a dangerous physiological response to noxious stimuli below the level of the SCI that causes symptoms including increased blood pressure. Of note, children with SCI usually have lower blood pressure than those without, so elevations 20 to 40 mmHg above baseline may be a sign of autonomic dysreflexia
Autonomic storming
occurs in some children with brain injury and presents as cyclic symptoms that occur after a severe insult to the brain. Physical manifestations may include posturing of the limbs and trunk and increase in heart rate, respiratory rate, blood pressure, and sweating.
Burn injuries
Severity of complications = Depth of injury
Skin has 2 layers: Epidermis (no blood vessels) and Dermis (blood vessels)
1st degree/Superficial: Damage only to epidermis
2nd degree/Partial Thickness: Damage enters dermis
3rd degree/Deep Partial or Full Thickness: Majority or entire dermis damaged
Majority of pediatric burns (60%) are caused by kitchen or bathroom scalds, whereas 25% are caused by flame, 10% by contact with hot objects or tools, and the remaining 5% by electrical or chemical interactions
Cognitive strategies
Compensatory approach
Used when immediate increase in function is needed to give the child a sense of accomplishment, when a plateau in performance improvement is experienced, or when an alternative approach to increase function is needed
Modifying activity demands to support increased child success
Electrical stimulation: SCI
Acute Care: May be used to managed orthostatic hypotension
Inpatient Rehabilitation: May be used to restore coordination and strength when integrated into a functional task at a motor or sensory threshold level
Outpatient: May be used as adaptive equipment long term to compensate for grasp deficits in the form of a surgically implanted or transcutaneous upper extremity
Orthostatic hypotension: SCI
Acute Care: May be managed conservatively (e.g., using functional electrical stimulation) and/or pharmacologically following SCI
Interprofessional team
Due to the complexity and intensity of trauma-induced medical conditions, collaboration of an interprofessional team is required to further support children’s holistic rehabilitation
Beyond safety, coordinated interprofessional team members regularly collaborate with one another and the family to ensure the provision of consistent, goal-directed care
Multidisciplinary Team
Members communicate their individual plans of care to each other
Interdisciplinary Team
Members analyze and synthesize their plans of care.
Rancho Levels of Cognitive Functioning
Describes behaviors typically observed at each of eight stages of recovery and can be helpful when determining the occupational therapy goals and interventions for a child who has survived a TBI
The OT critically appraises the child’s cognitive functioning and supports advancement to the next level using activity analysis within meaningful occupations
Each child and each brain injury is unique; therefore the rate of progression through the eight stages of recovery varies greatly
Restorative approach
Facilitates the child’s performance skill progression toward his or her prior level of function. The child may reach a plateau in performance skill improvement owing to limitations in child readiness or body structure and function.
Self-management
Including motivational interviewing (an open-ended, empathetic method of talking with caregivers) may help the practitioner identify sources of family’s stress when returning home
May be used to support caregivers’ ability to identify and problem-solve barriers preventing implementation of home programs, because the OT no longer has the benefit of a controlled environment to ensure follow-through with necessary therapeutic recommendations
Sensory stimulation: TBI
ICU: Depending on the child’s level of consciousness, the occupational therapist may introduce appropriate sensory stimulation in a controlled manner to evoke a localized, volitional response to the environment; Monitoring the autonomic nervous system’s response to sensory stimulation can provide information on the client’s potential return to consciousness
Acute Care: May be used to increase or decrease alertness as appropriate to facilitate participation in functional tasks
For children with TBI…
environmental sensory stimulation is modulated to prevent agitation.
Spinal cord injury
Happens when spinal cord tissue is bruised or torn by traumatic or nontraumatic means
Most common cause of pediatric SCI is a motor vehicle accident
Other traumatic causes of SCI include violence, falls, and sports injuries.
In these instances, spinal cord tissue is usually damaged by displaced bone fragments, disc material, or ligaments
Nontraumatic causes of spinal cord lesion include
Spinal tumor, spinal procedure, or disease process such as transverse myelitis.
Spinal cord injuries are classified in one of two ways: complete or incomplete
Complete: Involves a total loss of motor and sensory connection below the level of injury
Incomplete: Indicates that the individual maintained some motor and sensory function below the level of injury.
Task training
SCI
Inpatient Rehab: For example, task training or practicing a task repeatedly, has been shown to improve function of clients with SCI and may be supported by brain plasticity; Of note, family-centered goal setting and specificity of task training results in improved performance of the practiced task but does not necessarily translate to other tasks
Traumatic brain injury
Brain injuries are classified as traumatic when the injury is caused by an external force.
Typical causes of TBI
Falls, motor vehicle accidents, sports-related injuries, nonaccidental trauma, and gunshot wounds.
Nontraumatic
Causes of acquired brain injury include but are not limited to stroke, anoxia, arteriovenous malformation rupture, brain tumor resection, seizure activity, seizure foci resection, infections such as meningitis or encephalitis, and metabolic disorders.
