Trauma Induced Ch 31 Flashcards
Post-Trauma Occupational Therapy Interventions
Preparatory methods
Purposeful activity/ Occupation-based intervention
Education
Caregiver grieving —> caregiver education —> multidisciplinary teamwork —> Therapeutic relationships
Post-traumatic scope of care
Care is focused on survival and basic medical
recovery
Child is often sedated
Child’s crucial occupations are rest and sleep
ICU
OT goals of ICU
Contracture prevention
➢ Ulcer prevention
➢ Pain management
➢ Safety
➢ Introduce family to condition
OT interventions of ICU
➢ Stretching
➢ Soft tissue mobilization
➢ Splinting
➢ Bed positioning
Increased medical stability.
Increased interaction with environment.
Intervention strives to promote homeostasis and
prevent secondary injury.
Pain management—does pain interfere with
functional progress?
May be the longest phase of inpatient care.
Acute care setting
OT goals of Acute Care
Resume available
motor functions
➢ Build tolerance to
activity
➢ Actively engage child
➢ Build rapport
➢ Provide in-depth
education on condition
OT interventions of Acute Care
➢ Bedside sitting
➢ Transfers
➢ Preferred activities
Medical stability is established.
Therapy can be provided in a structured, twice
daily sessions of all needed disciplines.
Focus is to facilitate independence.
Prepare for transition to home.
Generally the most “intense” phase of care for
the child and family.
Multidisciplinary teamwork is crucial for a
successful discharge.
Inpatient rehab
OT goals of inpatient rehab
➢ Adequate preparation
for transition home
➢ Increase
independence in self-
care skills
➢ Facilitate continued
progress toward prior
level of functioning
➢ Communicate with
other disciplines
OT intervention of inpatient rehab
➢ Begin balance
between restorative
and adaptive
approaches
Care becomes the primary responsibility of the
family for the first time.
This is often when reality sinks in and families
begin a stage of acute grief.
Progress toward independence pivots on family
priorities and values.
Outpatient Rehabilitation and Community Reintegration
OT goals for Outpatient Rehabilitation and Community Reintegration
➢ Identify family priorities
and values
➢ Clearly identify
differences between
current and premorbid
status
➢ Identification of
appropriate community
resources
OT intervention for Outpatient Rehabilitation and Community Reintegration
➢ Client-centered
interview
➢ Self-management
strategies to empower
the family and child
Incidence of pediatric spinal cord injury
➢ 1.99 times per 100,000 children
➢ Approximately 0.002%
➢ ~1455 new injuries per year
➢ < 4% of all spinal cord injuries
Gender discrepancy of pediatric SCI
➢ Boys are twice as likely to experience SCI than girls.
Traumatic causes of pediatric SCI
➢ Motor vehicle accident
(primary)
➢ Violence
➢ Falls
➢ Sports injury
Medical causes of pediatric SCI
➢ Spinal tumor
➢ Spinal procedure
➢ Disease process
Pediatric SCI
Can be at any spinal
level.
Young children are
more likely to have an
upper cervical injury
more than other age
groups.
Pediatric SCI—Therapeutic Overview
Major impairments are in motor function.
Motor return will not occur for complete injuries
but is possible for incomplete.
Main focus of therapy is to regain independence
in self-care skills and functional mobility.
It is essential to instruct care and injury
prevention for nonfunctional limbs in order to
maintain overall heath.
Preparatory methods for SCI in ICU
• Bed positioning
• ROM
• Pain management via collaboration
Purposeful activities for SCI in the ICU
Communication via adapted call lights
Education in SCI in the ICU
Introductory info
Pressure area prevention
Autonomic dysreflexia
Preparatory methods for SCI in acute care
• ROM
• Splinting
• Tone management via collaboration
• Orthostatic hypotension management
Purposeful activities of SCI in acute care
• Neuromuscular re-education
• Supported sensorimotor activities
• Use of equipment to promote function
Education for SCI in acute care
• In-depth education on SCI
• Model empowerment of the child to direct own care
Preparatory methods for SCI in inpatient rehab
• Pain management
• ROM
• Tone/Spasticity
management
• Positioning
schedules
• Pressure relief
schedules
• Tenodesis grasp
promotion
Purposeful activities for SCI in inpatient rehab
• Developmentally
appropriate play
• Task training
• NMES with
functional activity
• Movement
pattern training
• Bowel & bladder
regimen training
• Skin inspections
Education for SCI in inpatient rehab
• In-depth, level-
specific
information
• Preliminary
prognosis
• Sexual function
• Safety
Preparatory methods for SCI in outpatient
• Pain management
• Tone management
• Surgery to promote
function
Purposeful activities for SCI in outpatient
• Neuromuscular re-
education
• Functional NMES
devices
• ADLs, iADLs
• Leisure and
exercise activities
• Collaboration with
school
• Client-centered
goal focus
Education for SCI in outpatient
How to problem-
solve
environmental
barriers to
participation
• Referral
• Community
resources
• Social supports
Cause for pediatric TBI
➢ Falls
➢ Motor vehicle accidents
➢ Sports-related injuries
➢ Non-accidental trauma
➢ Violence-related
Cause for pediatric ABI
➢ Stroke
➢ Anoxia
➢ Arteriovenous
Malformation rupture
➢ Tumor resection
➢ Seizure activity
➢ Seizure foci resection
➢ Infection (meningitis
and encephalitis)
➢ Metabolic disorders
Functional prognosis in ped TBI
➢ Severity of injury
➢ Location of injury
➢ Extent of injury—localized or diffuse
➢ Premorbid factors — Socioeconomic status & Behavior and academic performance
➢ Rancho level of cognitive functioning
Therapeutic overview of ped TBI
Impairments can be motor, neurological, or
cognitive.
Return of function is much less predictable due
to neuroplasticity of the brain.
Therefore, rehab focus may be in one or many
functional areas.
TBI in ICU
Preparatory methods — automatic storming management, low stimulation environment
Purposeful activities — sensory stim
Education — rancho levels
TBI in acute care
Preparatory methods — ROM, splinting, tone, cognition, sensory, safety measures
Purposeful activities — environmental interaction, task grading, neuromuscular re-education
Education — TBI education, motor learning
TBI in inpatient
Preparatory methods — arousal, pain, and tone management; ROM
Purposeful activities — neuromuscular reeducation, NME, cognition and behavior, assessment of visual-perceptual skills
Education — standardized assessment and preliminary prognosis
TBI in outpatient
Preparatory methods — arousal, pain, tone management; ROM and splinting
Purposeful activities — neuromuscular redaction, constraint induced movement, cognitive and behavior training/management
Education — Neuroplasticity education, alt treatments, equipment, resources, community, social support
Pediatric burn injury may require
Skin grafting — Generally performed when an otherwise healthy
(noninfected) wound would take longer than 3 weeks to heal on it’s own
Sheet grafting
Meshed grafting
Develops any time the dermal layer of the skin that is damaged.
The collagen fibers in hypertrophic scarring are orientated in a “whorl-like” pattern, as compared to normal skin in which collagen aligns in a parallel pattern.
Scar
Identified by changes in four characteristics of
the skin:
➢ Vascularity (increases; may be red, pink, purple)
➢ Height (increases; thick)
➢ Pliability (decreases; firm)
➢ Pigmentation (can either decrease or increase; may
be hypo or hyper)
Active hypetrophic scarring
scars that grow
beyond the border of the initial
wound boundary.
It is a genetic condition with
generally poor outcomes and
minimal treatment options.
Keloid scarring
Functional problems w/ scarring
Limit ROM when crossing a joint = functional deficits
Therapeutic overview of pediatric burns
Major impairments are in soft tissues, which
result in primarily motor deficits.
Treatment focus is on maximizing skin integrity
and function, then resuming participation in
occupations.
It is essential to discuss and facilitate
acceptance of changes in the physical body.
Burns in the ICU
Preparatory methods — anti deformity, protective splinting, PROM 1x daily
Purposeful activities — interests?
Education — intro info
Burns in acute care
Preparatory methods — scar massage and PROM 2x/day 5-10 days post wound closer; splinting and pressure therapy
Purposeful activities — pain management, ROM w/ func activity
Education — scar management, scar progression photo
Burns in inpatient
Preparatory methods — aggressive ROM 2x daily; splinting
Purposeful activities — ROM
Education — ROM HEP, HEP tolerance
Burns in outpatient
Preparatory methods — ROM, scar massage, pressure therapy, splinting, progressive exercise
Purposeful activities — client-specific occupations
Education — school reentry, social supports, HEP
