Acquired brain injury (ABI) is defined as brain damage that occurs after birth and is not in any way related to congenital or degenerative disease (Atchison, Dirette, & Conti, 2012, p. 179). Diseases, substance abuse, oxygen deprivation, infection or a blow to the head are all possible causes of an acquired brain injury. ABI generally is any type of brain damage that occurs to an individual after birth. It includes traumatic brain injury (TBI), tumor, stroke, brain hemorrhage as well as encephalitis. ABI symptoms depend on the part of brain that is being affected. The long-term impacts of ABI are very difficult to predict and ranges from mild to extreme. Each patient has different effects and displays their deficits uniquely. Impairments as a result of ABI are heterogeneous and affect sensory motors, cerebral and emotional functions. Patients with ABI experience increased mental and physical fatigue, slackening response, slow rate of processing information and solving problems. They also undergo change in their behavior and personality, physical and intellectual abilities, or senses. These changes may be short or long-lived resulting to partial or functional disability or mental instability (Atchison, Dirette, & Conti, 2012, p. 179) .
Daily occupations are always a challenge to persons suffering from ABI. The most common limitation of patients with ABI in their daily life is performing ADL-activities. Problems involving performing I-ADL activities are also experienced and tend to be even more complex and difficult to adapt to (Holmqvist, 2012). The definition of occupation according to occupational therapy is a person’s performance and experience of an activity and the value they assign to such activities. Occupational therapy theory and research argue that cognition is an essential tool needed in the performance of everyday tasks (AOTA, 2013). However, not much is known about perceptions of occupations after acquired brain injury. In addition, there is very little knowledge on what patients do, want to do, or how to assess their perceived occupational gaps and satisfaction in their daily life. More research needs to be carried out to enhance knowledge about occupational perceptions of ABI patients. This research paper focuses on cognitive problems and explores the causes, types, and effects of the impairments as well as prognosis/treatment of ABI by occupational therapy. The objective is to identify effective occupational therapy interventions for ABI patients.
CAUSES AND TYPES OF ABI
There are many causes of acquired brain injury. Traumatic head injuries result from penetration of the skull or brain by an object e.g. a bullet, the skull being crashed, a fracture on the skull and even a hard strike. The impact can cause bruising swelling, bleeding twisting or tearing of brain tissue. A blocked artery occurring where there are blood clots in the brain tissue limiting the availability of oxygen causes stroke. It can also be as a result of bleeding where a blood vessel on the brain bursts. Near drowning, hanging, cardiac or respiratory arrest causes Anoxia (absence of oxygen in the brain). Diseases such as Meningitis and Encephalitis can cause damage to brain cells. A tumor, just like blot clot, compresses surrounding tissues and hence leading to malfunction of the brain. Surgery can also cause damage to the brain (NBIA, 2014).
Symptom of acquired brain injury can be categorized into three parts. They are cognitive related symptoms, perceptual symptoms, and behavioral symptoms. Cognitive related symptoms are most common and tend to be fatal. Symptoms can be shortened attention span, slow thinking ability, memory loss, or low problem solving abilities. Perceptual related symptoms are majorly connected to the senses and personal experience. This includes any change in the senses such as vision, deficits in proprioception, drowsiness or dizziness, and sensitivity to pain. It also involves physical symptoms such as headaches, fatigue, and seizures amongst others. The third category is behavioral and emotional symptoms. Flattened or heightened emotional responses and reactions as well as irritability, impatience, inflexibility and lack of initiative are common.
TBI that is accompanied by loss of consciousness and amnesia is one of the most common brain damages. It is categorized as an ABI but differs slightly. It involves a complex matrix of physical, cognitive, communicative, and neurobehavioral limitations that have a long life effect on an individual’s occupational functioning (Atchison, Dirette, & Conti, 2012, p. 180). Some of the symptoms include: seizures, hydrocephalus, fatigue, motor defects, cranial nerve dysfunction, deep venous thrombosis or dysautonomia. On the other hand, unconsciousness, dizziness, drowsiness, vomiting, headaches, nausea, and confusion characterize ABI. Furthermore, altered sleep patterns, personality change, depression, seizures and irritability may be evident.
EFFECTS ON DAILY LIVING RESULTING FROM ABI
Cognitive defects are a major consequence of acquired brain damage. Patients may experience long term or short term memory loss. Memory impairment is one of the most common traits of ABI. They become easily distracted and have difficulty in multi-tasking. Their thinking ability may become slow or sluggish. The cause of injury, extent of damage, level of severity, and part of the brain affected determine the outcome of ABI. Cognition is associated with the information processing activities carried out by the brain. These include memory, problem solving, self-monitoring and self-awareness amongst others. Patients with cognition dysfunction are declared to be functioning below the normal human levels.
Cognitive dysfunction brings about neurobehavioral deficits. These are common in patients suffering from mild or extreme TBI. It is often accompanied by irritability, poor control of temper, impulsivity, perseveration, and apathy. Research shows that depression and loss of self-esteem are common in children with TBIs (Atchison, Dirette, & Conti, 2012, p. 187).
Cognitive impairments are seen in nearly all ABI patients in varying degrees. Impairments affecting metacognitive functions can lead to complete loss of activity. The consequences of cognitive impairments have a larger influence on independence, and of a patient being able to carry out daily activities, than physical impairments. Cognitive impairments affect the ability of one to go back to work, performing self-care tasks, life planning and daily scheduling, living with a perceived diminished life satisfaction, and their intellectual capability.
TREATMENT & PROGNOSIS
The main aim of occupational therapy is to enable and empower ABI patients to carry out meaningful activities. This enhances welfare and minimizes the effects of dysfunction or environmental barriers. According to Holmqvist (2012), humans are occupational beings: occupation gives them meaning, structures livelihoods and improves health. Interventions used in occupational therapy include teaching clients new ranges of skills or helping them re-establish skills they have lost. A wide range of physical and neuropsychological impairments can have an impact on activities and meaningful occupations, while reducing a person’s level of social participation, including their ability to participate in educational and vocational activities (ACNR, 2013).
In order to determine TBI prognosis, an occupational therapist should carry out trauma score tests, GCS, hypoxia tests, and biomarkers tests. GCS is a scale developed to forecast mortality and probable outcome for a comatose patient (Atchison, Dirette, & Conti, 2012, p. 184) . Cognitive assessment requires neuropsychological procedures such as Glasgow Outcome Scale and level of cognitive Functioning Scale (LCFS) to determine the extent and type of disability (Hagan, 1997). LCFS has eight levels. These are: Level I-No Response, Level II- Generalized Response, Level III- Localized response, Level IV-Confused, agitated response, Level V-Confused, inappropriate, non-agitated response, Level VI- Confused, appropriate, response, Level VII- Automatic, appropriate response and Level VII- Purposeful appropriate response (Atchison, Dirette, & Conti, 2012, p. 187).
Occupational therapists work with the patient and the patient’s family, to help them make sense of their injury and achieve personal goals through participation in a range of meaningful and purposeful activities like cooking, shopping, working, hobbies, leisure interests etc. OTs use cognition rehabilitation to treat cognition dysfunction. Cognition rehabilitation treatments are therapeutic interventions used to improve cognition functioning of patients. Treatments involve those daily activities that have been affected by the cognitive problem. OTs can have the patients participate in memory skills training, brain games, daily activity practice, and simple directive activities. In addition to rehabilitative practices, habilitative approaches to cognitive functioning are used as the patient develops the functioning to retain learned information.
Occupational therapy interventions have been successful in improving the occupational performance of patients. This paper outlines the key recommendations from effective treatment measures that occupational therapists should put into practice. Occupational therapy scholars have come up with models to help explain and guide intervention. These models are used by OTs to solve cognition problems. Some of these models include: Dynamic Interactional Model, Cognitive Rehabilitation Model, Cognitive Disabilities Model, and Neurofunctional Approach (AOTA, 2013). The development of these models is still an ongoing process. Occupational therapists are well qualified to assess and treat acquired brain injury patients. They have a greater understanding of cognitive functioning, task analysis, learning, diagnostic conditions as well as initiative. As practitioners, OTs are able to take into account the entire life experience and use their knowledge of these models to apply interventions most appropriate to achieve the desired outcome of functioning.
Understanding a patient, their roles in daily occupations, and the contexts involved make occupational therapists more than qualified to address cognitive, behavioral, and perceptive defects that affect the life of a person.
Based on the theoretical models and occupational therapy interventions, OTs are adequately addressing and treating patients. The result of these methods has been positive and most patients regain their occupational skills after recovering.
Advances in clinical Neuroscience and Rehabilitation (ACNR). (2013, September 20) New Guidance for Occupational Therapists on Acquired Brain Injury. Retrieved from: http://www.acnr.co.uk/2013/09/new-guidance-for-occupational-therapists-on-acquired-brain-injury/
American Occupational Therapy Association (AOTA). (2013). Cognition, Cognitive Rehabilitation, and occupational Performance. Retrieved from: https://www.aota.org/-/media/Corporate/Files/AboutAOTA/OfficialDocs/Statements/Cognition Cognitive Rehabilitation and Occupational Performance.ashx
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