Occupational Therapy Practice Guidelines for Adults with Traumatic Brain Injury Kathleen Gosliz, OTR, OTD, National Guideline Clearinghouse Page 1 of 16

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  When it comes to rehab after TBI, the earlier the better — and the more thorough, the better the outcome. Transcript of this video.
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  Neuropsychologist Dr. Tedd Judd talks abou the way professionals can help their patients with brain injury — and their families — who are from different countries or cultures.
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  Produced by Victoria Tilney McDonough and Brian King. This neuropsychologist shares his experience and advice about culture, ethnicity, and brain injury rehab. Transcript of this video.
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  Produced by Victoria Tilney McDonough and Brian King. This neuropsychologist shares his experience and advice about culture, ethnicity, and brain injury rehab. Transcript of this video.
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For professionals, this guide is a thorough overview of the occupational therapy process for people with traumatic brain injury.

Disease/Condition(s)

Traumatic brain injury, including:

• Traumatic acquired brain injury
• Nontraumatic acquired brain injury

Guideline Category

• Counseling
• Evaluation
• Management
• Prevention
• Rehabilitation
• Risk Assessment
• Screening
• Treatment

Clinical Specialty

• Family Practice
• Internal Medicine
• Neurology
• Physical Medicine and Rehabilitation
• Preventive Medicine

Intended Users

• Advanced Practice Nurses
• Allied Health Personnel
• Health Care Providers
• Health Plans
• Hospitals
• Managed Care Organizations
• Nurses
• Occupational Therapists
• Physical Therapists
• Physician Assistants
• Physicians
• Psychologists/Non-physician Behavioral Health Clinicians
• Social Workers
• Speech-Language Pathologists
• Utilization Management

Guideline Objective(s)

• To provide an overview of the occupational therapy process for individuals with traumatic brain injury (TBI)
• To define the occupational therapy domain and process and interventions that occur within the boundaries of acceptable practice
• To help occupational therapists and occupational therapy assistants, as well as the individuals who manage, reimburse, or set policy regarding occupational therapy services, understand the contribution of occupational therapy in treating adults with TBI
• To serve as a reference for health care professionals, health care facility managers, education and health care regulators, third-party payers, and managed care organizations

Target Population

Adults with traumatically-acquired and nontraumatically-acquired brain injury

Interventions and Practices Considered

1. Referral for occupational services
2. Evaluation
   • Developing the occupational profile
   • Analysis of occupational performance through observation and assessment
3. Developing an intervention plan
4. Interventions during the coma recovery phase
   • Sensory stimulation programs
   • Neuromuscular recovery programs
   • Management of heterotopic ossifications
5. Interventions during the acute rehabilitation recovery phase
   • Intervention addressing the needs of patients with agitation
   • Intervention addressing motor recovery
   • Intervention addressing cognitive impairment
   • Intervention addressing areas of occupational performance
6. Interventions during the community recovery phase
   • Intervention addressing social and coping skills
   • Intervention addressing occupational performance
   • Intervention addressing education and work activities in context
   • Intervention addressing community mobility
7. Intervention review
8. Outcomes monitoring
9. Discontinuation, discharge planning, and follow-up
10. Occupational therapy services to organizations and populations

Major Outcomes Considered

• Validity and reliability of assessment tools
• Performance of activities of daily living
• Sensory perceptual skills
• Motor and praxis skills
• Emotional regulation skills
• Cognitive skills
• Communication and social skills
• Occupational performance
• Long-term disability

Methodology

Methods Used to Collect/Select the Evidence

• Hand-searches of Published Literature (Primary Sources)
• Hand-searches of Published Literature (Secondary Sources)
• Searches of Electronic Databases
• Description of Methods Used to Collect/Select the Evidence

Evidence-based Literature Review

Four focused questions and one subquestion were developed for the evidence-based literature review on rehabilitation of adults after traumatic brain injury (TBI). The questions were generated to provide needed information to update the previously published guidelines for the practice of occupational therapy with persons after TBI. The questions reviewed were:

1. What is the evidence that challenging demands to the brain, such as therapy, activity, or sensory stimulation, reorganizes brain function beyond spontaneous recovery after traumatic brain injury?
   1. What is the evidence for the effect of sensory stimulation on the arousal level of persons in coma or persistent vegetative state after traumatic brain injury?
2. What is the evidence for the effect of interventions (published between 2000 and 2006) to enable persons with TBI to participate in areas of occupation (activities of daily living, instrumental activities of daily living, work, leisure, social participation, and education)?
3. What is the evidence for the effect of interventions to address psychosocial, behavioral, and social functions on the occupational performance of persons with TBI?
4. What is the evidence for the effect of interventions to address cognitive/perceptual functions (attention, memory, executive functions) on the occupational performance of persons with TBI?

National Guideline Clearinghouse (NGC). Guideline summary: Occupational therapy practice guidelines for adults with traumatic brain injury. In: National Guideline Clearinghouse. Excerpted from the original by the American Occupational Therapy Association, 2009. Available at: www.guideline.gov. Used with permission.

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