OTHY300

Who is Chloe?

Chloe was an 18 year old university student and elite swimmer when she was involved in a car accident which resulted in a sever traumatic brain injury.

Symptoms resulting from this head injury can include:

• Loss of consciousness
• Headache
• Dizziness
• Respiratory issues
• Convulsions
• Nausea and vomiting
• Cerebrospinal fluid leaking from nose or ears
• Speech and language problems
• Vision issues
• Emotional and behavioural changes

Cognitive

-Memory dysfunction

-Anterograde amnesia: “defined as the inability to learn new long-term declarative information” is present as Chloe expressed difficulty at university, finding it “a lot harder”

-Difficulty at university

-Finds it hard “adapting to new or cognitively demanding situations (Atchison, & Dirette, 2012 p. 184).

-Neurobehavioral deficits (impulsivity, aggression, irritability, poor control of temper)

-Chloe releases her frustration and agitation through shouting and screaming

-Difficulties in impulse control, sustained attention, concentration, memory and comprehension.

Traumatic axonal injury

TAI results from high-velocity translational or rotational forces acting on the large, gyrencephalic human brain, typically due to a motor vehicle accident or fall. Inertial forces shear and stretch axons to breaking point/primary axotomy or partially damage them.

An elongating stretch of at least 10% that occurs in 100 milliseconds or less appears to represent a threshold for sublethal axonal injury with secondary consequences, this often results in coma

Person

“Cognitive and behavioural problems are among the most common, difficult, and long-lasting consequences of all levels of TBI” (Atchison, & Dirette, 2012 p. 184)

Recovery

Spontaneous recovery period is when the brain attempts to recover and repair the bruised neurons. The process takes weeks and may extend for months.

Cognitive retraining, which presumes that at least some of the brain's cognitive capacity can be restored by constant repetition of certain simple tasks.

Decompressive Craniectomy:

Chloe's frontal skull was removed from temple to temple to allow the brain to swell out of the hole to reduce brain pressure to an appropriate level.

Initial assessments:

• Glasgow Coma Scale (GSC)
• Westmead post traumatic amnesia test

OT Assessment

Occupational assessment used to discover areas for occupational intervention.

• Gross motor function – can participate in meaningful occupations.
• Personality and behaviour- limiting relationships in many environments = assess this area
• Cognitive function – limiting participation at university= assess this area

Assessments identified:

The Montreal Cognitive assessment (MOCA)

Behavioural Assessment of the dysexecutive syndrome (BADS)

CMOP-E

“In the CMOP-E, occupational performance is the result of the interdependence between the person, the environment, and the person’s occupations” (Christiansen, Baum, & Bass, 2015 p. 38).

Client factors for assessment:

• Motivation, choice and relationship
• Cognitive capacity to complete test
• Reinforcement from therapist
• Frustration arising from test
• Fatigue and breaks
• Self-awareness
• Environment – noise, time of day, temperature

Spirituality:

-Kokoda Track was a place where determination and meaning was found

-Persistent to complete track even after doubting self

-Expression of saying thank you to her doctors and nurses that looked after her after her accident

-Provided Chloe and her father with a means of reconnection, strengthening their relationship

Through intensive medical management in the ICU, Chloe’s life was saved and her condition initially stabilised.

Chloe’s brain was continuing to swell which increased intracranial pressure. The surgical team would need to relieve this pressure

Affective

-Ok with not being her old-self

-Self-belief

-Wanting to be able to walk again and do everything independently

-“Remarkable determination” – Dr Mark Langcake, Head of Trauma

-“She will just go and go and go” – Nyrie Palmer, Mother

-High focus and determination

-Very emotional

Physical

-Change in body shape, increase weight

-Plates and screws around head “like little horns”

-Scars described as “battle” and “survival” scars

-Lost ability to identify when she is hot and cold, resulting in a high risk of seizures

-Pain in leg and knees due to right leg injury

-Great muscle memory

What is traumatic brain injury?

“An alteration in brain function, or other evidence of brain pathology, caused by an external force” (Radomski, & Latham. 2008).

Closed head injury specifically known as a coupe-countrecoupe injury

Behavioural Assessment of the Dysexecutive Syndrome (BADS)

Assesses: Planning, attention, problem solving problems

Additionally:

• Motivation & behaviour
• Matches areas that need intervention for Chloe including cognition and behaviour

Occupation:

Self-care

- competence in self-maintenance roles (self-feeding, dressing, bathing, grooming and toileting)

Productivity

-Successfully started University, completing 1st semester of a Bachelor of Science, Majoring in exercise science.

-Successfully participated in a walk along the Kokoda Track to raise funds for research into trauma and intensive care with her health care team.

-Pain and constant overheating impacted upon performance however her self-determination and persistence led her to the finish line.

Leisure

-Pre-injury: got into an elite level squad, swimming 10km in open water with the hope of becoming an Olympic athlete, representing Australia.

-“Swimming was always my love

-Began swimming post-injury

-Swimming currently playing a great part in her rehabilitation, unlocking something “that had to be unlocked” – Nyrie Palmer, Mother

Environment

Physical

-Supports her involvement in day-to-day activities (accessing a swimming pool)

-Lives with family who support her transportation

Social

-Strong supportive network (medical team and parents)

-Gained a greater relationship with others following involvement in the Kokoda Track.

Institutional

-Particular concern upon brain injury

-Trek for Trauma was completed, raising funds of $200,000 that will assist in further research into brain injury and paracetamol

-Pursue of University studies provides a great opportunity for growth and recovery

-Cognitive retraining through mental stimulation (Christiansen et al., 2015).

-Improvement in communication through age-appropriate socialization (Christiansen et al., 2015).

Long Walk Back

Neurological conditions group presentation by:

Omar Al Hayek

Jemma Yazbeck

Katie Headrick

Goal Attainment Scale (GAS): Goal 1

Goal Attainment Scale (GAS): Goal 2