OTA 2: Lecture 6Mental HealthTraumatic Brain InjuryStroke
July 3, 2012
Mental Health, TBI & Stroke Brain-based, but distinct from one
another 1st half of class: Mental health▪ Mental health: can be psychologically based or
physically/biologically based
2nd half of class: Intro to TBI and Stroke• Biologically or physiologically based
Mental Health: Occupational Therapy and OTA Role
Occupational therapists address barriers to mental health by creating home, work and community environments that facilitate meaningful occupation
(CAOT Position Statement) Under the direction of the OT, the
OTA assists the OT in the application of research, best practices, the recovery model, and demonstration of outcomes.
Source: http://www.providencecare.ca/objects/content_revision/download.cfm/revision_id.205934/workspace_id.-4/Occupational%20Therapy%20-%20Mental%20Health%20Services.pdf/
Mental Health and OT
Found in: Community OT Mental Health facilities Community facilities Long-term Care facilities Forensic systems (Prisons) Everyday client populations dealing with
physical dysfunction
Psychosocial Aspects of Physical Disability Chapter 3 (Early Text) Experience of loss can be profound
Especially in relation to ROLE LOSS Effects both:
Client Client’s family & friends
Key Factors Influencing Psychosocial Effect of Disabilty
1. Time of life and developmental stage2. Extent and location of deficit3. Is deficit obvious?4. Social definition of the deficit5. Attitudes of family/loved ones6. Extent to which disability affects functioning7. Disruption of valued goals
** visit these factors in your regular interactions and conversations with clients**
Consider the Model of Human Occupation (MOHO)
What skills, habits, and roles has this person lost or reduced as a result of the disability?
What is the person’s sense of personal causation?
What values and interests does this person have?
What is the person’s social and object environment?
What interventions will increase the person’s sense of personal causation and put the environment more within his/her control?
Role Checklist: Homework Oakley, 2006 Based on the MOHO Review the instructions and
complete the checklist for yourself. I do not want a copy of the results,
but I would like you to hand in a paragraph reflecting on what you thought of the results.
Psychosocial Consequences of Acquired Physical Dysfunction Different from congenital dysfunction. Both are equally valid and may surface during
treatment, but more likely to surface with OT with acquired injuries
Affected by: Personal reactions: Feelings of self-worth,
Acceptance of disability▪ Address with: personalized approaches to golas and
treatment objectives Societal reactions: Attitudes, Appearances, (own)
vulnerability▪ Address with: education, collaboration, advocacy
Barriers to Healthy Adjustment Non-acceptance
Person with disability not accepted into society: no place
Examples? Spread factor
Evaluation of the visible disability is spread to other characteristics not affected
Examples? Labelling/Stigmatization
Language: retard, crip, psycho, quad…
Adjustment to Disability: Kerr Coping mechanisms and response patterns Analogous to Kubler-Ross grief processes
1. SHOCK: “this isn’t me!”2. EXPECTANCY: “I’m sick, but I’ll get well”3. MOURNING: “All is lost”4. DEFENSIVE:
1. Healthy: “I’ll go on in spite of ___”2. Pathological: marked use of defense to deny the
effects of the disablity5. ADJUSTMENT: “It’s different, but not bad”
How do these stages of adjustment play out? You may see a variety of coping
mechanisms in practice. The same coping mechanism that is
helpful or healthy in one client may be harmful to another.
The OT will guide how these coping mechanisms are addressed in treatment
Coping Strategies
Projection Displacement Sublimation Aggression Dependency Regression Compensation Fantasy Passing
Key: Self Acceptance and the Recovery Model
Recovery is the personal process that people with mental illness go through in gaining control, meaning and purpose in their lives.
Recovery involves different things for different people. For some, recovery means the complete absence of the
symptoms of mental illness. For others, recovery means living a full life in the
community while learning to live with ongoing symptoms. Recovery involves changes in the way individuals
with mental illness think, act and feel about themselves and the possibilities in their lives (CAMH, 2012).
Exercise:
This lunchtime, wear something embarrassing or use an aid in public while you have your lunch break. When we return, discuss: What coping mechanisms you used to
deal with this small change? What though processes did you go
through?
Break:
See you all at 12:00
Stroke: Cerebrovascular Accident (CVA)
Leading cause of serious long-term adult disability
Caused by a sudden loss of blood supply to the brain
Blood loss/loss of oxygen leads to damage and death of brain cells
Results in deficits relating to these areas of the brain
Remember: stroke to one side of the brain results in deficits in the opposite side of the body
Dysfunction:
Immediately after stroke: Flaccid paralysis Hypotonicity (low muscle tone) Impaired posture control Sensory deficits Visual impairments Perceptual dysfunction Cognitive dysfunction Behavioral and personality changes Impaired speech and language
Recovery
Outcome depends on many personal, environmental, and health-related factors
Spontaneous recovery of motor function occurs primarily in first 3 months, but can occur up to one year
Improvements in functional ability continually improve with treatment and adjustment
Role of Occupational Therapy Improving the motor function of the
affected side Integrating sensory, visual-
perceptual, and cognitive functions Facilitating maximal level of
functional independence Encouraging return to life roles
Goals of Occupational Therapy For Clients with Stroke
Consider the goals for OT on page 468
Go through your text and find a treatment strategy that will address each of these for a client with stroke.
For this exercise, it need not be something that the OTA will implement, you can consider yourself to be working in collaboration with the OT guiding you for each goal.
Traumatic Brain Injury (TBI) Results from a penetrating or non-
penetrating injury to the brain A spectrum of disability No two clients are the same, despite
the injury TBI is a life-altering experience that
causes physical, cognitive, behavioral, and emotional changes.
Difficult on both clients and families
Levels of Cognitive Functioning:Rancho Los Amigos Scale of Cognitive Functioning
I. No response: Total AssistanceII. Generalized Response: Total AssistanceIII. Localized Response: Total AssistanceIV. Confused-Agitated: Maximal AssistanceV. Confused-Inappropriate, Nonagitated: Maximal
AssistanceVI. Confused-Appropriate: Moderate AssistanceVII. Automatic-Appropriate: Minimal Assistance for Daily
Living SkillsVIII. Purposeful and Appropriate: Standby AssistanceIX. Purposeful and Appropriate: Standby Assistance on
RequestX. Purposeful and Appropriate: Modified Independence
Damage
Primary Damage Occurs at the time of trauma
Secondary Damage Can occur immediately after the injury,
or hours-days later Can be life-threatening Can result in widespread damage
OT in the ICU
Establishing a bed and wheelchair positioning program
Establishing and implementing a sitting program if possible
Preventing contractures Increasing endurance Establishing a baseline cognitive
status Educating the family Facilitating client participation in
basic ADLs
Clinical Picture of a Client with TBI Neuromuscular changes
Deficits in:▪ Primitive reflexes▪ Muscle tone▪ Postural stability▪ Motor control▪ ROM▪ Strength▪ Sensation▪ Endurance
Clinical Picture:
Reduced Attention and Concentration
Impaired initiation Impaired memory Decreased safety awareness Delayed processing of information Impaired executive functioning and
abstract reasoning Changes in behavior Psychosocial changes
Treatment
Client-centred (always) Consider the impact of the changes
to personality To the client themselves (are they even
aware?) To the family
Depends on severity of the injury Refer to your text, there are good ideas
there Role of education
+++ helpful to clients and families