Improving Psychosocial Function in Adults with Brain Injury

Liz Walton, OTSSpalding UniversityJanuary 24th, 2014

Brain Injury –The Silent Epidemic

• http://www.youtube.com/watch?v=Wo4Nq3S7Bns

Causes of Brain Injury

Brain Injury Statistics

• More than 5 million people in the US are living with the after effects of brain injury - CDC

• About 1.7 million people receive a brain injury every year – CDC

• An estimated 214,000 Kentucky Residents have a brain injury – Brain Injury Association of Kentucky

Brain Injury Statistics

• Brain injury is costly. A severe brain injury is estimated to cost between $4 - 7 million dollars over the lifetime of the individual – Brain Injury Association of Kentucky

• The cost of treating, rehabilitating and caring for the victims of TBI costs the U.S. $30 billion each year- CENTER FOR BRAIN INJURY AND REPAIR, University of Pennsylvania

• A person with a brain injury is 7 times more likely to wind up in prison than those without a brain injury

– Brain Injury Association of Kentucky

Psychosocial Function – What does that mean?

• Emotional stability and regulation• Social skills• Coping skills• Behavioral regulation• Sense of self efficacy• Communication skills• Community participation• Social integration

Why is this important?

• Dysfunction in these areas can disrupt all other therapeutic interventions

• Isolation

Research

All articles were from no earlier than 2007 and were published in scholarly peer reviewed journals

Databases:• Academic Search Premier• CINAHL • Medline• OT Search• World CAT

Journals

• OTJR: Occupation, Participation and Health• Brain Injury• Disability and Rehabilitation• Archives of Physical Medicine and

Rehabilitation• Clinical Rehabilitation

Level of Evidence:

Level I – 3 articles

Level II – 3 articles

Level III – 2 articles

Themes found during research:

• Group sessions• Interdisciplinary approach• Family/caregiver participation in therapy

Group Sessions

• Education about brain injury and recovery• Peer discussions with feedback• Coping skills training – workbooks and discussion• Coaching and feedback about how to handle

challenging situations• Individualized goal setting with input from peers• The awareness that one is not alone• Self awareness• Stress management techniques• Promotion of interaction

Interdisciplinary Approach

• OT• PT• SLP• Psychologists• Social workers• Coaches

Family/Caregiver Involvement

• Participation in individual and group sessions

• Education and support

The Road Forward…

• Implement evidence based practice• Advocate for the role of OT in BI rehabilitation

The Road Forward…

• Further research needed

Review

• Why is it important to address psychosocial function?

• What were the 3 prevailing themes found?

• How can you implement these findings into your practice?

• Scott DeBurger, OTR/L – Baptist Health La Grange• Joanne Ehrman, OTR/L - Neurorestorative• Staff at Neurorestorative

• Clients for sharing and allowing me to learn from their experiences

Questions?

Liz Walton, OTSLizWalton21@gmail.com

REFERENCES• Backhaus, S., Ibarra, S., Klyce, D., Trexler, L., & Malec , J. (2010). Brain injury coping skills group: A preventative

intervention for patients with brain injury and their caregivers . Archives of Physical Medicine and Rehabilitation, 91(6), 840-848. doi: http://dx.doi.org/10.1016/j.apmr.2010.03.015

• Blake, H. (2009). Exercise intervention in brain injury: A pilot randomized study of tai chi qigong. Clinical Rehabilitation, 23(1), 589-598. doi: 10.1177/0269215508101736

• Dahlberg, C. A., Cusick, C. P., Hawley, L. A., Newman, J. K., Morey, C. E., Harrison-Felix, C. L., & Whitenect, G. G. (2007). Treatment efficacy of social communication skills training after traumatic brain injury: A randomized treatment and deferred treatment controlled trial. Archives of Physical Medicine and Rehabilitation, 88(12), 1561-1573.

• Doig, E., Fleming, J., Kuipers, P., Cornwell, P., & Khan, A. (2011). Goal directed outpatient rehabilitation following TBI: A pilot study of programme effectiveness and comparison of outcomes in home and day hospital settings.

Brain Injury, 25(11), 1114-1125.

• Fleming, J., Kuipers, P., Foster, M., Smith, S., & Doig, E. (2009). Evaluation of an outpatient, peer group intervention for people with acquired brain injury based on the icf ‘environment’ dimension. Disability and Rehabilitation, 31(20), 1666-1675. doi: 10.1080/09638280902738425

Liz Walton, OTSLizWalton21@gmail.com

REFERENCES• Geurtsen, G. J., Martina, J. D., Van Heugten, C. M., & Geurts, A. C. H. (2008). A prospective study to evaluate a new

residential commnity reintegration programme for severe chronic brain injury: the brain integration programme. Brain Injury, 22(7/8), 545-554.

• Lundqvist, A., Linnros, H., Orlenius, H., & Samuelsson, K. (2010). Improved self-awareness and coping strategies for patients with acquired brain injury – A group therapy programme. Brain Injury, 24(6), 823-832

• Wheeler, S. D., Lane, S. J., & McMahon, B. T. (2007). Community participation and life satisfaction following intensive, community-based rehabilitation using a life skills training approach. OTJR: Occupation, Participation and Health, 27(1), 13-22.

• Brain Injury Association of Kentucky

• CENTER FOR BRAIN INJURY AND REPAIR, University of Pennsylvania

• Centers for Disease Control and Prevention