Seminar Tbi.docx

SEMINAR Traumatic Brain Injury Sir Amado Torres, M. Ed., MNZSTA University of the Philippines (1990) ABI Rehabilitation Ltd New Zealand (Auckland & Wellington) -

The role of the SLT in the rehabilitation of a client with a severe TBI from a minimally conscious state to emergence from PTA within an intensive rehabilitation setting to the community.

*MDT = multidisciplinary team *MCS = Minimal conscious state Coma Is a state of sustained pathologic unconsciousness in which the eyes remain closed and the patient cannot be aroused (MSTF, 1994). Usually caused by trauma  from vehicular accidents, assaults, falls due to age/substance abuse/attempted suicide, self-inflicted accidents. Neuroanatomy: heart beat (/), respiration (/), etc. = the only thing functioning is the brain stem. o Brain is being separated from the brain stem; space from foramen magnum *explanation for trauma: an egg yolk inside the container is being shook  the container is okay but egg yolk is already destroyed. Vegetative State (VS) A condition in which there is complete absence of behavioral evidence for awareness of self and environment, with preserved capacity for spontaneous or stimulus-induced arousal (Aspen Workgroup, 2001). There’s awareness, but unlike the coma, kahit ano gawin mo, wala Individuals have complete/partial preservation of brainstem and hypothalamic autonomic functions, but show no evidence of sustained, reproducible, purposeful or voluntary behavioural response to auditory. Visual, tactile or noxious stimuli, or evidence of language comprehension or expression. (Laureys, S. et. al., 2000) o hypothalamus very significant in memory and emotion Minimal Conscious State (MCS) the MCS is a condition of severely altered consciousness in which minimal but definite behavioural evidence of self or environmental awareness is demonstrated (Giacino J.T. et. al, 2002). MCS vs. Coma 1st school of thought better to have MCS since you can engage more stimulation; can’t work with anything in a coma. 2nd school of thought

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better to have coma because there is no way but up; the rewards are very powerful in the patient’s life.

Behavioral Criteria for Differential Diagnosis Behavior MCS VS Coma Eye opening Spontaneous Spontaneous None Spontaneous Automatic/obje Reflexive/pattern None movement ct ed manipulation Response to Localization Posturing/withdr Posturing or pain awal none Visual Object Startle/pursuit None response recognition/pur (rare) suit Affective Contingent Random None response vocalizations Commands Inconsistent None None Verbalization Unreliable None None Communicati Unreliable None None on

Best Practice Guidelines best practice for people in MCS is individualized, holistic and patient-centered care. Best practice care requires a high standard of coordinates physical, medical, allied health, and psycho-social support, delivered with compassion and respect by a specialist team of health professionals working in partnership with the family. Roles of MDT in Rehab of MCS 1. Specialist Medical Care 2. Nursing care 3. Physiotherapy 4. Occupational therapy 5. Clinical psychologists and social workders 6. Dietician People who get usually confined: poor in executive function (“pusakal” lol) A range of non-medical approaches such as music therapy, massage, recreation therapy, spiritual therapy, etc. In NZ and US: SLTs work close with dieticians. Dieticians rely on the SLTs for the amount of food they present. o In a hospital setting, patients cannot feed without the presence of SLTs SLT’s Role 1. Swallowing 2. Communication 3. Cognition 4. Education of family along with MDT TRAMS: tracheostomy team When a patient has tracheotomy: the vocal folds will not be exposed to respiration, amplification, phonation, and eventually articulation. Clinical Assessment of the Minimally Conscious Client Behavioural Assessment Methods remain to be the gold standard of diagnosis & prognosis of the clients in MCS

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Standardized Consciousness Rating Scales Glasgow Coma Scale – GCS (1974) Full Outline of UnResponsiveness – FOUR (2005) Coma Recovery Scale – CRS-R Rappaport Coma/Near Coma Scale – C-NC (1987) Sensory Modality Assessment and Rehabilitation Technique – SMART (2004) o Wessex Head Injury Matrix – WHIM (2000) o Disorders of Consciousness Scale – DOCS (2005) o o o o o

“It is not the amount of time, but the intensity of your communication with your patient.”