Multi-disciplinary TBI evaluation

Transcription

1 Multi-disciplinary TBI evaluation Date: September 16, 2017 Ryan Rockwood, ATC Jennifer Wilhelm, PT, DPT, NCS Kyla Laraway, OT, DOT Haley Landau, M.S., CCC- SLP

2 Adapted from Collins MW et al; Knee Surg Sports Traumatol Arthosc 2014 OHSU Model Vestibular Ocular Migraine Cervical Concussion Cognitive Autonomic Auditory Anxiety/ Mood

3 Interdisciplinary Approach: Concussion Symptoms OT/neuroopt Neuropsych/psy chology School/ Work Patient Concussion Family Medical provider SLP PT

4 Athletic Trainer s Sideline Evaluation Injury Mechanism Hx of concussion Risk Factors Symptoms Log Testing Orientation Memory (immediate) Concentration Digits backwards Months in reverse Neruological Screen Balance Delayed Recall

5 Athletic Trainer Clinic Evaluation Intake Mechanism of injury Risk factors Current physical activity level Current status at school/work Symptoms Log Testing SCAT BESS VOMS Neurocognitive Computerized Testing Concussion Care Manager

6 PT evaluation: Headaches Vision screen VOMS Exercise tolerance Buffalo treadmill test VOR: vertical Cervical screen ROM Segmental mobility Motor control Strength

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8 PT evaluation: Dizziness/balance BESS Decreased BOS Vestibular screen Vestibular Ocular Reflex VOR VOR cancellation/visual motion sensitivity Dynamic balance DGI Integration of balance and vision Change in head position Cervicogenic Orthostatic Otholith stimulation

9 PT evaluation: Exercise Intolerance Buffalo test Bike Treadmill Vestibular Ocular Reflex Vertical VOR

10 OT evaluation: Vision Interview Subjective report of difficult activities Reading, driving, past point reaching Rivermead Post Concussion Questionnaire Vision screen VOMS: Smooth pursuits, saccades, convergence, VOR, visual motion sensitivity Accommodation Pupillary Response Diplopia Stereopsis/ Binocular Dysfunction Timed Ann Arbor and Number Saccades

11 OT evaluation: Sensory Processing Disorder and Sensory Integration SPD: dysfunction in the way the nervous system receives messages from the senses and turns them into responses.

12 OT evaluation: Sensory Integration Occupational Profile Semi-formal interview Current activities and limitations Triggers/ Alleviators Adolescent Adult Sensory Profile 60 questions Likert scale Treatment Education Initial compensatory strategies Gradual, graded exposure

13 +/++ Sensory Sensitivity Low Registration +/++ +/++ Sensation Avoiding Sensation Seeking

14 _ neurotypical mtbi overstimulation threshold registration point With this profile, a person spends less time in the window of optimal function.

15 OT evaluation and treatment Other areas of practice Sleep hygiene Lighting adaptations School/work accommodations Occupational engagement and deprivation Stress and pain management Functional pacing Family education

16 SLP evaluation: Cognitive Function & Endurance Interview General symptoms: Headaches, sleep, mood changes Triggers? Ways that alleviate symptoms? Current endurance? Cognitive changes: Memory, attention, speed of processing, planning/organizing Baseline tools? Current cognitive demands: School, work

17 SLP evaluation: Cognitive Function & Endurance Standardized Assessments Memory, attention, word retrieval, organization, speed of processing Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Trail Making Test Controlled Oral Word Association Test (COWAT)

18 SLP evaluation & treatment : Informal Assessments Attention and executive functions questionnaires Symptom logs Next steps Develop and train compensatory cognitive strategies Provide recommendations for school & work return Cognitive exercises

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21 Non-neurological factors ADHD, Reading LD, Math LD, Behavior problems Maladaptive coping Parental factors such as distress and anxiety Effort Good Old Days Bias Several other factors.

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25 Dancer s outcomes from recent concussion treatment clinic participation PHQ-15 (Somatization Symptoms) GAD-7 (Anxiety Symptoms) PHQ-9 (Depressive Symptoms) PSQI (Sleep Quality) 5/3/2017 5/9/2017 5/16/2017 6/6/ (Severe) 13 (Moderate) 8 (Mild) 3 (No clinical concern) 13 (Moderate) 10 (Moderate) 9 (Mild) 2 (No clinical concern) 21 (Severe) 20 (Severe) 11 (Moderate) 2 (No clinical concern) 9 (>poor quality) (>5 poor quality)

26 Soccer player s outcomes from recent concussion treatment clinic participation 6/12/2017 6/19/2017 7/11/2017 PHQ-15 (Somatization 11(Moderate) 10 (Moderate) 7 (Mild) Symptoms) GAD-7 (Anxiety 8 (Mild) 6 (Mild) 2 (No clinical concern) Symptoms) PHQ-9 (Depressive 9 (Mild) 4 (No clinical concern) 2 (No clinical concern) Symptoms) PSQI (Sleep Quality) 8 (>5 poor quality) - 6 (>5 poor quality

27 Interdisciplinary approach: OHSU Model ATC On the field ED Sports Med Comprehensive Neurological Rehab Team OT PT SLP 3 wks Vision Therapist Neuro optometrist School coordinator Neuropsychologist Outside referral (MD, PT, DC, other)

28 Thank You