Brain Injury and Occupational Therapy

Phillip Wendt, MScOT, OT Reg. (Ont.)

An Acquired Brain Injury, or ABI for short, refers to any brain injury that has occurred after birth. This includes a large variety of diagnoses such as concussion, hypoxic brain injury, stroke, subdural hematoma, traumatic brain injury, and others. It does not include hereditary or congenital illnesses.

How does someone know they have one, particularly if it’s not severe enough to show up on a brain scan (MRI or CT)?

Most ABI’s will have a sudden onset of marked changes that can be seen on imaging or neurological examinations (MRI, CT, etc.). However, mild ABI’s such as concussion may not. Indeed, a person may not even be aware that they have sustained a concussion. In these instances immediately after one sustains an impact to their head, it is important to look for signs and symptoms such as confusion, disorientation, and irritability. Lingering symptoms can then included headaches, fatigue, changes in sleep patterns, dizziness, difficulty concentrating, light and sound sensitivity and nausea.

Why is it so important to treat a mild to moderate ABI such as concussion? Won’t it heal all by itself?

The good news for most people who have suffered a concussion is that symptoms will resolve in time with minimal intervention. For these people, light manual therapy and education about symptom management will usually suffice and has been found to reduce stress and anxiety about their injury, leading to better overall treatment outcomes. However, there are certain populations of individuals that tend to benefit from additional post concussion management from specialized professionals. In an average population, about 10% of people will continue to experience lingering symptoms and should seek further treatment. Additionally, athletes and workers in physical jobs benefit for further intervention due to the increased risk of incurring subsequent concussions and the magnified effects that these further injuries can have on their brains. Finally, women and the elderly have been found to have a significantly higher risk of developing persistent post concussive symptoms and would benefit from receiving specialized care should symptoms linger.

How is mild ABI/concussion treatment by an Occupational Therapist so helpful?

A very typical problem for people post concussion is that they have been told to rest for several days and then return to normal activity. They know how to rest well enough but they have difficulty returning to normal activity without increasing their symptoms (usually headaches and fatigue). Occupational therapy focuses on the relationship between activities that people perform in their day to day life and how those activities impact their health. For concussion, this translates to finding a person’s threshold of activity before symptoms appear and learning to work within, and increase, this threshold until normal baseline activities levels are reached. Using this approach, an occupational therapist can help you return to daily activities such as work, school, or family life sooner and with less symptoms and complications.

How long does it take to treat ABI?

Treatment time can vary widely depending on the severity of the ABI. For a concussion, treatment may be as little one to two education and symptom management sessions.

What are many of your clients surprised to learn from you as you offer support for their brain injury?

Although most people I see have read some educational material about rest and symptom management, many people are surprised to see how many of their daily activities have a significant impact on their brain functioning in ways they never thought. I recently helped someone to significantly reduce their headaches simply by changing the lighting at their jigsaw puzzle table (they were so engrossed in the puzzle that had never noticed how the over head light was glaring off the shiny tabletop right into their eyes, causing headaches).

Why do you enjoy treating ABI?

Each ABI is different and I think the example above speaks to my enjoyment of being an occupational therapist treating ABI. Though my approach has a structured methodology to it, there are so many unique situations and creative solutions that emerge as I work with each person. It is an enjoyable approach and it allows me to really get to know the people that I work with.