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How Do Occupational Therapists Help Individuals Ease Back into the World After TBI and/or PTSD?

How Do Occupational Therapists Help Individuals Ease Back into the World After TBI and/or PTSD?


How do occupational therapists help individuals ease back into the world after TBI and/or PTSD?

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[Dr. Kristen Maisano] When we're talking about occupational therapists working on integrating back into occupations, there's different reasons why the person is not completing the occupation. One of the most common is an inability to tolerate the environment that they're in or tolerate public places. So what we do is we try to find where the person is right now. What are they able to complete right now comfortably with minimal anxiety? Then we talk about where they want to be. What is your goal? Do you want to be able to ride the Metro at rush hour, or do you just want to be able to go to your kid's soccer game with minimal anxiety? Then basically we build a set of stairs. We rank things from easiest to hardest, and we work on each of those until they're really comfortable. Then we go to the next one. We use the skills that we talked about in the basic ones like breathing techniques, compensatory strategies, planning ahead, those kind of things, so that basically we train the brain again that you are safe. You are safe in this environment, and you can do this. A lot of those strategies are pulled from Dr. Beck's Cognitive Behavioral Therapy. It works beautifully with both PTSD and mild traumatic brain injury, but one of the key things that an occupational therapist needs to do is they need to meet the person where they are. They need to find the just right fit challenge because many service members are used to jumping head in, and they're used to going for the gusto. We need to take single increments so that we can positively reinforce in the brain that we are okay. We're no longer in a violent situation such as Afghanistan or Iraq. We're in Arlington. We're in Seattle. We're in safer places. The just right fit and then challenging according to that. One of the authors calls it flow, so getting that just right challenge so that we keep them challenged but in an appropriate way.

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Produced by Victoria Tilney McDonough and Erica Queen, BrainLine.

Kristen Maisano, OTDKristen Maisano, OTD is an occupational therapist and the interim director of Rehabilitation Services for the Traumatic Brain Injury Clinic, Fort Belvoir Community Hospital in Virginia. She specializes in evaluating and treating military patients with traumatic brain injuries.

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