Occupational therapy for mild head injury

I’ve created this page separately to post my thoughts about working with children with head injury.

I’ve recently seen several young children with concussion/mild head injury who have not recovered quickly.  One of the issues I’ve been talking about with another therapist is the most effective way to manage the fatigue the children present with. They clearly tire more quickly complaining of problems such has headache, double vision or nausea. Or sometimes their behaviour changes, with obvious irritability. Previously, rest was prescribed for adults with the above symptoms. But more recently there has been discussion in the literature about the need for rest versus having a graded return to previous activities – ie that we don’t recommend sleep in the afternoon for example, but that people return to work quite quickly, even if for short periods on quite different duties.  My issue is that return to school is much harder… cant control as many of the variables as you can in the workplace, and also that these kids seem to need to sleep.  I’ll use this site to record what I find, and my reflections on my learning. Please feel free to follow my searching and to comment on what I find, or point me in the right direction.


10 Comments (+add yours?)

  1. adiemusfree
    Nov 12, 2007 @ 01:57:33

    Merrolee I totally agree that we need to provide help for people with MTBI. After my concussion I realised that I needed to place a high priority on RESTING and titrating the cognitive demands I placed on myself. And those demands include the need to filter out stimuli, the degree of cognitive demand in the actual activity (eg visual vs verbal vs words). In the case of MTBI it’s NOT like chronic pain where ‘pacing’ equals gradually increasing activity level and pain is not the guide – it’s much more about using subtle symptom cues to guide the demands over a day, and recognising that any energy deficit from the day before will carry over to the new day – demanding more rest!


  2. Stephanie Hessell
    Jun 29, 2008 @ 23:25:04

    Hi Merrolee,

    I’m very pleased I have stumbled onto your blog. I’m not sure how this works, and perhaps this discussion should be on the NZAOT site, your advice would be appreciated. Anyway – just this very morning I did an assessment with a boy diagnosed with post-concussion syndrom. I noticed that you mentioned double vision; here in Hamilton we some times refer to a vision therapist for this problem, but the referral often results in a very long and time consuming vision therapy programme. Often these kids/families have a lot of other things going on, and I’m not sure whether it is beneficial to go down the therapy vision track. I’m sure a lot of centres dont even have vision therapists. I would love to know whether you and others have found that double or blurred vision usually resolves spontaneously, or if vision therapy is a valuable addition to therapy?


  3. Jena Casbon
    Dec 24, 2008 @ 16:58:52

    I am sorry to leave this on your blog –> I couldn’t locate a direct e-mail address:

    My name is Jena and I am a Speech-Language Pathologist in the Boston area. I was doing some searching on the web for private clinicians and came across your site. I am in the process of developing materials for physical, occupational and speech therapists to learn more about seeing private patients. While I have some products about ready to launch, I am interested in learning more about people who are actively seeing private patients and what kinds of topics they feel they want to learn more about.


    If you have an extra two minutes, would you mind filling out my survey? In exchange for filling it out, I will make sure that you are among the first to know when my resources are available.
    Thank you again in advance,



  4. flora vinnarasi
    Jan 03, 2010 @ 07:07:48

    i am an occupational therapist working in a CBR set up ,your paper is informative,we always look at major areas of intervention ,we strive to attain it. we do not look at the minute areas.the type of category u have chosen is good,i think these type of people need lots of attention.u have talked about fatigue which i consider as major problem in terms of developing personality and skills.


  5. flora vinnarasi
    Jan 03, 2010 @ 07:09:13

    keep doing ur good work


  6. tracy
    Mar 18, 2010 @ 08:31:48

    found your blog when doing some research for mtbi resulting from domestic violence. The american journal of ot produced an article on MTBI with service men, sept/oct 2009 – they produced some clinical guidelines which are very comprehensive. Obviouslt, for use with adults, but just thought i would let you know


  7. secondchancetolive
    Jul 19, 2010 @ 15:39:18

    Hi Kia,
    I would like to be of service to you and to the men, women and families that you serve my friend. Please let me introduce myself. My name is Craig J. Phillips. I an individual living with a brain injury, a masters level rehabilitation counselor and an expert on addressing, handling and overcoming adversity.

    My vision and mission is to encourage, motivate, empower and provide hope to individuals so that they will pursue their passions through their gifts, talents and abilities as they follow their dreams and their destinies — regardless of their disability or disadvantage.

    On February 6, 2007 I created Second Chance to Live to share the principles and strategies that have encouraged, motivated and empowered me to succeed beyond all reasonable expectations. I also created a Translate feature on Second Chance to Live to empower my non-English speaking visitors.

    To date, I have written and published a total of 641 articles for Second Chance to Live. These articles can be found with in my Site Map. During the past 40 months articles from Second Chance to Live have been published in journals, newsletters and other publications in the United State, Canada, Europe, the United Kingdom and Australia on 16 different occasions. For a listing please see my Publications Page.

    Most recently, my article “To Empower Nurses is to Empower Their Patients” has been published in JARNA — The Official Journal of the Australasian Rehabilitation Nurses’ Association.

    Second Chance to Live has also been included as part of the Center for Disability Studies at the University of Hawai’i at Manoa.

    With the above being said, I am offering to be of service through Second Chance to Live and to have articles from Second Chance to Live published in your journal, periodical, magazine or newsletter — at no cost to you.

    My motivation is to serve. Please see my Media page.

    You may also add Second Chance to Live to the list of your related links and useful resources. consider including Second Chance to Live as helpful resource on your web site.

    I look forward to hearing from you and being of service to the individuals who you serve.

    Have a simply phenomenal day.


    Craig J. Phillips MRC, BA
    Second Chance to Live

    Our circumstances are not meant to keep us down, but to build us up!


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