Disclosures: Tracy Floyd, MS OTR/L: Nothing to disclose

Case Description: Single-subject case study combining functional interventions within an interdisciplinary rehabilitation approach. The service member’s (SM’s) goals were based on tasks with high ecological validity and considered the SM’s self-selected vocational and personal goals (e.g. regaining driver’s license). Fifty-two weeks of group and individual intervention focused on cognitive domains of cognitive flexibility and visuospatial skills. Therapy approaches included the following: 1) Metacognitive training; 2) Driving simulation; 3) Robotics; and 4.) Role-playing and coaching.

Setting: Three months post-injury, the SM participated in outpatient occupational, recreational, and speech-language pathology intervention at a U.S. Army Medical Center.

Patient: A 22-year-old male SM with a severe TBI secondary to a high-velocity projectile and resulting in severe facial and skull fractures, epidural hematoma, and subdural hematoma. Post-injury symptoms included depression, anxiety and mild cognitive disorder characterized by deficits in visual motor construction, executive function, sustained attention, verbal learning, memory, and cognitive flexibility. Concomitant physical conditions included monocular vision with complete loss of visual field in the left eye and hearing loss in the left ear.

Assessment/Results: Results of the QOLIBRI indicated improvement in health-related quality of life in the Daily Life and Autonomy (4.18% increase) and Social Relationships (10.08% increase) subscales from pre- to post-intervention. On the PGIC, the SM reported a considerable improvement (score of 7) in his status since the start of care. Functional results included reinstatement of driver’s license with no restrictions and increased insight to better inform vocational goals.

Discussion: The case study demonstrates the importance of including ecologically valid and contextual therapy tasks in outpatient rehabilitation. The interplay between self-selected goals and therapy approaches aligned with those goals positively influenced both health-related quality of life as well as functional outcomes for the SM depicted in this case study.

Conclusion: Future research should consider ecologically valid tasks and routines as the cornerstone of effective rehabilitation practice.

Level of Evidence: Level IV

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ecological-validity-in-the-rehabilitation-of-a-service-member-with-severe-tbi/