GLA Newsletter  |  Issue 18  |  November 2015
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Whats new at GLA
The GOS-E will replace the GCS: What we need to know

Impact of Mild Traumatic Brian Injury and How to Treat the Symptoms
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Hello to all of our Readers,

And they are changing it again!!
In this edition of the newsletter, we have chosen to highlight the new SABS catastrophic impairment definition for spinal cord injury.

In the current SABS, any individual who has sustained paraplegia or quadriplegia in a motor vehicle accident, is automatically considered CAT.

As of June 2016, the definition will change to the following:

“Paraplegia or tetraplegia that meets the following criteria:

  1. The insured person’s neurological recovery is such that the person’s permanent grade on the ASIA Impairment Scale can be determined.
  2. The insured person’s permanent grade on the ASIA Impairment Scale is or will be,
  • A, B or C, or
  • B. D, and
  1. the insured person’s score on the Spinal Cord Independence Measure, Version III, item 12 and applied over a distance of up to 10 metres on an even indoor surface is 0 to 5,
  2.  the insured person requires urological surgical diversion, an implanted device, or intermittent or constant catheterization in order to manage a residual neuro-urological impairment, or
  3.  the insured person has impaired voluntary control over anorectal function that requires a bowel routine, a surgical diversion or an implanted device."
The ASIA Impairment Scale is a system of tests used to define and describe the extent and severity of a client’s spinal cord injury and help determine future rehabilitation and recovery needs.

It is divided into 5 “grades” including:

Grade A – Complete lack of motor and sensory function below the level of injury (including the anal area)
Grade B – Some sensation below the level of the injury (including anal sensation)
Grade C – Some muscle movement is spared below the level of injury, but 50% of the muscles below the level of injury cannot move against gravity
Grade D – Most (more than 50%) of the muscles that are spared below the level of injury are strong enough to move against gravity
Grade E – All neurologic function has returned
The ASIA scale should ideally be completed within 72 hours following injury.
According to the new CAT definition, Grades A, B and C are automatically CAT. This means that all complete spinal cord injuries will continue to be CAT.

Some incomplete injuries will be CAT, depending on the amount of muscle movement presented below level of injury, their mobility status and their bladder and bowel function.

To determine if incomplete spinal cord injuries are CAT, the Spinal Cord Independence Measure (SCIM) is introduced. The SCIM is an assessment that includes 19 items and assesses 3 domains: self-care, respiration and sphincter management, and mobility.

Item #12 in the SCIM, as indicated in the new requirements for CAT, discusses “Mobility Indoors”. In order to be designated CAT, you need to have a score between 0-5 in this section.

0 – Requires total assistance
1 – Needs electric wheelchair or partial assistance to operate manual wheelchair
2 – Moves independently in manual wheelchair
3 – Requires supervision while walking (with or without devices)
4 – Walks with a walking frame or crutches
5 – Walks with crutches or 2 canes

A score between 6-8, attributes that you use either a cane, a leg orthosis only, or no aids for walking indoors. A score between 6-8 is not considered CAT.

Finally, the new CAT definition considers bladder and bowel function. If the client requires catheterization or implanted device for bladder, they are CAT. If the client requires a bowel routine or implanted device for the bowel they are CAT.

In this month’s edition of the newsletter, we chose to highlight another change to the SABS definition of catastrophic impairment, the introduction of the GOS-E (extended).

To read more about the GOS-E and what we need to know about it, please visit our Blog post.

In addition, our second blog is about mild TBI or concussion and the importance of identifying it early as well as how to treat the TBI by early identification.
Please click here, to read our blog post.

We are excited to have a booth at the OBIA Conference in Niagara Falls on November 12 and November 13, 2015. We hope to see you there!

Best Regards,

Galit Liffshiz, MA OT Reg.(Ont.)
President of GLA


The GOS-E will replace the GCS: What we need to know

In 1981, the Extended Glasgow Outcome Scale (GOS-E) was proposed. It includes 8 categories. The categories of severe disability, moderate disability and good recovery on the original GOS are divided into a lower and upper category.


Impact of Mild Traumatic Brain Injury and How to Treat the Symptoms

About 80-90% of all TBI’s are classified as mild (or a concussion). The incidence of mild TBI is 600/100,000. However due to a lack of recognition and missed diagnoses this number may be twice as high1.

True mild TBI’s are often overlooked and clients miss the opportunity for early intervention. This may be due to the fact that the client comes to the hospital with other physical injuries and these are being treated first, such as fractures.

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