GLA Newsletter  | Spring Issue  |  March 2021
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Hello everyone,
We hope everyone’s new year is off to a great start.
In this edition of our newsletter, Jamie Laframboise, Occupational Therapist (OT) with GLA Rehab, summarizes Mickelson v. Sodomsky 2019 BCSC 806.
This case illustrates how important careful data collection is, when working with clients with mild injury (mTBI). 
Little objective evidence of mTBI typically exists.
The symptoms of mTBI are not unique to this population, and without objective evidence, it is difficult to determine whether the client’s symptoms are the result of mTBI, other MVA-related injuries, or pre-existing conditions.
In Mickelson v. Sodomsky 2019 BCSC 806, Ms. Mickelson was involved in an MVA in November of 2015. The airbags deployed and hit her in the head, causing her to feel dazed and confused.
There were gaps in Ms. Mickelson’s recollection of the collision and time following.
Ms. Mickelson claimed that the MVA caused soft-tissue injuries and mTBI, resulting in post-concussive syndrome.
She was experiencing impaired sleep, tinnitus, noise sensitivity, mental fog, confusion, and difficulties with word-finding and decision making which rendered her competitively unemployable.
The defendants admitted liability for the collision and accepted that Ms. Mickelson experienced tinnitus, anxiety, and depression.
However, they submitted that there was no proof that Ms. Mickelson’s cognitive issues were caused by a mTBI, and argued that they were caused by psychological distress, fatigue, and tinnitus.
Mr. Justice Thompson cited several precedents, stating that scientific proof of causation is not necessary, and that conclusions about causation can be drawn from carefully examining sequences of events over time.
He determined that subjective complaints provide sufficient evidence of the effects of the MVA on health and functioning, especially when they can be corroborated by collateral evidence.
Using subjective reports, collateral evidence, and expert opinion, Ms. Mickelson was able to illustrate the nature of her injuries, their impact on her daily functioning and that the damage was the direct result of a mTBI sustained in the MVA.
Self-report and collateral evidence illustrated a significant change in Ms. Mickelson’s status from pre- to post-MVA.
Ms. Mickelson had pre-existing intermittent low back pain and a short period of depression, but was happy, outgoing, motivated, active, and hard working prior to the MVA. After the MVA, she became withdrawn and socially isolated.
OTs are experienced at assessing the impact of physical, cognitive, and psycho-emotional impairments on pre- and post-MVA functioning.
This allows them to differentiate the impact of pre-existing conditions versus MVA-related impairments on function, and to determine the relative impact of various MVA-related impairments on function.
In the subject case, OTs could have helped illustrate the impact of Ms. Mickelson’s pre-existing intermittent back pain and depressive episode, versus MVA-related impairments on her function, as well as the impact of her various MVA-related impairments on her function.
Expert opinion also influenced Mr. Justice Thompson’s decision in this case.
Our OTs are experienced at identifying the need for referrals to other specialists who can explore diagnosis and prognosis. 
In this case, Dr. Cameron, Neurologist, and Dr. Muir, Psychiatrist, contested the defendants’ argument, that because Ms. Mickelson didn’t lose consciousness and had a GCS of 15, according to EMS and emergency department personnel, she didn’t suffer a mTBI.
They argued that Ms. Mickelson did experience an altered state of consciousness, as evidenced by the fact that, following the MVA, she was “dazed and confused” and had gaps in her memory.
Dr. Dumper, Otolaryngologist, documented that tinnitus was not responsible for Ms. Mickelson’s distractibility and communication difficulties, as these symptoms were not better in an environment without competing sound, as is usually the case with tinnitus.
Dr. Friesen, Neuropsychologist, determined that Ms. Mickelson’s test results indicated deficits in attention, memory, and executive functioning, as well as symptoms of psychological distress including depression and posttraumatic anxiety.
She concluded that her pattern of test scores was consistent with frontal lobe dysfunction related to ongoing symptoms of mTBI, rather than depression or alcohol dependence.
The nature of Ms. Mickelson’s recovery influenced Mr. Justice Thompson’s decision as well.
In this case, Ms. Mickelson’s cognitive impairments did not improve when her depression and pain symptoms reduced.
As such, Mr. Justice Thompson concluded that her depressive and pain symptoms were not responsible for her cognitive impairments or her inability to work.
Our treating OTs see clients on a regular basis. This allows them to evaluate changes in their physical, cognitive, and psycho-emotional capacities and functional abilities over time.
This information can be used to determine the primary cause of functional impairment, in cases where it is being contested.
GLA Rehab highly recommends including OTs on rehab teams in cases where mTBI and post-concussive symptoms are suspected.
In addition to helping clients learn strategies to function with their impairments, OTs are equipped to provide information about clients’ symptoms, impairments, and discrepancies between pre- and post-MVA functional status, and to document progress over time, which can help illuminate the relative impacts of various impairments on function.
Mickelson v. Sodomsky, BCSC 806 (2019).

Will Canada Approve a Hand-Held Diagnostic Tool for Traumatic Brain Injury?

By Jamie Laframboise, MSc (OT), OT Reg. (Ont.)

Traumatic brain injuries (TBIs) occur when brain function is disrupted by injury to the head, and they are a leading cause of death and disability worldwide (CDC, 2020).

TBIs vary in severity from mild (commonly diagnosed as concussion), to severe.

With proper diagnosis and treatment, people with mild TBIs are expected to recover within three months post-injury.

Read full article

Using “Occupational Gifts” to Maintain Meaningful Routine during COVID-19

By Jamie Laframboise, MSc (OT), OT Reg. (Ont.)

Daily routines, or the regular sequences of activities we follow in our daily lives, are crucial for our health and well-being (Matuska & Barrett, 2014).

Consistent, meaningful routines that maintain balance between work, school, play, rest, and sleep.

They help create structure in our daily lives, improve our health and well-being and reduce anxiety and stress (Matuska & Barrett, 2014).

Read full article
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