GLA Newsletter  |  Issue 13  |  May 2016
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Whats new at GLA
The King's Outcome Scale for Childhood Head Injury (KOSCHI)

Management of Pediatric Concussion
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Hello to all of our Readers,


Announcement: We are very pleased to let our referral sources know that we are now providing OT services in Niagara Falls and Sudbury!

With the new SABS coming on June 1, 2016 and the new Catastrophic definition, assessing Daily Functional status is becoming one of the most important in designating an individual Catastrophic, and therefore, OTs are becoming a major component of the Catastrophic assessment team.

There are four major criterion that OTs will be required to provide their opinion:
  1. Head Injury – Assessments using the GOS-E structured interview
  2. Mental and Behavioural
  3. Combining the Physical and Mental, specifically assisting the mental status assessor with scoring the PIRS questionnaire (in the AMA Guides 6th Edition)
  4. Physical (OTs can assist with marking the ASIA, the SCIM, and Table 3 in Chapter 4 in the AMA Guides 4th Edition for neurological problems)

In this newsletter, we chose to focus on assessing function according to the new Criterion 4 of the OCF-19, the GOS-E.

This tool was created in 1981 to provide an overall summary of outcome and facilitate comparison for individuals who have experienced a TBI.

In 1998, the use of a “Structured Interview” was integrated into the GOS-E. The interview explores the following categories: independence inside and outside the home; major social roles; work; social and leisure activities; family and friendships; and a return to normal life.

The above categories of the GOS-E all describe an individual’s FUNCTION. The new criterion for the GOS-E states that the individual must be CAPABLE of carrying out activities regardless of whether or not they actually do them.

Capability of completing a task cannot be determined by asking the client questions over the phone or even by a sit down interview at a clinician’s office. It has to be OBSERVED.

For example: Can the individual plan a route to the grocery store? Can they compile a grocery list and negotiate the grocery store independently? Can they communicate appropriately with strangers?

OTs observes the clients performing functions and participations in daily activities.

The OT assessment will need to be situational in nature, including observing the individual in their home and in the community. This of course is while following the questions on the Structured Interview.

According to the GOS-E questionnaires, areas to be addressed are: amount of time the person can be left alone, ability to carry out activities such as getting washed, preparing meals for themselves, handling minor domestic crisis within the home or in the community, strategies used if getting into trouble, level of employment or ability to perform any vocation, time and quality of leisure activities, time and quality of interaction with family and friends etc.

Once a situational assessment is completed, the assessment team should have a better understanding of the client’s functional level, allowing them to score the GOS-E.  

To learn more about the GOS-E or about the upcoming changes to the OCF-19 in June 2016, please do not hesitate to contact us.

Our blog posts this month are related to pediatric head injury.

The first blog post will look at the King’s Outcome Scale for Childhood Head Injury (KOSCHI), a new assessment tool that was developed as an outcome measure in children who obtained a TBI.

Understanding the KOSCHI and the conditions to apply under this criterion for catastrophic designation is important, as starting in June 2016, it will be included in the OCF-19 definition of a catastrophic impairment for children. 

The second blog post will look at the diagnosing and management of pediatric concussion. Concussions in children may result from a motor vehicle accident, sports injury or a fall; however, in whichever way they sustained the injury, the management remains the same.

To learn more about the KOSCHI, please click here.

To learn more about the management of pediatric concussion, please click here.

On May 26 and May 27, 2016, please stop by our booth at the OTLA conference in Toronto. We look forward to seeing you there!

Best Regards,
Galit Liffshiz, MA OT Reg. (Ont.)
Expertise and Experience in Life Care Planning
Designated Capacity Assessor

The King's Outcome Scale for Childhood Head Injury (KOSCHI)

According to the article, “A practical outcome scale for paediatric head injury” 1, The KOSCHI was created by Crouchman and colleagues “due to the lack of evaluation of active and rehabilitation therapies after TBI.” It is meant to be an adaptation of the original Glasgow Outcome Scale (GOS) for adults. 


Management of Pediatric Concussion

This blog post is going to focus on the diagnosing and management of pediatric concussions. It should first be noted that “pediatric” is considered any persons under the age of 18 years.

In 2014, the Ontario Neurotrauma Foundation created a set of guidelines and recommendations for parents and/or caregivers on how to manage concussions. These guidelines are made public on the Ontario Neurotrauma Foundation website.

Copyright © 2016 Galit Liffshiz & Associates, All rights reserved.

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