An Occupational Therapy Pathway for Mild Traumatic Brain Injury Emergency Department presentations across the lifespan

Occupational Therapy (OT) Referral Pathway (Cohort 2): The OT referral pathway aims to provide specialist follow up for patients seen in ED for a head injury, outside of business hours and demonstrating characteristics most at risk of experiencing functional deterioration. This pathway is being implemented as routine care regardless of a patient's participation in the study. Patients will be referred to their respective services by the ED treating team: -Adults (over the age of 18yrs, OR no longer attending formal schooling due to lifestyle and behaviour factors) -Paediatrics (5yo or school attending, and under the age of 18yrs). Patients will be provided with written educational material about head injury by the ED team upon referral to the OT pathway. The OT clinic provides telehealth counselling sessions aimed at education, symptom management and intervention based on patient goals and occupational engagement to promote client centred care and re-integration into community / productivity roles. Initial assessment (which will take up to 30 minutes) will be completed over telephone by an Occupational Therapist and aims to obtain a detailed history, impact of symptoms on daily functioning including the administration of the Rivermead Post Concussion Symptom Questionnaire, WHODAS 2.0 and if clinically indicated a Vestibular Screening Tool. Patients will be offered subsequent reviews as clinically indicated, focusing on their re-integration and patient specific goals. As such, the number of times of intervention and duration of intervention will vary depending on the patient's presentation and may range from a single 30 minute follow up phone call to several 30-60minute appointments over 3-6 months. (Nature, duration and attendance at each session will be recorded and monitored as part of the data collection process for this research). Sessions may be administered via telehealth, telephone or face to face as required. Face to face sessions will be conducted at the Gold Coast University Hospital, OT clinic rooms. Intervention provided on the pathway is based on a local evidence-based clinical guideline and may include the following management: - Normalising symptoms and expected outcomes - Reassurance - Gradual return to activities and life roles - Strategies to manage symptoms; - Sleep hygiene - Relaxation and modification of environment - Graded return to daily routine, activity and employment responsibilities or occupational roles - Graded return to school and leisure activities - Fatigue management - Sensory modulation approach - Relevant cognitive assessment and intervention - Mental health and associated symptoms and referrals - Visual disturbances associated referrals - Vestibular and balance disturbances and associated referrals Interventions are provided until symptoms resolve, or significant improvement has been reported, as identified in either goal achievement and/ or perceived symptoms within the Rivermead Post Concussion Symptom Questionnaire. Alternative indicators for referrals and discharge options will also be explored including referral to GP, community psychology or Vestibular Physiotherapy for ongoing management and care.