As part of our series of ‘cheat-sheet’ notes for the busy professional, Harpreet Kaur provides a useful snapshot of physiotherapy after traumatic brain injury.
The role of physiotherapy in the comprehensive rehabilitation process following a traumatic brain injury (TBI) is multifaceted and critical to the overall recovery of the individual.
Traumatic brain injuries can result from various causes, such as accidents, falls, sports injuries, or assaults.
TBI can lead to a wide range of physical impairments that affect mobility, strength, balance, and overall functional independence.
The primary goal of physiotherapy in TBI rehabilitation is to address the physical impairments & help individuals regain functional independence and improve their overall quality of life.
As seen during the acute phase, the therapist more commonly focuses on respiratory care, passive range of motion treatment, and reduction of spasticity.
Whereas, during the later stages, the treatment involves more functional training along with training of compensatory strategies, among other approaches.
Having been part of a rehabilitation team in a TBI rehabilitation centre in New Zealand for almost seven years, I suggest some key aspects of physiotherapy rehabilitation after TBI:-
Assessment & Evaluation
The rehabilitation process starts with a comprehensive assessment. A physical therapist’s assessment considers the individual’s medical history, cognitive and physical abilities, mobility, balance, muscle strength, coordination, any existing impairments & functional goals.
This assessment helps them create a personalised treatment plan tailored to the patient’s specific needs.
Mobility Training
Depending on the severity of the injury, individuals may experience difficulty with their walking, standing, or moving around abilities.
Physiotherapists work on improving mobility through exercises that target muscle strength, joint flexibility, and coordination. They develop tailored exercises and interventions to help individuals regain the ability to stand, walk, and move around safely and independently.
Gait Training
Gait training is an essential component of TBI rehabilitation. This requires assessment and analysis of an individual’s walking pattern (gait) and identifying any abnormalities or asymmetries.
Gait training involves but not limited to teaching individuals to walk properly, focusing on stride length & step symmetry.
Assistive devices such as walkers or canes might be used initially and gradually phased out as the patient progresses.
Balance and coordination
Balance & coordination challenges are quite common after a TBI due to disruption of the vestibular system, which can increase the risk of fall.
Physical therapists use exercises that challenge balance and coordination to help patients regain stability, improve proprioception, reaction time, dynamic stability and reduce the risk of accidents.
Strength and Endurance
As we say “USE IT OR LOSE IT” . Because of inactivity & disease, muscle wasting & weakness along with decreased endurance are common with TBI. Physiotherapist design exercises to help patient’s regain muscle mass, strength, stamina and improve overall physical conditioning. These exercises are progressively modified as the patient’s strength improves.
Range of Motion Improvement
Individuals with TBI may experience limited joint range of motion due to muscle tightness or spasticity. Physical therapists use a range of motion exercises to maintain or restore joint flexibility, reduce muscle stiffness and prevent contractures.
Functional Activities
Physical therapists focus on helping individuals regain the ability to perform daily activities independently. These activities are practiced in a controlled environment to enhance functional independence. They integrate functional tasks into therapy sessions to ensure that patients can transfer their gains in strength and mobility to real-life situations.
Assistive Device Training
Physiotherapists assess the need & might recommend and train individuals on the use of adaptive equipment like orthotics, braces, walkers, or canes which can enhance safety and independence.
Family education & home exercise programme
Physical therapists provide patients & families with tailored home exercise programs to encourage ongoing progress and independence beyond formal therapy sessions.
They are educated about the nature of the injury, proper body mechanics, fall prevention strategies, and safe movement techniques at home to optimise recovery and prevent further injuries.
Summary
Overall, the role of physical therapists is essential in helping individuals with TBI regain as much functionality and autonomy as possible while minimising the impact of physical impairments.
Rehabilitation is a gradual process & regular assessments are required to adjusts the intensity and complexity of exercises as the patient’s physical condition improves.
Remember that the specific approach to physiotherapy rehabilitation will vary based on the individual’s unique needs, the severity of the brain injury, and other medical considerations.
Regular communication with the healthcare team, setting realistic goals, and maintaining patience are all essential components of the rehabilitation journey after a traumatic brain injury.
Harpreet Kaur is a physiotherapist, sports exercise specialist, corrective exercise specialist & REPS certified fitness coach. With 15 years of experience in the health industry, she recently started as an
entrepreneur, with a goal to educate the community about exercise connection with human body. See more at fitwithpreet.com
