Each year the Brain Injury Association of America leads the country in observing Brain Injury Awareness during the month of March. Through many of our posts we’ve explored how physical therapy goes beyond helping people recover from knee, hip, or back surgeries. Physical therapists help with many different conditions and injuries, including brain injuries. Physical therapists help people with TBI (traumatic brain injury) regain their physical function, relearn daily tasks, and restore their fitness and wellness.
What is a Traumatic Brain Injury?
“Traumatic brain injury (TBI) occurs when an injury disrupts the way the brain functions. The most common causes of TBI are falls, car crashes, and blows to the head. There are 2.8 million cases of TBI diagnosed each year in the United States. Concussion, which is a mild TBI, makes up approximately 80% of all diagnosed TBIs. Traumatic brain injury can happen to anyone; however, some people are at higher risk than others. Children under the age of 4 are at risk of injury from falls and child abuse. Adolescents aged 15 to 19 are at an increased risk due to sports injuries and car crashes. People aged 75 years and older are at risk from falls. Depending on the severity of the injury the patient’s level of consciousness will vary. When a person is said to be in a vegetative state, some basic brain functions resume, such as eye-opening on a regular sleep/wake cycle, breathing, and digestive functions, but they are unaware of surrounding activity. When a person is said to be in a minimally conscious state, they show beginning signs of awareness (the ability to do purposeful things), but these responses are often not consistent.”
If you have experienced a head injury, seek medical help immediately!
Signs and Symptoms
“Because the brain controls our ability to move, think, sense, and socialize, the symptoms that result from TBI can vary widely. They may include:
- Physical symptoms, such as weakness or difficulty moving the arms, legs, body, and head. The affected person may have difficulty sitting, standing, balancing, walking, or lying down and changing position in bed.
- Cognitive symptoms, which can include difficulty remembering, paying attention, or solving problems. The affected person may have a reduced awareness of these difficulties, which can cause safety concerns.
- Sensory symptoms, which can include changes in vision, hearing, or the sense of touch. Balance senses that are aided by the inner ear may also be impaired.
- Emotional and behavioral symptoms, which can include difficulty in controlling emotions, or a change in personality. If cognitive deficits are significant, the affected person’s inability to understand what has happened may result in significant emotional agitation.”
TBI’s and Physical Therapy
“The physical therapist will work with the patient, family, and other health care providers to develop goals and an individualized treatment plan to address the challenges and functional limitations associated with the injury. Depending on the severity of the injury, the patient’s level of consciousness, and the problems the patient has the treatment plan will widely vary.
During the vegetative state, the physical therapist will help with positioning and equipment that will ensure proper posture and flexibility, reduce the likelihood of any problems, such as bed sores, and encourage the individual’s responsiveness to the environment. During the minimally conscious state, a physical therapist will help with stretching, positioning, and equipment use while working with the individual to increase consistent responses to commands for movement and communication.
As the person becomes more conscious and is able to more actively participate in physical therapy, the physical therapist will use a combination of exercise, task-specific training, patient and family education, and different types of equipment to help the patient improve, including:
- The ability to maintain alertness and follow commands
- Muscle and joint flexibility that may be reduced after inactivity
- The ability to move around in bed, to sit without support, and to stand up
- The ability to balance safely when sitting, standing, or walking
- The ability to move by strengthening and the practicing of functional activities
- Balance and coordination
- Strength and energy, reducing any feelings of fatigue that occur from inactivity or injury to the brain itself
- A return to sports and fitness activities
If limitations prevent the return to preinjury activities, a physical therapist can help an individual improve mobility and master the use of equipment, such as an ankle brace, a walker, or a wheelchair.”
Choosing a Physical Therapist for TBI Treatment
All physical therapists are prepared through education and experience to treat TBI. However, you may want to consider:
- A physical therapist who is experienced in treating people with neurological conditions/injuries. You may find these physical therapists affiliated with rehabilitation centers that commonly serve individuals with stroke, brain injury, and spinal cord injury.
- A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in neurologic physical therapy and uses the designation NCS (board-certified clinical specialist in neurologic physical therapy). This physical therapist has advanced knowledge, experience, and skills that may apply to this condition.
- Sometimes physical therapists with a strong interest in brain injury have the credential of Certified Brain Injury Specialist (CBIS), from the Brain Injury Association of America.
General tips when you’re looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people who have traumatic brain injury.
- During your first visit with the physical therapist, be prepared to describe the physical issues and symptoms that are causing the most difficulty following the brain injury.
- Plan to talk about what goals are most important to help increase the patient’s independence performing daily activities, and ensure a healthy future.”
“Traumatic brain injuries can be prevented by taking steps to protect the head when engaged in risky activities, and by lessening participation in those activities. Awareness of the signs and symptoms of injury can help quicken response time should a TBI occur. To lower the risk of sustaining a TBI:
- Always wear an appropriate helmet when taking part in activities that increase the risk of falling, such as biking, rock climbing, motorcycling, skateboarding, skiing, or skating.
- Always use your car’s seatbelts; infants must be secured in an appropriate car seat, according to safety requirements and instructions.
For small children:
- Provide appropriate adult supervision in fall-prone areas like playgrounds.
- Use child barriers to prevent home-based falls around areas such as stairs and second-story windows.
- Educate teens about the many factors associated with death and brain injury in car crashes, including the use of alcohol or other substances, speeding, or texting or phone use while driving.
- Educate teens about mild TBI (Concussions) or severe injuries related to sports.
For older adults:
- Educate older loved ones about the risk of falls in the home related to daily mobility and housework activities that carry a greater risk of brain injury, such as using a ladder or footstool, walking on a wet floor, or vacuuming stairs.”
For more information about TBI’s visit: https://www.biausa.org