Physical Therapy Guide to Traumatic Brain Injury
March 24, 2021
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.
CAUTION: If you have experienced a head injury, seek medical help immediately.
Physical therapists help people with TBI regain their physical function, relearn daily tasks,
and restore their fitness and wellness.
What is Traumatic Brain Injury?
TBI occurs as a result of forces exerted on brain tissue. Common causes of TBI are falls, car accidents, blows to the head, and battlefield injuries. Movement of the brain that causes damage even though the skull is intact is called a closed injury. Damage caused by a wound that breaks through the skull, such as a gunshot or a puncture by a sharp object, is called a penetrating injury.
Those who sustain moderate-to-severe TBI require specialized hospital and rehabilitative care to address the serious physical, cognitive, and emotional changes that result from injury to the brain. Nearly half (43%) of those who need hospitalization for TBI will have some form of disability 1 year after the injury.
Severe TBI often causes a period of unconsciousness, called coma. During this time, the person may not be responsive to outside stimulation. Consciousness may gradually improve, but many brain functions can be affected by the injury, including those guiding thought, movement, sensation, and behavior.
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, lying down, and changing the bed position.
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 personality change. If cognitive deficits are significant, the affected person's inability to understand what has happened may result in significant emotional agitation.
How Is It Diagnosed?
Upon the individual’s arrival at the hospital, an attending physician will diagnose the level of TBI by assessing factors such as the ability to open the eyes, to speak, and to move in response to a command.
Imaging studies will be conducted (e.g., MRI, CT scan) to determine what parts of the brain are injured or any bleeding or fluid that could be pressing on the brain tissue. A physical therapist often works with the medical team to understand what areas of the brain are injured so that the physical therapy evaluation can focus on potential problem areas.
With a severe injury, a person may arrive at the hospital by ambulance and maybe on life support and/or in a coma (the eyes are shut, and there is no response to external stimuli). Over time, the individual will likely be able to open his or her eyes. Sometimes eye-opening is accompanied by a rapid recovery of other abilities, such as talking and physical movement. For other people, recovery is slower.
How Can a Physical Therapist Help?
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 patient's problems, the treatment plan will vary widely.
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. During this phase, the physical therapist will help with positioning and equipment that will ensure proper posture and flexibility, reduce the likelihood of any problems, such as bedsores, and encourage the individual’s responsiveness to the environment.
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. During this phase, a physical therapist will help with stretching, positioning, and equipment use while working with the individual to increase consistent movement and communication commands.
As the person becomes more conscious and can 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 more actively.
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 practicing 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. Have more questions? Call us at 702.840.1222 or click→ here to schedule a free 15-minute telephone consultation.
Source: ChoosePT