helps restore movement and function to as near normal as possible when someone
is affected by a brain injury. Neuromuscular
(brain, nervous system and musculoskeletal system) specialist physiotherapistsplay
an essential role in the multidisciplinary team, working with brain injured
persons. The role of a physiotherapist starts right from the acute stage
(initial days after the injury) of brain injury through the rehabilitation phase
to the long term care.
the acute stages, the physios work with the injured person to maintain/ improve
their respiratory status, commonly known as chest physio. This helps the injured
person to clear the secretions from their airways thereby minimizing chances of
infections and promoting weaning of tracheostomy tube if appropriate. Physios
also deal with maintaining range of motion of the joints in the body by
exercises and positioning them. Physiotherapists contribute to the multisensory
stimulation program (sometimes called as coma stimulation) along with the other
members of the team. Also, early mobilization of the patient from bed to
chair/tilt table, standing, walking are also carried out whenever possible.
the rehabilitation phase, physiotherapists assess the brain injured person’s
abilities to perform movements, participate in activities and move from one
place to the other. This assessment finding is translated in to realistic goals
around the person’s need to maximize the existing capacities. The treatments may
include management of increased tone (spasticity, rigidity), gait (walking)
training, postural management (optimum and comfortable positioning in wheelchair
and bed) etc.
the long term care phase, the physiotherapist aims to maintain the physical
abilities of the person with brain injury while monitoring for any changes that
may occur. The levels of input required from physiotherapists depend upon the
extent of disability the person lives with.
Maintenance of good respiratory status, strengthening/maintaining
endurance of the active muscles, range of motion in the joints, minimizing
adverse effects of increased tone, management of optimum posture, fatigue
management etc. are the key principles
of physiotherapy at this phase.
No two persons with brain injury are the same. They tend to have different
combination of abilities in physical, cognitive, behavioural areas. So a
multidisciplinary team approach is likely to benefit more. Response and outcome
of therapies varies from individual to individual.
are some specialist approaches physiotherapists use in the management of persons
with brain injury
known as hydrotherapy, Exercises done in the water to achieve therapeutic goals
A recreation and Leisure program in the water.
and management of the posture of persons with brain injury. Includes provision
of wheelchairs and bed positioning equipment. Considers the persons positioning
needs round the clock.
Physiotherapy: Aims to improve ventilation of the lungs by
removing the secretion load. Helps to ease breathing and prevent chest
infections. Include use of different positions and manual techniques.
a series of casts to increase ROM in joints, once the desired effect is achieved
a new cast is made in the new range of the joint.
of external support to maintain the joint position, can be pre-fabricated or
Exercises designed to increase the strength of the active muscles.
be Passive (done by the physiotherapist) or Active (performed by the person with
brain injury). A technique to stretch the length of the muscle, used to reduce
spasticity and maintain/improve range of motion
Binu Cherian, Chartered Physiotherapist. You may contact the author by Email: