Physiotherapy 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.

In 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.

In 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.

In 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.

Remember! 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.

Here are some specialist approaches physiotherapists use in the management of persons with brain injury

Aquatic Physiotherapy-Also known as hydrotherapy, Exercises done in the water to achieve therapeutic goals

Aquability: A recreation and Leisure program in the water.

Postural Management: Assessment 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.

Respiratory 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.

Serial Casting: Making 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.

Splints (Orthoses): Use of external support to maintain the joint position, can be pre-fabricated or custom made.

Strengthening: Exercises designed to increase the strength of the active muscles.

Stretching: Can 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

Useful Websites:

www.csp.org.uk

http://acpin.net/