How Therapy Plays a Role in Brain Injuries


This blog is targeted at brain injuries after birth that are not hereditary, congenital or degenerative.

What is a Brain Injury?

A brain injury is any insult to the brain causing altered brain function or pathology by an internal or external force, which results in changes in the brain’s cellular activity, causing impaired motor and/or mental functioning.

What kind of Brain Injuries are there?

There are two main classifications of a brain injury, traumatic and non-traumatic.

Traumatic:

A traumatic brain injury, which you may have heard called a TBI is caused by an external force to the head.

A mild traumatic brain injury is also called a concussion or mTBI.

Some examples include hitting your head during a fall, whiplash from a motor vehicle accident, shaken baby syndrome, assault or sports related injuries such as being hit against the head with a bat or ball

Non-Traumatic:

A non-traumatic brain injury is caused by an internal force, such as a stroke (cerebral vascular accident) due to blood vessel rupture causing bleeding (hemorrhage) or blood clot obstructing the blood flow (ischemic).

A mild stroke can be referred to as a mini-stroke or a TIA (transient ischemic attack) which is a temporary disruption of blood flow in the brain that subsides due to the clot dislodging or dissolving, causing no permanent damage. It is important to acknowledge the symptoms of a TIA, as it is often a precursor for a more severe stroke to come.

Other causes of non-traumatic brain injuries are due to lack or loss of oxygen (hypoxia/anoxia) often due to near drowning, choking, or drug over dose, tumors, seizures, and infectious diseases such as meningitis

What does a Brain Injury look like?

There are a wide range of symptoms with brain injuries and can vary significantly depending on the severity. It is important to recognize the symptoms of each.

Traumatic: Loss of consciousness (for any amount of time) the longer the greater risk for more significant impairments, nausea/vomiting, impaired concentration, blurred vision, difficulty speaking and impaired balance

Stroke: Drooping or numbness on one side of the face, arm weakness or numbness, loss of or slurred speech, difficulty understand others

FAST is an acronym to help remember the warning signs of a stroke or TIA, standing for the face, arm, speech and time to call 911:

F – ask person to smile, is it uneven? Drooping eye?

A – ask person to lift their arm, are they able to, does one arm have a lag?

S – ask person to repeat a simple sentence, can they? Are they understanding?

T – time to call 911

What are the symptoms of a brain injury?

Symptoms can range from mild to severe, depending on severity

Traumatic:

·  Problems with mental functioning

·  Problems with internal brain functions

·  Problems with emotional control

·  Problems with motor control

  1. Impaired coordination & Increased muscle tone (spasticity or hypertonicity)
Stroke:

·  Problems with mental and physical functioning

·  Decreased muscle tone (flaccidity or hypotonicity)

·  Problems with vision

·  Problems with facial expression

·  Problems with visual spatial functions

·  Problems with body space awareness

·   Problems with pain

What can therapy do for me?

We start out with an evaluation where the therapist and patient will conversate about the injury and the patient’s limitations. The therapist and patient will then decide upon appropriate goals together to work on during therapy sessions. Your therapist will provide ongoing evaluation of limitations and progression of goals. Your therapist will also provide individualized home exercise programs to ensure carry over of progress at home.

Specific Treatment Approaches

Home preparation/modification – with severe brain injuries the patient may go home from the hospital in a wheel chair or with a walker initially and the home will likely need to be modified and/or adapted to make it more safe and accessible for both the survivor and the family members. We can assist you in a home evaluation including measuring and identifying modifications to enhance the survivor’s independence with daily activities, reduce care giver burden, and accessing adaptive equipment to ensure safety in the bathroom and safe transfers from the wheel chair to bed/chair.

Return to work environment – we can provide ergonomic assessments at your place of employment to ensure proper ergonomics are in place, often required due to new onset of physical limitations to reduce repetitive use injuries, improve ability to perform job duties and prevent/reduce pain.

Mental functioning for return to school/work/play/sport – we can provide assistance with regaining cognitive functions as well as creating compensatory techniques for return to school, work or home in areas like money management, time management, schedules, course work, learning new information, and transportation. And monitor cognitive functions while increasing physical demand for return to play/sport.

Return of physical function – we can provide rehabilitation for return of motor control, coordination and balance by designing specific treatment/exercise programs to target areas of deficits as well as use of therapeutic handling for return of muscle control

Return of visual function – we can prove rehabilitation for return of motor control of your effected eye through exercises that target the muscles and pathways impaired for reading, maintaining eye contact during conversation, using computer/smart phone and maintain visual control for walking or driving

Return of hand function – we can provide rehabilitation for regaining fine motor control and dexterity for managing clothing (buttons/zippers), managing containers for cooking, writing and more.

Splint:

With muscle tone impairments in the hand, you may require a splint (custom made orthosis) to maintain hand in a safe/functional position to prevent injury or contractures and maintain skin integrity

Botox:

With increased muscle tone in the arm or leg, you may require medical treatments such as Botox injections from a neurologist to reduce the tone. We will work with scheduling you for therapy in conjunction with your Botox treatments to improve motor control of your affected limb(s).

What is neuroplasticity?

Neuroplasticity is the ability of the brain to rewire or reorganize itself after injury. There are various studies over the past decade that have shown that the adult brain can “rewire” itself when damaged by creating new neurons (neurogenesis) through support from neighboring unimpaired neurons. Similar to a traffic jam, you can utilize alternate roads that are connected to the one you are stuck on to bi-pass the traffic jam, ultimately reaching the same destination. Through neuroplasticity you are creating new pathways for cognitive and motor control.

Why should I choose a specialist from ProActive?

Brain injuries can be extremely complicated to recover from, requiring knowledge of the brain’s functions and the impacts of an injury as well as experience treating brain injuries to provide adequate rehabilitation.

We have a therapist with advanced training and knowledge in neurological issues, and more specifically in brain injuries who works off the theory of neuroplasticity. Our therapist has the following specializations:

C/NDT

indicates a therapist has had specialized training and is a certified neuro-developmental treatment specialist, with emphasis in stroke and brain injury. An NDT therapist is one who implements a hands-on treatment approach, guiding a patient through specific movement patterns, inhibiting and facilitating certain movements to create/restore posture and motor control.

Hand Specialist

Indicates a therapist who specializes in working with patients with shoulder, elbow and hand dysfunctions as well as splinting.

We will help to quickly identify areas of deficit and create appropriate treatments to improve those areas. Severe brain injury survivors often require ongoing treatment throughout their life to manage their symptoms.

References:

National Stroke Association www.strokeassociation.org

Brain Injury Association of America www.biausa.org

Shepherd Center www.shepherd.org

www.stroke-rehab.com


Rachel Locke

OTR/L, C/NDT | North