The Role of Physiotherapy in Recovering from Brain Injuries

Acquired brain injuries (ABIs) are injuries to the brain that occur after birth and are not related to congenital or degenerative conditions. Brain injuries can cause changes to the brain’s neurological activity and can have a significant impact on many areas of an individual’s life.

Brain injuries can occur due to various factors such as: 

• Trauma
  Brain injuries can occur due to external force or an impact to the head. The most common causes of traumatic brain injuries (TBIS) are car and motorbike accidents, sports injuries, falls and violence (e.g. assaults and physical altercations).
• Stroke
  A stroke occurs when blood flow to a part of the brain is interrupted, leading to brain cell damage. Ischaemic strokes result from blocked or narrowed arteries, while haemorrhagic strokes occur due to bleeding in the brain. Strokes can cause various impairments depending on the affected brain region, such as paralysis, speech difficulties or cognitive deficits.
• Infections
  Certain infections, such as meningitis or encephalitis, can lead to inflammation and damage to the brain tissue.
• Degenerative diseases
  Degenerative diseases, such as Alzheimer’s Disease or Parkinson’s Disease, can cause a progressive deterioration of brain function over time.
• Concussion
  A concussion is a mild form of TBI resulting from a blow to the head or sudden acceleration/deceleration of the brain within the skull. It often causes temporary cognitive and physical symptoms but typically resolves with rest and proper management.
• Hypoxic or anoxic brain injury
  A hypoxic brain injury occurs if the flow of oxygen to the brain is restricted. An anoxic brain injury occurs when there is no flow of oxygen to the brain. A severe lack of oxygen supply to the brain can lead to brain cell death. Hypoxic or anoxic brain injuries can occur as a result of asthma attacks, strokes, drowning, suffocation, cardiac arrest or severe respiratory failure. This type of brain injury can cause profound neurological deficits and may be life-threatening.

Traumatic brain injuries can have profound effects on an individual’s physical, cognitive and emotional functioning. The severity of brain injuries can range from mild concussions to severe traumatic brain injuries (TBIs) with long-term implications. The severity of the effects of a brain injury can depend on factors such as the extent of the injury, the specific brain regions affected and the individual’s overall health.

Because brain injuries are individualised, the symptoms and long-term effects can be different for different people. The long-term effects of a head injury can include:

• Motor impairments, such as paralysis, muscle weakness, muscle spasms and reduced coordination in the body, arms or legs.
• Reduced mobility.
• Reduced muscle strength.
• A loss of balance.
• Cognitive impairments, such as difficulties with memory, attention, concentration and processing.
• Sensory deficits, such as changes in vision, hearing, taste and smell.
• Emotional changes, such as experiencing depression, anxiety, irritability, impulsivity and mood swings.
• Behavioural changes.
• Language and communication difficulties.

Treatment and rehabilitation strategies aim to maximise recovery, restore function and improve the individual’s quality of life. Because no two brain injuries are the same, treatment plans need to be personalised. 

To create a personalised treatment plan, you need to understand the diverse nature of brain injuries and their causes. This is essential for developing effective treatment strategies and providing appropriate rehabilitation interventions. Comprehensive rehabilitation programmes tailored to the individual’s needs are essential for optimising outcomes and promoting recovery following a brain injury. An integral and often effective factor in an individual’s treatment plan is physiotherapy.

Understanding the Importance of Physiotherapy 

Many people don’t realise the important role physiotherapy plays in brain injury rehabilitation. Physiotherapy plays a fundamental role in addressing the physical, cognitive and emotional aspects of recovery. The complex nature of brain injuries often results in a wide range of impairments, including motor deficits, balance and coordination issues and cognitive challenges. Neuro physiotherapists are highly trained healthcare professionals specialised in the assessment and treatment of these impairments. They can utilise various techniques and interventions to improve long-term outcomes and promote overall well-being.

Some ways that physiotherapy can help with brain injury rehabilitation are:

• Physical rehabilitation
  Physiotherapy focuses on restoring and enhancing physical function following a brain injury. Physiotherapy can help to restore muscle strength and joint stability and can help to reduce muscle spasms and stiff joints. This includes improving mobility, strength, flexibility and coordination to help individuals regain independence in activities of daily living. Physiotherapists utilise specialised exercises, manual therapy techniques and assistive devices to address motor deficits and promote optimal movement patterns.
• Balance and coordination
  Many individuals with brain injuries experience difficulties with balance and coordination, which can increase their risk of falls and injuries. Physiotherapists use specific exercises and training programmes to improve balance, proprioception and spatial awareness to reduce the risk of falls and other accidents and enhance safety during mobility tasks.
• Gait training
  Walking impairments are common among individuals with brain injuries, affecting their ability to walk safely and efficiently. Physiotherapists can help to re-educate individuals on how to walk by designing personalised training programmes, focusing on an individual’s specific deficits in walking pattern, speed and endurance. Some techniques they may use include treadmill training, overground walking practice and gait aids as needed.
• Functional rehabilitation
  Physiotherapy aims to enhance functional independence and participation in meaningful activities. Therapists work with individuals to develop strategies for performing daily tasks more effectively, such as dressing, grooming and household chores. They may focus on everyday actions, such as sitting to standing, turning over in bed and any other activities the individual performs regularly. By practising real-life scenarios and incorporating functional activities into therapy sessions, physiotherapists help individuals regain confidence and autonomy in their daily lives and help to improve independence and quality of life.
• Pain management
  Chronic pain is a common issue among individuals with brain injuries, stemming from musculoskeletal imbalances, nerve damage or secondary complications. Physiotherapists employ various modalities, such as manual therapy, therapeutic exercise, electrotherapy and education, to alleviate pain and improve overall comfort.
• Education
  Physiotherapists can help to educate individuals and their families about the nature of brain injuries, their rehabilitation goals and self-management strategies. A physiotherapist can provide valuable guidance on home exercises, safety precautions and adaptive techniques to help the individual make continued progress outside of therapy sessions. They can also train family members or carers, for example, on manual handling, positioning and the specific exercise programme. Additionally, physiotherapists offer emotional support and encouragement throughout the recovery process, empowering individuals to overcome challenges and achieve their rehabilitation goals.

Physiotherapy Techniques and Approaches 

Physiotherapists can use a variety of techniques and exercises tailored to the specific needs and impairments of individuals with brain injuries. Physiotherapy interventions aim to address the physical, cognitive and emotional challenges while promoting recovery, independence and overall well-being.  

Some physiotherapy techniques that may be beneficial for someone with a brain injury include:

Balance and coordination exercises 

Balance and coordination deficits are common following brain injuries. Physiotherapists employ exercises such as: 

• Neuromuscular coordination exercises.
• Standing on one leg.
• Tandem walking.
• Weight shifts.
• Using balance boards or stability balls to challenge and improve balance reactions.
• Sensory integrative therapy.
• Marching in place.
• Staggered stance.

These exercises can help to rewire the brain so that healthy brain regions can take over the functions that were affected by the brain injury. This can help individuals regain stability and reduce the risk of falls.

Strength training

Weakness in muscles, particularly those involved in posture and movement, is often present after a brain injury. Physiotherapists design strength training programmes targeting specific muscle groups to improve overall strength and functional abilities, build stamina and reduce fatigue. Exercises may include: 

• Resistance training using weights.
• Resistance bands.
• Bodyweight exercises.
• Hydrotherapy exercises.

Range of motion exercises 

Brain injuries can lead to stiffness and reduced range of motion in joints, limiting mobility and function. Physiotherapists prescribe a range of motion exercises to stretch and mobilise affected joints, preventing contractures and promoting flexibility and joint mobility. This can include:

• Passive and active-assisted stretching techniques.
• Joint mobilisation.

Functional activities and task-specific training 

Physiotherapists incorporate functional activities into therapy sessions to help individuals practise and improve the skills necessary for daily living. Task-specific training involves practising activities such as dressing, cooking or household chores in a structured and progressive way, with the aim of improving independence and confidence in performing these tasks. Physiotherapists may also focus on teaching new ways to do functional activities, such as using the non-dominant hand and using objects and aids to help with everyday tasks. 

Cognitive rehabilitation exercises 

Cognitive impairments, including difficulties with memory, attention and problem-solving, are common after brain injuries. Physiotherapists may incorporate cognitive rehabilitation exercises into therapy sessions to improve cognitive function and promote cognitive recovery. These exercises may include memory games, attention tasks and problem-solving activities tailored to the individual’s abilities and goals.

Proprioceptive and vestibular rehabilitation 

Proprioception (the sense of body position) and vestibular function (balance and spatial orientation) may be impaired following a brain injury. Physiotherapists implement specialised exercises and activities to stimulate and improve proprioceptive and vestibular function, such as balance exercises, gaze stabilisation drills and head movement retraining.

Cardiovascular conditioning 

Improving cardiovascular fitness is essential for overall health and well-being. Physiotherapists may include aerobic exercises such as walking, cycling or swimming in the rehabilitation programme to enhance cardiovascular endurance and stamina.

Collaborative Care: The Role of Healthcare Teams

Because brain injuries are so complex, collaborative care, involving physiotherapists, doctors and other healthcare professionals, is essential to promote comprehensive rehabilitation and improve both short-term and long-term outcomes. Some ways collaborative care can be beneficial to individuals with brain injuries include:

• It allows for a more comprehensive assessment
  Different healthcare professionals bring unique expertise to the table, allowing for a comprehensive assessment of the individual’s needs and challenges following the brain injury. Physiotherapists can evaluate physical impairments and functional limitations, while doctors and other specialists can assess cognitive, emotional and medical issues. By collaborating, the healthcare team can develop a holistic understanding of the individual’s condition and tailor treatment plans accordingly.
• Multidisciplinary treatment
  Brain injury rehabilitation often requires a multidisciplinary approach, with input from various healthcare disciplines. Physiotherapists, doctors, occupational therapists, speech therapists, neuropsychologists and other specialists can collaborate to develop integrated treatment plans that address the individual’s unique needs and goals. This collaborative approach ensures that all aspects of the individual’s health and well-being are considered and addressed effectively.
• Coordination of care
  Effective collaboration among healthcare professionals facilitates coordination of care across different treatment settings and stages of rehabilitation. Physiotherapists may work closely with doctors to monitor medical status and adjust treatment plans accordingly. Likewise, communication between physiotherapists and other team members ensures that interventions are aligned and complementary, which can lead to more efficient and effective rehabilitation outcomes.
• Optimised rehabilitation outcomes
  By pooling their expertise and resources, healthcare professionals can optimise rehabilitation outcomes for individuals with brain injuries. Physiotherapists play an important role in implementing physical rehabilitation strategies, while doctors oversee medical management and address any complications or comorbidities. Collaboration allows for early intervention, ongoing monitoring and timely adjustments to treatment plans, leading to better functional recovery and improved quality of life for individuals with brain injuries.
• Improved support for patients and families
  Collaborative care extends beyond the individual with the brain injury to include their family members and caregivers. Healthcare professionals can provide education, counselling and support to help families navigate the challenges of caregiving and promote their involvement in the rehabilitation process. By working together, healthcare teams can ensure that individuals and their families receive the support they need to cope with the long-term effects of brain injury and achieve optimal outcomes.

Encouragement for Recovery

Recovering from a brain injury can be a challenging process, but it is important to remember that progress and recovery are possible. While the recovery process can seem daunting, drawing on the support of your loved ones and healthcare professionals and focusing on maintaining resilience and determination can aid in your recovery.

There is a vast network of support ready to assist you throughout your journey to recovery. From skilled healthcare professionals specialising in brain injury rehabilitation to family members, friends and support groups, countless individuals can offer guidance, encouragement and support.

It can also be helpful to celebrate the small victories. Whether it’s regaining some mobility, improving cognitive function or finding physiotherapy a little bit easier every time, each milestone shows your strength and perseverance. Progress may be gradual but be patient with yourself and allow yourself the time and space to heal. Remember that it is okay to have setbacks and challenges along the way. 

It can also help to stay focused on the future and your goals. While life may look different after a brain injury, there are still countless opportunities for growth, fulfilment and happiness ahead. Explore new interests, set achievable goals and celebrate your unique strengths and abilities.