for brain injury
Acquired brain injury refers to any injury to the brain that occurs after birth. Brain injury can affect movement, thinking and emotional centres in the brain and can result in difficulties with everyday activities. Brain injury is relatively common, affecting over 700 000 Australians. Physiotherapy can assist with movement problems, which is important in the recovery process of brain injury—from hospital to home, return to work and sporting activities.
What happens when your brain is injured?
There are a number of causes of brain injury, which include direct injury to the brain such as trauma from a car or motorbike accident or falling from a height. This is called Traumatic Brain injury (TBI). Car accidents are the biggest cause of brain injury in those under 65.
Approximately 1 in 45 Australians have a brain injury resulting in some level of ongoing problems affecting how they move, think, feel and behave. These problems can impact on a person's ability to participate in work or study and also to form and maintain relationships. One in three people under 65 with a brain injury also require others to care for them in some way.
When brain cells have their blood or oxygen supply interrupted, they die. Brain cells cannot regrow again, but physiotherapy can help to rewire the brain to recover from the damage. This is called neuroplasticity and is a focus of rehabilitation with physiotherapists.
Other causes include an interruption to the brain's blood supply or bleeding in the brain for example in a stroke. A lack of adequate oxygen to the brain, tumours, infections, alcohol and viruses can all also cause a brain injury.
Can you measure how severe your brain injury is?
Due to the complex nature of acquired brain injury, measuring the severity can be difficult. Traumatic brain injury is classified by the amount of time spent in post traumatic amnesia: from very mild (less than 5 minutes) to extremely severe (over 4 weeks). Brain Injury Australia uses the following classification system:
- Mild: good recovery, limited concentration, able to return to work
- Moderate: improvement over time, difficulties with coordinating movements, inability to organise, may require different line of work
- Severe: decreased movement control, decreased ability to communicate, requires support with daily living, unable to return to work
- Very severe: unable to control movement, unable to communicate, requires 24-hour support, unable to return to work.
How do I know if I require physiotherapy or other medical attention?
The consequences of an acquired brain injury are complex and can vary greatly. Some of the physical problems commonly experienced include:
- difficulty walking or moving
- difficulty using your arms for everyday activities
- poor balance or co-ordination
- spasticity or tightness in your arms or legs
- tiredness or fatigue
- dizziness and loss of balance
A neurological physiotherapist can help if you are experiencing any of these problems. They can assist with referral to appropriate medical and other services.
People with a brain injury also commonly experience emotional and behavioural issues such as depression, anxiety, irritability and impulsive behaviour that are best managed by a team of health professionals (allied health, medical and nursing).
If you have had a mild brain injury and have not been managed by a team of health professionals, you should see your GP or a rehabilitation specialist if you have any worsening symptoms. These might include headache, poor vision, dizziness and problems with memory and concentration.
If it has been a while since your injury, a physiotherapist may be able to help if you:
- want to improve any aspect of your mobility
- feel that your mobility has gotten worse or could be better
- want to return to regular physical activity, sporting or leisure interests
- want to lose weight or improve your fitness
- need to manage pain
- need to learn to use or get new equipment like walking aids, orthotics and wheelchairs
How can physiotherapy help me in my rehabilitation?
Neurological physiotherapists are specifically trained to identify movement problems that may be caused by a brain injury and have specific knowledge and expertise in the treatment of acquired brain injury.
Neurological physiotherapy can help you to maximise your physical potential, whether it is learning to sit up, get dressed, walk or run. Exercise and physical activity is known to help with mood and can reduce your risk of many diseases such as heart disease, diabetes, osteoporosis and certain types of cancer.
Often people with a brain injury experience physical problems when they are no longer linked into formal therapy services, or because they did not receive formal rehabilitation after a mild injury. Neurological physiotherapists can help with these problems.
One of the most common and effective types of treatment is task specific training. This means helping you practise the task you are trying to achieve, such as walking, getting out of bed or picking up a cup to take a drink. They will know how to set up the exercise and challenge you to give you the best chance of re-learning how to do it again. A neurological physiotherapist may assist you to do strength, fitness or balance training. They may also give advice about aids and equipment or may use devices such as electrical stimulation, robotic devices or monitors to collect information about your movement and activity.
How effective is physiotherapy for my recovery and rehabilitation?
Neurological physiotherapy is an integral part of the rehabilitation team following acquired brain injury. Physiotherapy can help you to rewire the brain by using neuroplastic training principles which can help you to improve your movement and independence in a range of physical tasks such as:
- improving your ability to sit, stand, walk and use your arms
- improving strength
- improving cardiovascular fitness
Recent research demonstrated that there is benefit from formal intensive multi-disciplinary rehabilitation (which includes physiotherapy) that begins early after injury for working-age adults with moderate to severe acquired brain injury. It also suggests that improvement can be made for many years following the injury and continued outpatient therapy is beneficial.
There are evidence-based guidelines to guide treatment of acquired brain injury and they highlight many of the treatments that physiotherapists provide. Guidelines are made up from the best available evidence.
- ABIKUS Evidence Based Recommendations for Rehabilitation of Moderate to Severe Acquired Brain Injury (2007)
There are also a number of guidelines for treatment after stroke and much of this can also be used to guide brain injury management:
What can I do at home after a brain injury?
Once you leave hospital after having a brain injury, you should continue the exercises prescribed by your physiotherapist. Registering with the NDIS on or before discharge may be a very good way of funding and connecting you with the community based physiotherapists in your area.
It is important to stay as active as you can, within your safety limits. Becoming unfit and deconditioned can reduce your mobility and independence further, impacting on your confidence levels and social activities.
How long until I’ll notice a difference?
Recovery from brain injury can be rapid or can take many years depending on the damage caused. The most important thing is to stay positive and keep working at it. There is evidence to show that people with brain injuries can continue to make physical, cognitive and social improvements for a long time after their injury, however there is often a need for ongoing intervention.
Where can my family go for support?
The therapy team (therapists, doctors and nurses) are a great source of support and knowledge. There are also a number of organisations Australia-wide that are able to provide support to the person with a brain injury and their family and carers. Providing care to another person can be hard work and it is important for carers to remember to look after themselves and have some time out.
- Brain Injury Australia
- Brain Foundation
- Carers Australia
- National Stroke Foundation
- National Stroke Foundation Enable Me website
- Brainlink (VIC)
- Acquired Brain Injury Services NSW
- Acquired Brain Injury Outreach Service QLD
- Brain Injury Rehabilitation Program NSW
- Brain Injury Rehabilitation Services SA
- Headwest WA
- Lifetime Care and Support Authority NSW
- National Insurance Disability Scheme
- Acquired Brain Injury WA