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Rehabilitation After Mild to Moderate Traumatic Brain Injury

After a TBI, a person may experience changes in thinking, understanding, memory, attention, personality or balance.


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Even a mild TBI can cause physical or cognitive impairments that may require rehabilitation to regain motor, sensory, visual-perceptual, cognitive, balance and behavioral functions. Rehabilitation can help patients with
TBI return to their previous level of ability for home, school and work life.

What is a traumatic brain injury?

The brain is a mass of soft tissue that floats in fluid within the skull. When there is a sudden bump, blow or jolt to the head, the “floating” brain can be thrown forward and back, resulting in a traumatic brain injury. The degree of damage to the brain depends on several factors, including the nature of the accident and the force of impact. Prompt evaluation and treatment can help lessen the effects of the injury.

After a TBI, a person may experience changes in thinking, understanding, memory, attention, personality and balance. There may also be emotional or behavioral changes. If you or a loved one receives a blow to the head that concerns you or causes behavioral changes, consult a doctor. Even a mild injury to the brain is serious and requires prompt attention and an accurate diagnosis. 

Concussion

A concussion is a mild TBI that most often is the result of a fall or a blow to the head.  Concussions are also common among people who participate in contact and collision sports, even in athletes who wear protective helmets. Most concussions occur without loss of consciousness, and symptoms may not appear for hours or days following the injury.

Symptoms of Mild to Moderate TBI Physical symptoms may include headache, nausea or vomiting, fatigue or drowsiness, difficulty sleeping or sleeping more than usual, and dizziness or loss of balance. 

Sensory symptoms may include blurred vision, ringing in the ears, a bad taste in the mouth, changes in the ability to smell, and sensitivity to light or sound. 

Cognitive problems may include difficulty:

  • Concentrating
  • Processing and understanding information
  • Remembering
  • Prioritizing
  • Problem-solving
  • Organizing
  • Learning new information

Rehabilitation

A medical doctor specializing in physical medicine and rehabilitation, called a physiatrist, oversees the entire rehabilitation process, manages medical rehabilitation problems, and prescribes medication as needed. Physical, occupational and speech therapists offer rehabilitation services focused on improving a patient’s ability to perform activities of daily living. In addition, the interdisciplinary rehab team may include neuropsychologists, vocational counselors and recreational therapists.

Occupational Therapy

An occupational therapist views patients holistically, evaluating and analyzing all aspects of their ability to perform activities of daily living. For these patients, packing a book bag, gathering items for meal preparation or simply locating an article in a shopping aisle can cause frustration and confusion.

The occupational therapist helps patients re-learn activities such as bathing, dressing and grooming and may recommend assistive equipment. Structured activities are used to improve a patient’s range of motion, strength, and gross and fine motor coordination. To offset disruption in sleep patterns and decreased energy, the OT teaches ways to conserve energy and balance periods of work and rest.

For patients with TBI who have problems with higher level functions such as planning, organizing, abstract reasoning, problem solving, time management and judgment, an occupational therapist might suggest simple routines and schedules to help the patient regain independence. Devices such as electronic technology, memory books or checklists may be incorporated.

Patients often have trouble with social interactions and may withdraw from family and friends. Those around them may think that they lack motivation or initiative. Recognizing social unease early on can help prevent isolation and serious depression. The therapist may be able to suggest ways for family members to cope with such behavior changes and raise their tolerance for frustration.

Physical Therapy

When a TBI occurs, the neck absorbs the impact and twists. For six months or more following a TBI, this trauma to the neck may cause dizziness and imbalance. A physical therapist assesses the neck injury and focuses treatment on reducing pain and restoring mobility and balance. 

Along with neck pain or strain, damage to the cervical spine (the upper seven vertebrae that support the neck) can decrease a person’s ability to turn his head and may cause a “spacey” feeling. Using gentle muscle energy techniques and stretching, the physical therapist works to normalize mobility and also provides training to help the patient reorient awareness of his body in space.

If the function of the vestibular system (the balance system in the inner ear) is disrupted, it can cause a change in a person’s gaze or focus. A physical therapist helps improve vestibular function by having the patient do exercises in which he gazes at a target while his head moves.

If the calcium crystals located in the inner ear are displaced by a TBI, dizziness and/or extreme vertigo may occur upon movement of the head. The therapist may perform relocation maneuvers to move the crystals back to their normal position.

A TBI can also affect an individual’s balance when walking. There may be difficulty with turning or stepping on or off a curb, fear of falling, or a need to hold onto furniture or a wall while walking. Balance therapy may include exercises to decrease sway, weight-shifting activities to reduce the risk of falling, and dynamic activities to improve safety, such as walking, turning, reaching overhead and bending over. 

Speech Therapy

A speech therapist helps patients with TBI by breaking down language into short segments so that understanding is assured. The patient is taught to ask the speaker to repeat what he or she is saying, to use different words or to speak more slowly. A speech therapist may discuss a subject with a patient using an outline so that the patient can maintain focus and stay on topic. Lastly, communication aids such as pictures or words organized by topic (e.g., the weather) help patients respond to questions when the speed of word retrieval has been slowed.

How the Pieces Fit Together

Following a consultation with a physiatrist, patients with TBI benefit from combined occupational, physical and speech therapies. For example, if a patient wanted to buy a present at a department store for his wife’s birth- day, the physical therapist would address the issues of physical mobility, balance and strength that would be needed for the patient to travel to the store, purchase the gift and travel home. The occupational therapist might ask the patient to map out the route and sequence the steps involved in purchasing a gift. The speech pathologist would help the patient retrieve the words he would need to ask the clerk in the store for the desired item.


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