The Role of Physiotherapy in TBI cases

1. ROLE OF PHYSIOTHERAPY IN
TRAUMATIC BRAIN INJURY
BY MENAGA BAI

2. TRAUMATIC BRAIN INJURY

3. ACQUIRED BRAIN INJURY
 TRAUMATIC
 NON TRAUMATIC
-injuries that do not
involve external
mechanical force ( eg
: stroke,
meningitis,anoxia)

4. TBI can result from:
 Closed head injury
or..
 A penetrating injury
 Is one of two subsets
of acquired brain
injury

5. TBI can be
 MILD
 MODERATE or..
 SEVERE

6. TRAUMATIC BRAIN INJURY
 Cause major long
term disability to
survivors
 Disability depend on
-Severity of the injury
-Location of the injury
-Age & general health
of the pt

7. Brain injury can cause
o Problem with cognition
-Eg : Attention ,Calculation, Memory, Judgment,
reasoning
o Sensory processing
Eg: Sight, Hearing ,Touch ,Taste ,Smell
o Social Functioning
Eg: Empathy, Compassion, Interpersonal
Awareness and Facility
o Mental Health
Eg : Depression, Labile Moods, Anxiety,
Personality changes, Aggressions, Acting out,
and Social Inappropriateness

8. CAUSES AND RISK FACTOR OF TBI
 Transportation accidents involving automobiles, motorcycles, bicycles and
pedestrian cause half of all TBI and the largest portion of TBI in people
under age 75
 For those aged 75 and above, falls cause the majority of TBI

9. TBI MAY RESULT IN :
 Physically
-Changes in movt control
-Muscle weakness with reduces muscle tone
-Overactivity/increase muscle tone
-Incoordination

10. MAY ALSO CAUSE
 Fracture
 Open wound
 Pain

11. OTHER THING
 Balance Difficulties
-Problem in the ability to remain upright
-Problem inability to make adjustment in the body and limbs

12. AND ALSO MAY CAUSE
 Reduced endurance and general weakness
 Could be due to trauma and prolonged period of hospitalization

13. ACUTE CARE SETTING
 PT assess pt in the acute ward
 Scope & timing depend on the progress through PTA
 Assess pt’s capability to take part in activity in a therapy program
 The potential to become more independent as a result of physiotherapy
mx
 Career is identified to discuss on Tx program

14. ACUTE SETTING

15. AIMS OF PT TX
 To improve pt’s ability to function independently at
home and in society-active learning and participation in
Tx, co-ordination ,static & dynamic balance,
endurance-increase level of physical fitness

16. AIMS OF PT TX
 To assist pt to adapt to disabilities or change the pt’s
living condition to accommodate impairment
 To assist pt to improve mental function and skills after
TBI-increase in concentration & attention span

17. WHO’S INVOLVED?
DR
TBI
Family
Pt
PT
OT
ST
O/P
SN

18. PT TX
 BALANCE GROUP
- Works on balance
problem and aims to
improve the balance
skills necessary for
everyday activities

19. Person with motor impairment
following a neural lesion needs to
learn again how to control segmental
movt so that spatial configuration and
temporal sequencing of body movt
brings about an effective action,
thereby achieving individual goals with
min energy expenditure

20. TRUNK MOVT ACTIVITY

21. PT TX
 Aquatic physiotherapy
-Specialized weight relieving
exs in water
-Classes provide therapy for
special needs, and vary in
the level of difficulty and
supervision provided. Not
possible for everyone
Eg : Open wound, plaster,
casts

22. PT TX
o Circuit Group
-This is a physical conditioning group that
provide a gym like program for people
who requires strengthening or endurance
o Movt Group
This class use movt and dance to improve
the quality and awareness of movt
o Running Group
Aim to retrain the skills needed to be able
to run

25. Task orientated training is important
to gain necessary control
 To regain movt-pt
needs to practice exs
to activate and
sustain activity in
specific muscle group

26. Acquiring skills-learning must take place
 Stage of learning
1. Early -cognitive
2. Intermediate -associative
3. Final - Autonomous

27. Stage of Learning
 Getting the idea / knowledge /understanding
 Develop the ability
 The practice of action / movt

28. At early stage
 Pt struggle to learn again how to perform
eve simple movt as well as everyday
action
 They need to practice respectively in
order to get the idea of action the relearn
and train the neural coordination
necessary for effective performance
 As they gain more strength and control,
less attention can be directed towards
performing the action and more attention
to the goal and relevant environment cues

29. As motor control and skills
developed
 Changes occur at different levels
Eg : Less freeze
Degree of freedom movt
In energy expenditure
In walking : focus visual attention shifts from the feet to
surrounding

30. For movt to become
automatic
 Intensive practice is required in order :
-To practice endurance
-Opportunity to practice adapting the action to varying
environmental demands
Eg : walking in different environment

31. Focusing Attention
Attention abilities required for everyday
functioning include :
 Ability to focus attention
 Sustain concentration
 Shift attention

32. Learning of Motor Skills Involve
 Identify what is to be learn
 Understand how goal can be accomplished

33. Method of directing focus of
attention
 Demonstration
- assist pt to get the idea of the action
–spatial, temporal, shape,
 Instruction
- brief, not unnecessary words
-cue pt to concentrate
Eg :Sit to stand
Place feet back swing upper body
forward at the hip stand

34. Setting Goals
 To achieve meaningful and worthwhile to individual
 A functional task that is familiar is more likely to
produce more effective performance than an abstract
task

35. Experience in making mistake or
correct action, is part of learning
skills
 Not every attempt needs to be perfect
- Verbal guidance
- Physical guidance
- Visual cue

36. As skills progress:
Pt learns to direct their own vision and pay
attention to the critical features in the
environment to achieve goal and enable to
predict potential hazards

37. Major Goal Of Therapist
To assist pt to learn from the practice
environment ( rehabilitees setting ) to these
environments

38. Study
Transfer of learning from one performance
situation to another is an integral part of
skill
learning
(Magill 2001)
Motor skills is a frame work for encouraging
transfer to a particular motor task into
different environment
(Gentile 1987)

39. Pt may :
 Learn to walk in
closed environment
but not able to walk
outside unless given
the opportunity to
practice in open and
complex situation

40. In both strength training and skills
development
 Repetitive exs and practice of an action facilitates the contraction of the
muscle involved and improve performance