Traumatic brain injury (TBI) occurs when an external force damages the brain and can range in severity from a mild concussion to severe injury resulting in death. There are two main types - closed brain injuries which do not break the skull but cause bruising and tearing, and penetrating injuries which break the skull. TBI can cause cognitive, motor, sensory and other deficits with symptoms ranging from confusion to paralysis. Physiotherapy is an important part of treatment and rehabilitation, using techniques like exercises, manual therapy and education to improve mobility, balance, strength and overall functioning. The goals and specific techniques used depend on each individual patient's condition and needs.

1. TRAUMATIC BRAIN INJURY:
Traumatic brain injury (TBI) happens when a sudden, external,
physical assault damages the brain. It is one of the most common
causes of disability and death in adults. TBI is a broad term that
describes a vast array of injuries that happen to the brain. The
damage can be focal (confined to one area of the brain) or diffuse
(happens in more than one area of the brain). The severity of a
brain injury can range from a mild concussion to a severe injury
that results in coma or even death.
TYPES OF TRAUMATIC BRAIN INJURY:
 Closed brain injury: Closed brain injuries happen when
there is a nonpenetrating injury to the brain with no break in
the skull. A closed brain injury is caused by a rapid forward
or backward movement and shaking of the brain inside the
bony skull that results in bruising and tearing of brain tissue
and blood vessels. Closed brain injuries are usually caused
by car accidents, falls, and increasingly, in sports. Shaking a
baby can also result in this type of injury (called shaken baby
syndrome).
 Penetrating brain injury: Penetrating, or open head
injuries happen when there is a break in the skull, such as
when a bullet pierces the brain.

2. OTHER TYPES OF TRAUMATIC BRAIN INJURY:
Primary brain injury: Primary brain injury refers to the sudden
and profound injury to the brain that is considered to be more or
less complete at the time of impact. This happens at the time of
the car accident, gunshot wound, or fall.
Secondary brain injury: Secondary brain injury refers to the
changes that evolve over a period of hours to days after the
primary brain injury. It includes an entire series of steps or
stages of cellular, chemical, tissue, or blood vessel changes in the
brain that contribute to further destruction of brain tissue.
CAUSES:
There are many causes of head injury in children and adults. The
most common injuries are from motor vehicle accidents (where
the person is either riding in the car or is struck as a pedestrian),
violence, falls, or as a result of shaking a child (as seen in cases
of child abuse).
SYMPTOMS:
Some brain injuries are mild, with symptoms disappearing over
time with proper attention. Others are more severe and may result
in permanent disability. The long-term or permanent results of
brain injury may need post-injury and possibly lifelong
rehabilitation. Effects of brain injury may include:
 Cognitive deficits
o Coma

3. o Confusion
o Shortened attention span
o Memory problems and amnesia
o Problem-solving deficits
o Problems with judgment
o Inability to understand abstract concepts
o Loss of sense of time and space
o Decreased awareness of self and others
o Inability to accept more than one- or two-step
commands at the same time
 Motor deficits
o Paralysis or weakness
o Spasticity (tightening and shortening of the muscles)
o Poor balance
o Decreased endurance
o Inability to plan motor movements
o Delays in getting started
o Tremors
o Swallowing problems
o Poor coordination
 Perceptual or sensory deficits
o Changes in hearing, vision, taste, smell, and touch
o Loss of sensation or heightened sensation of body
parts
o Left- or right-sided neglect
o Difficulty understanding where limbs are in relation to
the body
o Vision problems, including double vision, lack of visual
acuity, or limited range of vision
 Communication and language deficits
o Difficulty speaking and understanding speech (aphasia)
o Difficulty choosing the right words to say (aphasia)
o Difficulty reading (alexia) or writing (agraphia)
o Difficulty knowing how to perform certain very common
actions, like brushing one's teeth (apraxia)

4. o Slow, hesitant speech and decreased vocabulary
o Difficulty forming sentences that make sense
o Problems identifying objects and their function
o Problems with reading, writing, and ability to work with
numbers
 Functional deficits
o Impaired ability with activities of daily living (ADLs),
such as dressing, bathing, and eating
o Problems with organization, shopping, or paying bills
o Inability to drive a car or operate machinery
 Social difficulties
o Impaired social capacity resulting in difficult
interpersonal relationships
o Difficulties in making and keeping friends
o Difficulties understanding and responding to the
nuances of social interaction
 Regulatory disturbances
o Fatigue
o Changes in sleep patterns and eating habits
o Dizziness
o Headache
o Loss of bowel and bladder control
 Personality or psychiatric changes
o Apathy
o Decreased motivation
o Emotional lability
o Irritability
o Anxiety and depression
o Disinhibition, including temper flare-ups, aggression,
cursing, lowered frustration tolerance, and inappropriate
sexual behavior
Rehabilitation program:

5.  Self-care skills, including activities of daily living
(ADLs): feeding, grooming, bathing, dressing, toileting, and
sexual functioning
 Physical care: nutritional needs, medicines, and skin care
 Mobility skills: walking, transfers, and self-propelling a
wheelchair
 Communication skills: speech, writing, and alternative
methods of communication
 Cognitive skills: speech, writing, and alternative methods of
communication
 Socialization skills: interacting with others at home and
within the community
 Vocational training: work-related skills
 Pain management: medicines and alternative methods of
managing pain
 Psychological testing and counseling: identifying
problems and solutions with thinking, behavioral, and
emotional issues
 Family support: assistance with adapting to lifestyle
changes, financial concerns, and discharge planning
 Education: patient and family education and training about
brain injury, safety issues, home care needs, and adaptive
PHYSIOTHERAPY MANAGEMENT:
The severity and the condition of the patient define the
recommended treatment protocol. The physiotherapy for post-
traumatic brain injury patients depends on their neuroplasticity
and motor control. Physiotherapy management sessions for the
TBI patients help with motor functioning. This aids in reducing the
severity of the disability.
Types of physiotherapy management for TBI

6. The physiotherapeutic interventions also depend on the aim of
carrying out the treatment. The different physiotherapy
management techniques for TBI include the following.
 Restorative measures: In this type, the physiotherapeutic
interventions focus on restoring the movements of the patients. It
includes reactivation of diaschisis and penumbra.
 Compensatory measure: These interventions focus on
enhancing the skills or functions that the patient can perform. This
helps to maintain the balance by improving the functions to
compensate for the lost functions.
 Preventive measures: In this type of physiotherapy
management, the primary focus is not allowing impairment or
disability to increase. Also, it includes promoting the general
health of the TBI patient.
 Complementary measures: For treating some patients, it is
essential to combine different therapies to get the best results.
These therapies include hydrotherapy, dry needling, acupressure,
acupuncture, therapeutic massage, and physiotherapy. These
treatments depend on the specific needs of the patient. These
measures help in weight management, muscle stimulation, and
overall fitness.
Benefits of physiotherapy for TBI patients
TBI patients pose difficulty in carrying out simple movements like
maintaining balance or even turning in bed. These patients
experience weakness in their limbs and neck. The outcome of
physiotherapy management in different patients depends on the
severity of the condition. The time taken to heal TBI patients also
varies depending on their condition. TBI patients can gain various
benefits with the help of physiotherapy management. It includes
the following.
 Physiotherapy helps to improve the patient’s balance, stability,
and coordination.

7.  It helps to increase their attention and alertness.
 It provides muscle strength, mobility, and flexibility.
 Physiotherapy promotes healing the injury and aids in decreasing
fatigue.
 It helps in improving movement patterns.
 With the help of physiotherapy management, TBI patients may
return to social participation in fitness, sports, and recreation.
Techniques for physiotherapy management for TBI
Physiotherapy management includes several techniques used for
treating the patients. These techniques are patient-specific and
are based on their problems or the severity. Following are various
approaches used in the physiotherapy management for the TBI
patient:
 Advice and education: The physiotherapist understands the
patient’s condition, level of injury, and other patient-related
factors. Hence, he/she gives suitable advice and educates the
patient. The physiotherapist advises the patients on different
exercises to maintain their body weight and aids to improve body
movements. Also, he/she advises various activities that the
patient should carry out to reduce the pain or injury and suggests
maintaining a proper posture for relieving the pain.
 Exercises and movement: After understanding the patient’s
case, the physiotherapist suggests some specific exercises and
movements that help to improve their function and mobility. These
techniques help to strengthen specific body parts. Sometimes,
activities like swimming or walking that involve the entire body
and help in recovery from surgery are advised. Exercising in
warm water like aquatic therapy or hydrotherapy helps the
patients relax their joints and muscles and strengthen them. In
case of difficulty in mobility, the physiotherapist also aids the
patient with crutches or canes to move around.

8.  Manual therapy: This type of therapy includes mobilization,
manipulation of the joint, stretching, massaging, and manual
resistance training. This therapy helps in relieving the pain and
stiffness. It improves blood circulation and also drains the fluid
efficiently from different body parts. Manual therapy improves the
movement of various body parts. Manual therapy is best for
reducing anxiety in TBI patients and improving the quality of
sleep.
Physiotherapeutic management techniques prove to be beneficial
in healing traumatic brain injury patients. This is because it
focuses on improving the condition of the patient and preventing
any further damage.