Tag: Physiotherapy

Types of rehabilitation

Please note: not all of the therapies listed below are available publicly and may not be covered by insurance providers. This means that there may be out of pocket costs, depending on the type of therapy you do.

There are several types of rehabilitation that individuals with brain injuries may find helpful in their recovery. We have included the most common and recognized rehabilitation therapies. Different rehabilitation therapies will be recommended for different people. Not every rehabilitation therapy will be available in every area. Speak with your medical team about rehabilitations available to you, and ways you can access them. In some cases, there may be online rehabilitation services that can make getting support even easier.

You can also reach out to your local brain injury association about available public groups.

Occupational therapy
Occupational therapy (OT) assists with activities of daily living (ADLs) and creating a home environment that is designed for the person with a brain injury to be as independent as possible. This includes things like:

  • Cooking
  • Eating
  • Bathing
  • Cleaning
  • Getting dressed
  • Going to the bus stop

After a brain injury, these everyday activities can be more challenging. If you’re experiencing problems with your fine motor skills, having trouble with memory or processing instructions, or have issues with vision, hearing, or touch, occupational therapy will be a big help.

An occupational therapist will perform a functional assessment of you, your family, and your environment. They identify impairments and environmental barriers and create a treatment plan designed specifically for you. Part of the plan is developing specific goals you want to achieve, and using tools and strategies to help you do so. An occupational therapist helps you re-learn self-care, work, and leisure skills. This includes teaching you new ways to do things if your capabilities have changed. Their job is to help you with your ADLs, and help you reach a place where you can do them as independently as possible. They’ll do this using tools, new processes, and activities. They’ll even complete an assessment of your home environment so it can be set up in a way that works best for you. This includes making recommendations for furniture placement and how to remove tripping hazards and prevent further injuries.

Physiotherapy
Physiotherapy focuses on improving movement and mobility. This is done through carefully monitored stretching and exercises. This is one of the most common therapies – most people recovering from physical injuries need it. A physiotherapist is a rehabilitation professional who will perform an assessment of your physical capabilities and create a treatment plan to improve strength, muscle tone, or mobility. Exercises and activities can include range of motion exercises (ROM), strengthening exercises focused on building endurance and muscle, balance exercises which will target areas of deficit, and gait training to improve posture and walking.

Physiotherapy can be short or long-term. You may also be given activities or exercises that you have to do between appointments. As you meet physiotherapy goals, your abilities and needs will be reassessed, and your plan adapted to make sure you continue making positive progress.

Psychological therapy
Psychological therapy – which can also be called counselling – is an excellent way to take care of your mental health and understand more about your emotions, behaviours, and thoughts. It’s also a great way to unburden yourself and receive considerate, thoughtful feedback from a professional. Counselling can be done by either a psychiatrist or a psychologist – both are licensed mental health professionals. The main difference is that a psychiatrist has a medical degree and is able to prescribe medication.

The health professional providing the treatment will first complete an assessment to help identify what you need and what goals you would like to reach.

Speech and language therapy
Possible effects of brain injury include cognitive communication challenges. You may not be able to process your thoughts, have difficulty organizing your speech, or struggle with reading/writing. A speech language pathologist (SLP) can help with relearning communication skills and new adaptive techniques.

A person may also experience difficulty speaking or trouble swallowing. These challenges are connected to the throat and mouth muscles. Not only can it be difficult to talk, but it can be challenging to eat or drink, causing further problems with nutrition and safe eating. An SLP will perform tests in the early (acute care) stages of recovery if a person is experiencing any of these issues. It may be recommended that the person continue to work with a speech language pathologist to improve speaking and swallowing abilities. This can be a long process that requires patience, and treatment will be updated on an ongoing basis.

Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy is rehabilitation that focuses on creating programs and activities that will help you engage in positive and productive behaviour. Cognitive behavioural therapy covers a lot of symptoms of brain injury, including neural feedback, appropriate behaviour, memory, and information processing. Since no two brain injuries are the same, cognitive behavioural therapy doesn’t have a set program of exercises and activities. Your therapist will perform an initial assessment and set goals with you that you will then work towards. Once those goals are met, new goals will be set, and the treatment plan will evolve to include activities that will help you reach those goals.

Cognitive behavioural therapy is becoming more and more common, but it is still a growing part of rehabilitation for brain injury and is not as widely available as other types of rehabilitation.

Vocational rehabilitation therapy
It can be challenging after a brain injury to go back to a job. Depending on your injury, you might not be able to return to your former workplace or you may have to come up with new strategies to help you complete work-related tasks. Vocational rehabilitation therapy focuses on helping you prepare to re-enter the workforce. They give you the tools and skills needed to find a part-time or full-time position. In partnership with the Vocational Rehabilitation Association of Canada, we have developed a guidebook to help you understand the return to work process.

Art therapy
Art therapy is a more experimental therapy. Patients complete art projects in a personalized program. When someone is working on a creative art project, it can stimulate multiple parts of the brain at the same time and encourage neural pathways to form. Art therapy can also improve fine motor skills, help with other cognitive challenges such as memory and attention, and improve mental health and moods. Art therapy is conducted by licensed art therapists and is normally an out-of-pocket expense.
Mindful meditation and yoga
Mindful meditation and yoga have become popular forms of therapy after brain injury. Both focus on the concept of quieting the mind, limiting outside distractions, and focusing on deep breathing and relaxing. Meditation can reduce stress and anxiety and allows for emotional self-check-ins and is a great technique for calming down.

Yoga also reduces stress and anxiety but adds an element of physical movement. Yoga moves are designed to be adapted and taken at the person’s pace. There are special classes and movements designed specifically for people who need adaptations.

Music therapy
Music therapy uses music to help people with functional goals, improve mental health and cognition, and promote self-awareness and reflection. Music can be used to help with speech problems through musical vocals, motor skills through instruments, and cognition through composing. Music therapists are licensed professionals who undergo several years of training. Music therapy is an out-of-pocket rehabilitation expense.

More information on music therapy

Recreational therapy
Recreational therapy uses leisure activities that a person would normally do to meet rehabilitation goals. The goal of this therapy is to help the person become as independent as possible when doing those activities. This could include walking, outdoor activities, arts and crafts, dancing – anything someone would normally do in their leisure time. Certified recreational therapists will use these activities to help with cognition, mental health, and even physical health if the activities are exercise-based.

Additional rehabilitation specialists

Depending on your rehabilitation needs, you may work with additional rehabilitation specialists who will help you with recovery. Please note: you may not need to work with every kind of rehabilitation specialist. Doctors will make recommendations and referrals based on your needs.

Audiologist
An audiologist is a healthcare professional with a focus in hearing loss related to the inner ear and vestibular system. They can diagnose and recommend treatment for people with brain injury who are experiencing hearing loss.
Behaviour therapist
A behavioural therapist is a professional that uses professional training to help people with behaviour challenges understand good vs. bad behaviour. The therapist will identify the problem behaviours, then outline a treatment plan based on what the person wants to achieve. While there are many different types of behavioural therapy, the therapist will help reinforce positive behaviours.
Case manager
A case manager is someone who can help you coordinate appointments and other daily activities after your brain injury, particularly if you are experiencing cognitive challenges that make planning and going to appointments difficult. They can also help you by going to appointments with you and assisting you with post-appointment activities.

Case managers are not available everywhere in Canada and may be an out-of-pocket expense. You should speak with your physician about available rehabilitation specialists in your area and what would be right for you.

Chiropractor
Chiropractors focus on treating neuromuscular (nerve and muscle) conditions by physically working on the person’s spine. Their focus is on improving muscle and skeletal structure and reducing pain in the back and related joints. Chiropractor services can be helpful for people with lingering pain from physical injuries.
Dietitian
A dietitian is a medical professional with a degree in nutrition science. They are able to understand how food impacts health and well-being, and work with individuals to create comprehensive diet plans that treat nutritional problems. Treating nutritional problems can aid in treating other conditions, such as brain injury.

Please note: There is a difference between a dietitian and nutritionist. Dietitian is a protected term in Canada, which means they need to have professional certification. Nutritionist is only a protected term in Alberta, Quebec and Nova Scotia. This means that someone may be a nutritionist in British Columbia but not have the same credentials as someone in Alberta. Dietitians of Canada has an explanation and a chart of protected titles by province/territory that can help you identify what kind of health professional to consult for dietary needs.

Ear, nose and throat doctor (ENT)
An ear, nose and throat doctor (ENT) – officially called an otolaryngologist – is a doctor that specializes in the connected systems in the head. An ENT can diagnose and provide treatment recommendations for conditions such as hearing loss, tinnitus, sinus issues, balance problems, and swallowing difficulties.
Life care planner
A certified life care planner is someone who can help you create a plan after a life-altering event such as a brain injury. This plan can include services, supports, and costs necessary from that point on. A life care planner will perform an in-person assessment and develop a plan that will help map out future needs. This is incredibly helpful, especially if a person’s abilities to plan are compromised, or their family is worried about care, finances, and emergency planning for the future.
Life skills planner
A life skills planner is someone who is trained to teach other people how to develop and improve life skills. Life skills is a broad term used to describe any skills that are helpful in activities of daily living (ADLs). Examples of life skills include communication skills, interpersonal skills, decision-making, and taking care of a home.
Personal support worker
A personal support worker is someone who helps you with your activities of daily living (ADLs) and self-care, and is either with you full or part-time in your home or at a treatment centre. Their role is to help make your day-to-day routine more manageable.
Neurologist
A neurologist is a medical health professional that specializes in treating the nervous system, which includes the brain. A neurologist is one of the physicians that would be able to make a diagnosis of brain injury and address symptoms. They also help with management of brain injury and its symptoms through treatment and referrals to other treatment options.
Neuropsychologist
A neuropsychologist specializes in understanding how the brain and behaviours are linked. For someone with an acquired brain injury, a neuropsychologist can help determine how the injury will affect their cognitive abilities and behaviours and make recommendations for what rehabilitations could be helpful in your recovery.
Physiatrist
A physiatrist is someone who specializes in physical medicine and rehabilitation. They can help a person with a brain injury by evaluating physical needs and making rehabilitation/treatment plans. The physiatrist can identify and make recommendations for treatment in relation to physical, cognitive or behaviours problems that can result from brain injury.
Recreational therapist
A recreational therapist is a professional that uses leisure and recreational activities as rehabilitation to build skills. The treatments are assessment-based and can be useful for people with social, cognitive, and behavioural challenges in developing independence and improving quality of life.
Respiratory therapist
A respiratory therapist is a professional that can assist with breathing difficulties. They work alongside doctors at hospitals to provide emergency respiratory care, or they can work in rehabilitation centres or at home to help people with ongoing breathing difficulties. Doctors will provide a recommendation if they think you need to see a respiratory therapist during rehabilitation.
Social worker
A social worker is a healthcare professional that provides ongoing support to the patient and the family by serving as an advocate and assisting with accessing services. They can also provide some levels of counselling. Their primary focus is improving overall well-being. A social worker can be a huge help for someone who is not sure where to find information or resources or needs someone to help support them while they look for services.

Tips for improving mobility

Most physical recovery gains will occur in the first 6-24 months – but that is not a strict rule. Every brain injury is different and will require its own treatment plan and timeline. There are actions you can take to help increase your mobility over time.

Work with physiotherapists, kinesiologists and occupational therapists

The best way to improve mobility is to work with experts. Physiotherapists, kinesiologists and occupational therapists specialize in helping people improve their gross motor skills and fine motor skills. By having the support of professionals and following a tailored rehabilitation plan, you will be able to make progress.

Repeat exercises and activities

Our muscles and body will learn movements the more we repeat them. The more you practice an exercise, the more your body will respond. However, practicing exercises should be spread out over time. This is a long process requiring a lot of patience. You do not want to go too hard or too quickly: that can result in diminished returns. In other words, you probably will not see progress as quickly. This can cause frustration with the process, which also has the potential to impact your progress.

The best way to see results is to follow the program set by therapists and use exercises or activities that mimic actions you enjoy and do in your day-to-day routines. Engaging and interesting activities will produce more dramatic and meaningful recovery as you are more likely to successfully repeat the action.

Medications

Medications may be used for controlling muscle tone, seizures, pain management (headache, central pain), dizziness and nausea. Medications should only be prescribed by and taken on the recommendation of your doctor.

You will benefit from having a good working relationship with your doctor. All aspects of brain injury recovery take time, and this will be a long-term relationship with many check-ins. You should feel comfortable telling them about any changes to your health and well-being throughout your recovery. They will be able to adapt your treatment plan as needed, helping you progress as much as possible.

Use mobility aids as needed

To both improve your mobility and keep yourself safe, you should always use any mobility aids your therapists or healthcare team recommend. Many individuals with brain injury continue to use some sort of aid like sturdy shoes or walking sticks to reduce the risk of further injury.

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Mobility

Many physical effects impact a person’s mobility, or the ability to move. Examples of this include, but are not limited to:

  • Being unable to walk (limps, poor posture, poor endurance, not able to walk and complete activities at the same time, poor balance, needing to use a walking aid like a cane or rollator).
  • Being unable to work, play or drive
  • Being unable to sit or get dressed
  • Pressure sores from staying in the same position for too long
  • Contractures (permanently stiff joints and/or tight muscles)
  • Loss of muscle mass from disuse
  • Experiencing impaired movement control
  • Increased dependency on others
  • Increased risk of falls
  • Poor bed and wheelchair positioning

When a person experiences changes in their mobility after a brain injury, it can be difficult to adjust to their new reality. This can lead to increased risks of mental health challenges, such as anxiety and depression.

It’s important to work with medical professionals, including physiotherapists, occupational therapists and kinesiologists, to address mobility issues and create a goal-oriented rehabilitation plan.

Topics in this section include:

How the brain perceives the environment & controls mobility

Our brain controls our ability to move, our physical responses and our ability to use and move objects.  While the location and size of the brain injury doesn’t always mean there will be mobility challenges, certain areas of the brain do control specific aspects of mobility, such as:

  • Basic body functions such as heart rate, blood pressure, respiration, sweating, consciousness, and alertness.
  • Coordination and balance, including smoothness of movement.
  • Information related to sight, touch, and spatial awareness. If the brain is having trouble determining where and what things are, it can make it difficult to perform movements like reaching for and picking up objects and moving in the environment.
  • Planning movements and putting them in order, and strength and coordination of muscles. This means that a person may be able to walk but have difficulty planning their movements or may move impulsively.
  • The vestibular system. Everyone has a vestibular system which is made up of organs in the inner ear and the vestibular nerve. The vestibular system provides the brain with information about motion, head position, and where you are in a space. It also helps with balance by stabilizing the head and body during movement and maintaining good posture.
  • Vision. Movements can become more difficult if there are visual deficits that make it more difficult to see.

Many survivors with traumatic brain injury will not have significant visible physical limitations because of the brain injury (although they may have additional temporary injuries like broken bones which will impact mobility). In many cases, physical deficits are ‘invisible’ to others. This is true of cognitive and behavioural effects as well. This is why brain injury is often referred to as an invisible injury.

Effects on mobility after brain injury

Balance
Balance is the ability to keep yourself centered as you walk, sit, and engage in other movements. It allows you to control and adjust your body before, during and after movement to keep from falling. Balance problems after a brain injury are common: 30-65% of survivors have reported some sort of issue with balance [1].

Balance requires functional muscle strength, vision, vestibular function (inner ear), sensation in the skin, muscles, tendons and joints (known as proprioception). It also requires cognitive function and movement planning. When you are keeping your balance, your brain is continually processing inputs and information from multiple senses and body parts. The brain then sends directions out to the body’s motor and sensory system (muscles in the arms, legs, core, and eyes) to keep you centered.

Common causes of balance problems after an acquired brain injury include:

  • Changes in blood pressure
  • The actual injury to the brain
  • Medications
  • Mental health issues like depression, anxiety, fear of falling, or fear of moving
  • Sensory impairments
  • Impairments in motor control
  • Dizziness, which is a sensation of light-headedness, spinning, or nausea.

Balance is important not only for walking but for doing all daily activities. Poor balance can keep you from taking part in activities such as sports, driving and work. Issues with balance and dizziness can increase the risk of falls and injuries, including another head injury. It can have an impact on your abilities and your mental health and well-being.

How can I improve my balance?

Balance problems will usually improve over time with activity and exercises. The more you move, the more you improve. You may be referred to a physiotherapist or other specialist who can help you with your balance. While many people with an acquired brain injury can walk or move independently within a few months of their injury, many will have problems with quick movements, running, sports and high-level balance activities. Some people will recover completely while others may have lasting deficits that change their daily lives.

If one or more of your balance systems is not working well, you can try to improve your balance by focusing on areas that are working. For example, if you have poor vision, make sure you have good shoes, optimal lighting, and vision aids

Other ways to cope with balance problems include:

  • Use mobility aids such as canes and walkers, if recommended by a healthcare professional.
  • Hold onto a family member or caregiver’s arm if you feel unsteady
  • Wear proper footwear (closed toe and heel, well fitting, flat-heeled)
  • Work with an occupational therapist to make changes to your home environment such as railings on stairs, installing railings and safety chairs in the bathroom, and removing rugs or other tripping hazards.
  • Clear high-traffic areas in your home
  • Use adequate lighting and nightlights (for example, smart lights that can be controlled by voice or by phone).
  • Avoid alcohol or other substances that can impair your sense of balance
Endurance
Endurance is having the strength, energy and ability to perform an action over an extended period of time. It can be measured by how well you perform an activity or how much you can increase the intensity or duration of the activity. For example, first you walk further, then you walk faster.

How to improve my endurance

It takes time, patience, and practice to build up your endurance. This will be regulated by your physiotherapist and occupational therapists, healthcare providers, and caregivers. Your therapist may give you strengthening exercises like using small weights or resistance bands. They may also recommend focusing on form and repetition to help your endurance and other aspects of mobility such as posture and gait.

One of the ways you can keep track of your progress is by keeping a record of the activities you are doing. For example, if your goal is to walk 100 metres on the treadmill in a set time, track that progress. Then set your next goal. Goal-setting is something your therapists can help with, and it can help you see how much progress you’re making.

Gross & fine motor skills
Mobility refers to the ability to move your limbs. This includes gross motor skills such as walking and larger movements and fine motor skills such as picking things up and writing. These skills are incredibly altered by brain injury. If you lose parts of your mobility, you have to cope with major lifestyle changes. Physiotherapy and occupational therapy can help with strengthening or re-gaining mobility as well as learning new ways to accomplish tasks. This could include activities such as:

  • Working with your fingers on small, detailed tasks such as writing or crafting
  • Range of motion and strengthening exercises

Certain exercises and activities will be recommended based on your needs.

Muscle tone, strength, and coordination
Muscle tone is the amount of tension in a muscle when it’s in the resting position (not being actively used). When muscle tone is normal, the limbs and body feel easy to move. A brain injury may damage your normal control of muscle tone. This may cause decreased muscle tone – your limbs feel floppy and heavy (also called hypotonicity or flaccid). It could also cause an increase in muscle tone – your limbs feel stiff and tight (also called hypertonicity or spasticity). Both affect the ability to control movement.

After a brain injury, muscles may show different degrees of weakness. Some muscles may be stronger in one limb than another. Damage to certain parts of the brain may result in slow, jerky, or uncontrolled movements. You may hear the terms:

  • Hemiparesis: muscle weakness on one side of the body only
  • Hemiplegia: muscle paralysis (no movement) on one side of the body only

Physiotherapy and occupational therapy can assist with working on muscle tone. This is a process that requires patience as it can take a long time. Your treatment plan will need to be adapted as your mobility changes, and you may never fully regain the mobility that you had before the injury.

How to improve muscle tone and strength

Ways to improve muscle tone depend on whether you are experiencing spasticity or flaccid muscles. If you are experiencing spasticity, your doctor may recommend medication along with stretching and range of motion (ROM) exercises overseen by a therapist. If you are experiencing flaccid muscle tone, treatment can include working on proper positioning, exercises, and joint-positioning devices [2]. Improving muscle tone requires time and patience.

Improving strength involves focusing on which muscle areas need the most help. Exercises such as resistance training can help increase strength over time and with a lot of practice and patience.

How to improve coordination

You need coordination for every movement you make. Improving coordination involves a lot of time and patience, like improving muscle tone and strength. While exercises will vary, they will contain several key components, including but not limited to:

  • Repetition
  • Goal of increasing speed and accuracy
  • Proper form
  • Inclusion of sensory cues
Posture
The head and neck give the eyes, mouth, and tongue a stable base. The trunk (the area of your body between the shoulders and hips) gives us a stable base so we can use our arms and legs. To move normally, the head, neck, and trunk need to be properly positioned when standing and sitting.

A brain injury can affect the muscles that control head, neck, and trunk positions. It can also affect the sense of what is upright and what is straight. For example, you may be leaning left or right because the muscles that hold your posture are affected. This may be caused by wrong information coming from the senses about position, limited range of motion, abnormal muscle tone or pain. If posture is poor, you can create a list of visual checks to make when you are sitting or standing. You can also ask for a caregiver to help.

Physiotherapy can be useful in helping you work on your posture when sitting and standing. Therapists will use specific exercises and gait training to help make improvements. Along with these exercises, you can work on your posture by:

  • Rolling your shoulders back
  • Use a wall to help straighten your posture. Your ears should line up with the middle of your shoulders
  • Sit all the way back in your chairs, and choose chairs with high backs
  • Wear shoes that provide proper support
  • Use a mattress that properly supports the spine

There are also some simple yoga stretches and positions to help with your posture and your flexibility. You should first consult with your therapists and doctors about whether you should perform yoga. If you are coping with balance issues, there are some forms of chair yoga that can be done from a seated position.

Sensations
Sensations tell us how we are moving, what we are feeling, and what’s going on around us. Forms of sensation include light touch, pain, temperature, moving joints and muscles, vision and hearing.

Changes to the way you experience sensation can affect your ability to sense movement or position, to feel changes in temperature, or to feel touch to the affected part of the body. It can also make it harder to re-learn movement since movement information must be sensed by thinking about the movement first. Loss of sensation can also make walking and balance more difficult.

Losing sensation can be a very serious safety issue because you may not be able to feel an injury or be aware of that part of your body anymore. It is important to know what types of sensations have changed to help keep yourself safe. For example, if you cannot feel hot or cold temperatures in a part of your body, use an unaffected body part to check the water temperature before a shower.

Managing changes in sensations can be challenging, but your healthcare team can help you learn ways to cope. Your treatment plan will depend on the sensation changes you are experiencing.

Assistance from caregivers

If you require mobility assistance, it is important that your caregivers are trained to provide it. Mobility assistance can include transferring you from a bed to a chair, helping you use the facilities, and walking. Caregivers need to know how to safely lift, position, and move you. This is important for everyone’s safety – proper training reduces the risk of injury for both of you. Caregivers will commonly receive this training from healthcare professionals involved in your care.

Physical rehabilitation

When a brain injury causes damage that affects mobility and movement, a physiotherapist will assess your physical status and abilities. After the assessment, a treatment program is created that fits your needs. Rehabilitation programs are goal-oriented, meaning the therapists work with you to develop a treatment plan that not only addresses areas of need, but will help you reach your goals. These goals and plans require ongoing re-assessment and modification as the treatment progresses and your goals change. Physical rehabilitation may consist of activities such as:

  • Strengthening exercises focused on building endurance and muscle
  • Range of motion (ROM) stretches, which often focus on specific joints
  • Balance exercises which will target areas of deficit
  • Gait training to improve walking
  • Dizziness/vestibular retraining
  • Visual/perception re-training

Physiotherapy can be short or long term and requires active participation. You may be given activities or exercises to do between appointments. Doctors may also recommend that you work with an occupational therapist to help meet goals surrounding activities of daily living (ADLs) and work. This could include cooking, typing, using public transportation independently, and more.

See sources