Did you know at least 5.3 million Americans live with a TBI-related disability? That’s one in every 60 people. In recognition of Brain Injury Awareness Month, Spooner Scottsdale’s Stephane Gilboy, PT, DPT shares some of what she has learned about treating patients with traumatic brain injuries and how physical therapy plays a vital role on the path to recovery.
What is a traumatic brain injury (TBI)?
A traumatic brain injury is a type of acquired brain injury, which means it is any injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma. This includes injuries such as electric shock, seizure disorders, substance abuse, or strokes. A TBI is caused by trauma to the brain from an external force. The leading causes of TBI are falls at 47.9%, followed by struck by/against at 17.10%. The other leading causes include assaults and motor vehicle accidents.
Stephanie explains, “When discussing traumatic brain injury rehab we are going to be talking more about patients that have experienced a brain tumor, car accident, or even a gunshot wound. Approximately 75% of the time, the cause of the injury is going to be an external force, like whiplash, concussions, car accidents, and falls. These patients are not going to follow as consistent of a pathway as say a stroke patient would.”
What is impacted?
“Everything is going to depend on the impact point when identifying what parts of the brain were affected by the injury. For instance, if you fall backwards and strike the back of you head, the occipital lobe and cerebellum are going to be impacted and the patient might experience balance and visual deficits. Falling to the side and striking the side of your head is going to impact your temporal lobe, which could bring about speech impairments. Falling forward or a blow to the front of your head will impact your frontal lobe and that’s when we could see some changes in personality,” says Stephanie.
A big part of initial treatment of a brain injury like a concussion or whiplash will be managing the swelling and the symptoms that initial shock introduces to the system. Some patients will present with minimal symptoms and the symptoms will increase after the swelling goes down while other patient’s initial symptoms are going to be the worst and then they’ll calm down as swelling decreases. We experience both ends of this spectrum, so the physical therapist’s responsibility is to figure out where the patient is in their journey when creating their treatment plan.
Path to recovery
The brain recovers in a fairly typical pattern, which is extremely helpful when it comes to physical therapy. It is actually going to recover in developmental milestones. There’s a big correlation between neuro regeneration and developmental milestones.
Stephanie ran through some questions that physical therapists ask themselves when treating a brain injury patient. What deficits do they have? Does your patient have a coordination deficit where they cannot do fine motor skills? Are they falling every time they close their eyes? Do they have a complication such as vertigo or dizziness? Did they have a brain bleed they might not know about?
All of these factors play into each patient’s case and what they are looking like in recovery. Your physical therapist is going to use all of the neurological principles to reeducate parts of the brain that aren’t working correctly, while also using neuroplasticity principles to reeducate the parts of the brain that might not have been impacted by the injury. Stephanie says, “Our job as therapists is to figure out what is important to each patient and what activities they want to get back to being able to do. Once we know that, we make our game plan.”
Stephanie says, “The hard part about true TBIs is that recovery is unpredictable. Patients can slip into these post TBI syndromes that can last up to a year or so. We have surgery on a knee and we give them 12 months to heal, but we have a closed head injury and we’re told they’ll be fine in 4 weeks? The brain just needs that time to heal, and that can take up to a year.”
It is so important to bring awareness to brain injuries such as concussions, the lasting affects we might experience as a result, and the potential impact on the different systems in the body. Stephanie explains how if we don’t talk about it, then people don’t know they can in their recovery from these injuries.
“You would be shocked how many people come in with lingering symptoms from concussions they experienced in the past that were not rehabilitated with physical therapy. You can have lasting deficits from any traumatic brain injury,” says Stephanie.
A brain injury is a whole-body injury. People suffering from a brain injury need a strong support system and a strong care team. The trajectory of healing is not always going to be predictable or straight forward. Things are going to eb and flow and patients will face challenging periods throughout their recovery.
Stephanie says, “We have these little wins throughout the course of treatment and I think that’s what excites me the most about treating brain injuries. When asked about my ‘why,’ I tell people that it is the little wins that keep me and my patients most excited about neuro therapy. I’m going to teach these patients how to do something that will make their life better. It’s so rewarding. We’re here to help them regain what they lost, compensate for what they no longer have, and really improve their independence and day to day life.”
Melissa’s story
Get a glimpse into what the path to recovery has been like for Stephanie’s patient Melissa. Thank you to Melissa for sharing your story and helping us bring awareness to brain injuries. We are so blessed to be a part of your team.
Learn more about Neurological Rehabilitation at Spooner Physical Therapy. Ready to schedule an appointment? Click here to schedule an appointment or complimentary movement screen with a Spooner physical therapist at one of our locations throughout the valley.
References
“BIAA.” Brain Injury Association of America, 1 Mar. 2021, www.biausa.org/.