Physical Therapy (PT)

What can physical therapy help with?

Brain injury, spinal cord injury, physical injury, and/or pain

What is physical therapy like?

Physical therapy can take place in a number of locations such as a hospital, a rehabilitation clinic, a doctor's office, a physical therapist’s office, or even in your home. The first step is evaluation to see where you need improvement and which parts of your body have been affected by your injury. The next step is creating a treatment plan that includes goals to work towards and a timeline of rehabilitation. The hands-on nature of the therapy will vary based on the severity of your injury.

If you lost feeling or movement in part of your body as a result of your injury, your physical therapist may spend time stretching out your limbs to help improve your range of motion, reduce pain and prevent muscle tightness. Electrical stimulation, heat or cold therapies, and massage may be used to help regain movement and sensation in affected limbs. PT activities also aim to increase motor strength, coordination and balance. This may involve engaging in exercises with or without the use of equipment (elastic bands, weights, a treadmill, a stationary bike etc). Yoga may also be integrated as part of your physical therapy program as it can help improve posture, balance, flexibility, body awareness and control. Teaching you to use assistive or adaptive devices (prosthesis, brace, wheelchair, walker, cane, etc.), can help you move around more easily and independently even if you still have problems moving on your own.

Sometimes physical therapy can be painful, but an experienced therapist will help you to know what pain is productive and what pain is damaging. As with any physical exercise, to some extent the old adage, “no pain no gain” holds true. But with repeated practice of exercises, you will develop greater strength and endurance which help lessen the pain. Yoga’s focus on breathing may also be helpful in working through pain during treatment. Some treatment plans may even include exercises you can do at your home, between visits to the physical therapist. Finally, your therapist should provide a post-treatment evaluation to see how you have progressed or if you might need more therapy.

How strong is the evidence for physical therapy use with brain injury?

Physical therapy is effective at treating many symptoms of brain injury. According to this 2016 study, “Physical therapy plays an important role in the recovery of impaired functions, during which the patient’s functional status is assessed and appropriate methods and measures are tailored to individual patients.” Additionally, the American Physical Therapy Association published a report in April of 2020, outlining the strength of the scientific evidence behind treatment of mild traumatic brain injury symptoms. They reported that many common treatments for motor, balance, and movement impairments had moderate-to-strong scientific evidence supporting their use. Another recent international study found that physical therapy was also effective when combined with other treatments, such as neurostimulation (a way of stimulating nerves to treat chronic pain). In this study, combined treatment also led to improved balance and gait, as well as reduction in headaches, and improvement of sleep quality in patients with chronic movement disorders who had plateaued in regular physical therapy.

The evidence is strong that physical exercise improves motor abilities, cognitive abilities, neuroplasticity, and enhances mood. In people experiencing chronic symptoms due to their brain injury, physical exercise has been linked to global increases in cognitive function.

What do patients say?

... I went from flat on my back to wheelchair, to crutches, to walking with a cane. I spent two one-hour sessions a day in rehab where the therapy focused on exercises such as weight lifting, pull-ups, push-ups, and walking with supervision. Once every session, a corpsman would place a huge belt with a handle on the back around my waist. He would then grasp the handle with one hand and let me walk through the halls. If I stumbled, he could prevent me from falling. We called it "walking the dog." I literally learned to walk all over again. My stay at Travis taught me that the person in control of my physical recovery (as much as, or more than, my doctors, nurses, and therapists) was me. They could provide me with a means, but I had to have a positive attitude and the motivation to succeed. I made use of therapy every moment I could. I did arm and leg exercises lying in my bed, I wheeled my chair all over the ward.”

— Robert L. Heriza, Veteran

Personal Stories

• The rehabilitation story of Gary, Veteran, U.S. Navy, TBI survivor
  From Bancroft NeuroRehab, YouTube
• Michael Wight and Elementary School After TBI
  From BrainLine

Video and Audio

• Selecting the Right Rehabilitation Facility After Brain Injury
  From BrainLine

References

Certified Brain Injury Specialist. (2020, October 16). Brain Injury Association of America.

Hugentobler, J. A., Vegh, M., Janiszewski, B., & Quatman-Yates, C. (2015). Physical Therapy Intervention Strategies for Patients with Prolonged Mild Traumatic Brain Injury Symptoms: A Case Series. International journal of sports physical therapy, 10(5), 676–689.

Lendraitienė, E., Petruševičienė, D., Savickas, R., Žemaitienė, I., & Mingaila, S. (2016). The impact of physical therapy in patients with severe traumatic brain injury during acute and post-acute rehabilitation according to coma duration. Journal of physical therapy science, 28(7), 2048–2054.

Madsen, P. J. T. (2020, June 4). Traumatic Brain Injury in Civilian and Military Populations. APTA.

Mandolesi, L., Polverino, A., Montuori, S., Foti, F., Ferraioli, G., Sorrentino, P., & Sorrentino, G. (2018). Effects of Physical Exercise on Cognitive Functioning and Wellbeing: Biological and Psychological Benefits. Frontiers in psychology, 9, 509.

Merck Manuals. (2017, July). Rehabilitation After a Brain Injury. Merck Manuals Consumer Version.

Ptito A, Papa L, Gregory K, Folmer RL, Walker WC, Prabhakaran V, Wardini R, Skinner K, Yochelson M. A Prospective, Multicenter Study to Assess the Safety and Efficacy of Translingual Neurostimulation Plus Physical Therapy for the Treatment of a Chronic Balance Deficit Due to Mild-to-Moderate Traumatic Brain Injury. Neuromodulation: Technology at the Neural Interface. 2020 Apr 29. doi: 10.1111/ner.13159. Epub ahead of print. PMID: 32347591.

Physical Therapy for Brain Injury. (2011, May 3). BrainLine.

Physical Therapy Guide to Traumatic Brain Injury. (2020, October 5). American Physical Therapy Association.

Quatman-Yates, C. C., Hunter-Giordano, A., Shimamura, K. K., Landel, R., Alsalaheen, B. A., Hanke, T. A., McCulloch, K. L., Altman, R. D., Beattie, P., Berz, K. E., Bley, B., Cecchini, A., Dewitt, J., Ferland, A., Gagnon, I., Gill-Body, K., Kaplan, S., Leddy, J. J., McGrath, S., … Silverberg, N. (2020). Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury. Journal of Orthopaedic & Sports Physical Therapy, 50(4), CPG1–CPG73.

Traumatic Brain Injury (TBI) - How Physical Therapy can help! (2017, September 7). STARS Physical Therapy | Boise ID.

Vanderbeken, I., & Kerckhofs, E. (2017). A systematic review of the effect of physical exercise on cognition in stroke and traumatic brain injury patients. NeuroRehabilitation, 40(1), 33–48.