Traumatic Brain Injuries

A traumatic brain injury occurs when the head is hit or shaken violently, causing injury to the brain inside the skull, for example, during a road traffic accident, following a fall, or Physiotherapy intervention following a brain injury should begin from the earliest stage possible. We work closely with parents, carers, Case Managers, Solicitors, and any other associated health professionals when managing children who are recovering from a traumatic brain injury.when a direct blow is sustained to the head. Events such as these can be devastating to both the individual and their family and, in some cases, life-threatening.

Traumatic brain injuries can alter the way in which an individual moves, speaks and processes information, depending upon which areas of the brain have been affected, and to what extent. The very nature of the trauma also means that additional injuries may have been sustained, such as fractures and soft tissue injuries, and therefore management of the clinical presentation as a whole can be not only challenging, but may need to take place over a prolonged period of time.

Traumatic brain injuries in children can differ from those sustained as an adult, as the child is likely to be still growing and developing. Traumatic injury to the brain of a child can therefore potentially interfere with their normal development into adulthood, which can have significant implications for their future. Difficulties may present physically, emotionally, behaviourally and / or cognitively, and so the physiotherapy input required will depend entirely upon their clinical presentation.

Physical difficulties may include:

• Paralysis or weakness on one or both sides of the body
• Difficulty with gross motor and / or fine motor skills
• Problems with co-ordination and / or balance
• Difficulty walking
• Difficulty in supporting their own posture when sitting and / or standing
• Altered taste sensation, and / or hearing, sight or speech difficulties

Emotional / behavioural problems may include:

• Difficulty interacting with and getting on with others
• Trouble relating to other people and understanding their actions
• Reduced control over their emotions and sudden mood changes
• Inappropriate emotions and / or reactions to situations e.g. crying / laughing / becoming angry
• Restlessness / agitation or conversely, reduced motivation

Cognitive difficulties may include:

• Trouble following instructions
• Difficulty in processing instructions and tasks
• Problems with planning and sequencing tasks i.e. understanding in which order the task should be performed
• Organisation of themselves and their day
• Difficulty in understanding some words, which affects their level of ability with reading, writing and conversing with others

Physiotherapy intervention following a brain injury should begin from the earliest stage possible, usually from within the hospital responsible for the care of the individual. Early management may include physiotherapy for chest clearance, positioning, teaching and assisting simple transfers (from bed-to-chair, chair-to-standing etc), passive movements and stretches to maintain joint mobility and soft tissue length and, as progress is made, strengthening exercises and functional rehabilitation including walking practice, as is appropriate to the age, developmental stage and the ability of the child. Progressive physiotherapy rehabilitation may then focus on promoting normal movement patterns, inhibiting synergy patterns, and developing co-ordination, finer motor skills and balance using neurodevelopmental therapy and sensory integration techniques.

Once the child is discharged from hospital and becomes an out-patient, physiotherapy input is often less frequent, but may continue through the NHS for a number of weeks or months. After this point, parents are often less clear as to how they can then access further physiotherapy as required. With insurance cases, physiotherapy management may then continue through a Case Manager or Solicitor who refers them to a private physiotherapy provider. Non-insurance cases may have to access ongoing physiotherapy via their own GP, or may need to source treatment privately themselves.

Physiotherapy management should continue for children who have suffered traumatic brain injuries over a prolonged period, long into the future, in order to fully support the changing and growing body and to maximise functional capacity through every stage of their life. Exercise and rehabilitation needs to be specific to a child’s age and developmental stage, adapting to their changing needs and optimising their potential ability.

At Yorkshire Children’s Physiotherapy, we work closely with parents, carers, Case Managers, Solicitors, and any other associated health professionals when managing children who are recovering from a traumatic brain injury. We understand how emotional and physically demanding caring for a child with such an injury can be, therefore we aim to provide physiotherapy rehabilitation, along with a wealth of experience and support, in order to help parents and carers cope through this difficult and challenging time. As our service can be mobile, we can provide the physiotherapy treatment within the child’s home or at their school if this is considered a more appropriate option than you visiting us at one of our clinics.

A large proportion of the children and young adults with whom we work have other associated injuries and complex needs, requiring co-ordinated care plans, individually-tailored management protocols and an integrated therapy approach to their rehabilitation. We are happy to work alongside other health professionals involved in the rehabilitation process and can arrange joint sessions with Occupational Therapists, Speech and Language Therapists and other support staff whenever necessary. Hydrotherapy (pool-based rehabilitation) can also be arranged as part of the physiotherapy programme if appropriate.

Detailed clinical reports and professional recommendations can be provided to Solicitors, Case Managers, GPs and Consultants as requested, and our specialist Paediatric Physiotherapists are also able to attend case meetings to discuss and plan the rehabilitation programme for a child should this be required.