Understanding a Traumatic Brain Injury

Traumatic brain injury (TBI) is an injury to the brain caused by trauma to the brain. If there is trauma to the brain but the skull is not broken, the TBI is known as a closed head injury.

This could occur, for example, if a person in an automobile accident hits his head on the steering wheel but doesn’t have a skull fracture.

If an object such as a bullet penetrates the skull and injures the brain, the TBI is known as a penetrating head injury. There are different types of TBI’s.

A concussion, which is the most minor and common. A skull fracture which occurs when the skull cracks or breaks. A contusion is bruising of the brain.

Coup and contrecoup injuries are contusions resulting from a strong blow to the head, causing the brain to slam against the inside of the skull. Coup injuries are brain contusions occurring at the point of impact.

Contrecoup injuries result when the brain impacts the side of the skull opposite the point of impact. Coup-contrecoup injuries can be caused by automobile accidents, or abusive or violent events (such as violently shaking a baby).

Here is an image to better explain:

After the initial injury, the brain swells much like any other part of your body after an injury. However, when the brain swells inside of the skull this can be very dangerous. The skull is very rigid intended to protect the brain in all directions.

When the brain swells inside of the already tight skull there is no room for the brain to expand. This creates an intense amount of pressure inside the skull and is very dangerous to the brain.

The brain is much like the CPU of a computer. It is where everything stems from and what ultimately makes you, “you”. The brain controls almost everything, your heartbeat, your breathing, your appetite, interprets smells, allows you to process sight, and is even able to send impulses to over 200 muscles with just the right amount of precision and force to be able to take one step.

8 Things to help Recovery for someone with a Traumatic Brain Injury

Working with the Neuro population we are always in awe of how many caregivers aid in recovery for their loved one’s condition. One of the most common questions we receive is what can we be doing while at home?

Here are 8 different objectives to consider. Please note that everyone is different and every condition is different. You should always consult with your physician first before beginning any exercise program or performing anything that is recommended on our site or anywhere else on the web.

1. Weight-bearing on the affected side

It is often considered that the reason that the legs tend to get more return, after a stroke or brain injury, rather than the arms is due to the constant attempts at weight bearing. When coming to stand the legs accept the body’s weight whereas the arms rarely accept that much weight.

Therefore, it is thought that weight bearing after trauma to the brain can be one of the best interventions to help with motor, sensory, and proprioception return.

*Please note that if standing is not an option these can be done in sitting with support and weighing the affected side.

2. Seated Posture and Balance

This is a great place to start prior to working on static standing and upright balance activities. If we can first bring together seated balance and posture then standing balance and posture will come more natural.

A mirror is often a valuable place to perform balance and posture activities offering feedback to the patient. Another thing to consider is more firm surface (beds are usually too soft) to allow for a better base of support, then working to a more soft surface.

Then incorporating reaching and throwing activities in sitting once balance and posture are secure. Always consider safety while practicing seated balance with someone as it is quick and easy to lose balance.

3. Rest

It is important to understand that rest is a part of the healing process. The brain needs rest to perform optimally. So a good night of rest is crucial to starting the day off right and for promoting recovery.

If you are having trouble with sleep there are several specialists, medications, and herbal remedies that you may want to try. Please consult with your physician about what would be best for you.

4. Ambulation

To walk about or move from place to place, if possible and safe. Ambulation in a controlled and safe environment is a great way to increase strength, confidence, and endurance. It also plays into the weight bearing to the affected side intervention mentioned earlier.

5. Positioning/Bed Mobility

For an individual that is primarily in a bed, chair or wheelchair throughout the day positioning is very important. To decrease the risk of ulcers/sores as well as contractures (tight muscles that can lead to frozen or locked joints), it is important to allow for relief of pressure points.

Changing positions every 2 hours through a series of different positions including side-lying to the left, right, or supine and also by utilizing the tilt-in-space features on the wheelchair.

Also, optimal positioning in slightly prolonged stretches can maintain or increase range of motion which brings us to our next objective.

6. ROM/Stretching

It is important to maintain muscle elasticity (looseness) and joint mobility for someone that is not able to move. This means helping the individual move their joints for them and performing light stretching activities as directed by therapists.

Often times someone suffering from a brain injury can have a spastic tone. This means that the person seems as though they are always tensing their muscles or “fighting” movement.

Please be considerate as they are not able to control the muscles and are not trying to “fight” movement. This abnormal tone is also velocity dependent meaning the faster they are brought into a stretch/position the more they resist. So stretching and ranging slowly is highly recommended.

Another common type of abnormal tone is flaccidity or the absence of muscle tone. Someone that has flaccid tone will not have any movement or tone in the arm and should be highly consulted upon prior to stretching as it will be easy to disrupt joint integrity and cause injury.

Some stretching examples might be:

7. Exercises

Exercises to perform while at home can be very beneficial to someone who is recovering from a TBI. Some of the major muscle groups to concentrate on are the thighs, glutes, core, ankle, hip rotators, and upper body for the chest and arms.

Some major muscles that could be used when standing or walking with a rolling walker could be the gastrocs, anterior tibialis, quadriceps, hamstrings, gluteus (max and medius), hip flexors, erectors spinae, abdominals, latissimus dorsi, trapezius, and triceps.

There are many different ways to exercise muscles including manual resistance, theraband, weights, or isometric exercises.

Below I have listed 11 exercises that one can perform at home with a caregiver. Please note that you should contact your doctor or physical therapist prior to starting exercises.

8. Therapy

In an earlier post Finding A Therapist, I talk about the importance of “shopping” for a good therapist. One that is specialized in treating neurological conditions. Some facilities offer all disciplines in one place such as Physical, Aquatic, Occupational, Speech, and Behavioral Therapies.

Visit the facility first and take a look at their equipment, a neuro-based facility will have invested in their equipment and staff. A good therapy program can be extremely beneficial for a patient and his/her caregivers.

There you have it, 8 things that you can do now to help the recovery of a TBI. These eight things, however, just begin to tip the iceberg of recovery and do not even touch on the most state-of-the-art treatments out right now.

They are simply things that you can do from your home or with a caregiver. For the most modern treatment CALL US! 410-871-8288

All above exercise/stretching images obtained from PhysioTherapyExercises.com
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