Traumatic Brain Injury (TBI) is an injury to the brain caused by a head injury (trauma to the head).

The severity of the TBI may vary from a brief period of unconsciousness, sickness or dizziness caused by a mild trauma to serious physical and cognitive deficits resulting from a severe head injury.

There are many different possible causes of head injury:

· Falls and Accidents at home, at work or when out and about

· Road Traffic Accidents

· Assaults

Minor Head Injury:

Brief period of unconsciousness (less than 15 minutes), or just feeling dizzy and sick. @ 75 – 80 % of all head injuries fall into this category. Post traumatic amnesia lasts for less than 15 minutes Attend A&E but experience no lasting effects

Moderate Head Injury:

Loss of consciousness for between 15 minutes – 6 hours, or a period of post traumatic amnesia of up to 24 hours Often kept in hospital overnight and then discharged Are likely to suffer from tiredness, headaches and dizziness, difficulties with thinking, attention, memory, planning, organising, concentration, irritability and word finding problems. For most people these symptoms gradually improve but for some they last for 6-9 months.

Severe Head Injury:

Unconscious for 6 hours or more or a post traumatic amnesia of 24 hours or more. Likely to need hospitalisation and extensive inpatient rehabilitation before discharging back into the community. Depending on the length of time in coma, these patients tend to have more serious physical deficits

The brain is a very intricate organ. Each area of the brain is responsible for controlling different body functions. The effects of brain injury are dependent on several factors e.g. type of injury, location of injury in the brain and severity of injury.

Symptoms may be:

· Physical e.g. movement disorders, balance problems, headaches and dizziness

· Mental e.g. cognitive (memory, processing and planning etc), behavioural (anger problems) emotional (tearful, depressed, labile)

Most people make an excellent recovery following a brain injury however some physical symptoms which may have a great impact on daily life, are not always noticeable to others. Physiotherapists with specialist knowledge in neurological conditions and TBI carry out a detailed assessment and help devise individualised treatment plans jointly with people who are living with TBI.

Areas where physiotherapists can help include where there may be problems with:

· Mobility – movement may be slow, and balance can be affected. People may need mobility aids or wheelchairs because their balance is poor. Physiotherapists can guide on the most appropriate mobility aid and the most appropriate exercises to improve balance and reduce the risks of falls. Specialist analysis of movement by a neurological physiotherapist will help guide improvements with efficiency and quality of movements.

· Spasticity – Dependent on the location of the brain injury often one side of the body may be affected more than the other. Limbs may be stiff or weak and the range of movement is limited. Physiotherapists can give specialist postural advice to help minimise the risk of contractures from developing. Physiotherapists can help devise weight bearing, stretching and range of movement exercises to minimise the negative effects of spasticity.

· Weakness or Paralysis (hemiplegia where one side of the body is more affected than the other) – Physiotherapists can help set strengthening programmes to target specific muscle groups, always with the aim to improve daily function. Sometimes physios may advise adaptive equipment that can be used to maximise function.

· Ataxia – (irregular, uncontrolled poorly co-ordinated movement) Physiotherapists can help develop strong core muscles which give a stable base from which limbs can lead and work from in a more co-ordinated way. Physiotherapists can set a programme of repetitive task practice to gain more accuracy of movements during activities. Improvements to balance and coordination of gait can help reduce the likelihood of falls.

· Sensory Impairment – following a brain injury it may be difficult for a person to know where their limbs are positioned without looking at them. Sensation of touch on the skin may be reduced lost or exaggerated. Walking patterns, balance and posture may all be affected by impaired sensation. Physiotherapists can advise on sensory stimulation treatments and can help target exercises at improving postural awareness.

· Fatigue – excessive tiredness is common following all types of brain injury, a huge amount of energy is being expired not only by the brain trying to heal but by the high levels of cognitive and physical burden the TBI may have caused. Physiotherapists can help with pace management strategies in order to ensure enough exercise is completed to stimulate the neurological system into wakefulness whilst ensuring enough rest time is factored in so that tasks may be achievable.