Physical Therapy and Brain Injury Recovery

By Jennifer Gibbs, PT, DPT, CBIS, AIB-VRC 

Brain injuries can lead to a variety of physical difficulties that can significantly affect a person’s quality of life, independence, functional mobility, and ability to complete daily activities. Physical therapy after brain injury can play a pivotal role in optimizing a person’s recovery journey and enhancing their functional independence.  

Primary Goals of Physical Therapy After Brain Injury  

Following a brain injury, an individual may experience motor deficits, including:  

• Paresis or paralysis in the arms, trunk, and/or legs 
• Ataxia (lack of muscle control) 
• Balance impairments 
• Coordination impairments 
• Gait abnormalities 
• Abnormal movement patterns 

A physical therapist will complete a comprehensive evaluation and work with the patient, their family, and other health care providers to develop goals. They will also develop a personalized treatment plan to address any challenges or functional limitations associated with the injury. Treatment plans can vary widely and will be personally tailored to the individual, depending on the severity of the injury and the types of deficits the individual has.  

The goal of physical therapy is to restore physical function and maximize independence. Physical therapy after brain injury utilizes the principle of neuroplasticity, which is the capacity of the brain to change, finding new connections and rewiring itself in response to the stimulation of learning and experience.  

Promoting Neuroplasticity with Physical Therapy 

Imagine your brain is like a city with an intricate network of roads and highways. Each road represents a neural pathway where information can travel from one part of the brain to another. When a brain injury occurs, it’s like a major highway being shut down, which causes problems with certain functions that relied on that specific pathway.  

Neuroplasticity is like the city’s ability to find detours or create new roads and bypass the damaged area. The brain uses neuroplasticity to recognize the disrupted pathway and starts to reorganize itself. It forms new neural connections and pathways, sometimes having to create entirely new paths to get the information where it needs to go. Rehabilitation plays a crucial role in this process. Think of therapists – including physical therapists – as the construction crew, guiding the brain to build these new detours effectively. By engaging in repetitive practice and task-oriented training, the brain is encouraged to strengthen these alternative pathways. 

• Repetitive Practice: Physical therapy often involves repetitive practice of specific movements or exercises to encourage the brain to rewire itself and learn new skills. Your brain requires repetition to learn and adapt. After all, children don’t learn to walk in a day of two! It takes numerous attempts and failures before the brain starts to develop the pathway that makes walking automatic.  

• Task-Oriented Training: Task-oriented training includes focusing on functional activities, such as walking, reaching, or grasping. This type of training helps individuals regain the ability to perform everyday tasks. For example, focusing on walking, reaching, and grasping can help a brain injury survivor with coordination impairments move from their bedroom to their kitchen, open the refrigerator door, and get themselves a drink of water.  

Benefits of Physical Therapy After Brain Injury 

There are many benefits for survivors who pursue physical therapy after brain injury, including: 

• Improved Mobility and Pain Management: With physical therapy, individuals with brain injury can regain the ability to walk, move, and participate in daily activities. Physical therapy can also help to manage pain and reduce inflammation.  

• Increased Strength and Endurance: Physical therapy helps individuals rebuild muscle strength and endurance, making it easier to complete certain physical activities.  

• Enhanced Balance and Coordination: Physical therapy can help individuals improve their balance, coordination, and spatial orientation, reducing the risk of falls – and subsequent brain injuries! 

• Increased Independence: When physical therapy helps brain injury survivors regain the ability to perform daily tasks, they also regain some of their independence.  

• Improved Quality of Life: Physical therapy can improve overall quality of life by helping individuals regain their physical function, mobility, and independence. Successful participation in physical therapy can boost self-esteem and motivation.  

• Addressing Cognitive and Emotional Challenges: While physical therapists may not directly treat cognitive or emotional impairments, their treatment often indirectly addresses these types of issues. By engaging in challenging physical tasks, patients may see improvement in cognitive skills like attention, focus, and memory.

Common Strategies to Restore Physical Function 

Physical therapists may utilize a variety of therapies and training techniques to help restore physical function, including: 

• Range of Motion and Strengthening: Physical therapists help individuals maintain or regain joint flexibility, prevent muscle stiffness or contractures, and maintain joint integrity. Some individuals experience spasticity following a brain injury, which can cause pain and tightness and make stretching difficult. Physical therapists can assist in reducing the effects of spasticity. Strengthening exercises are used to rebuild muscle strength and endurance, which can be affected by brain injury.  

• Balance and Coordination Training: Balance exercises are important for brain injury survivors. Impaired balance increases the risk of falling – and sustaining another brain injury – and limits mobility. Balance and coordination training help to improve a person’s ability to move different body parts together smoothly and efficiently.

• Gait Training: Physical therapists work with individuals to improve walking patterns. Depending on an individual’s deficits or abilities, a physical therapist may recommend assistive devices like canes or walkers to support mobility and independence. Physical therapists can also make recommendations and work with orthotists to utilize braces, which can help maximize movement and independence. In some cases, a physical therapist may recommend body weight-supported treadmill training. 

• Vestibular Therapy: This type of therapy focuses on improving balance and coordination by addressing issues in the inner ear. Vestibular therapy involves specific exercises designed to improve the functioning between the inner ear, brain, eyes, muscles, and nerves. These exercises are intended to help minimize balance issues and treat dizziness, vertigo, and spatial orientation deficits caused by vestibular impairments that some individuals experience after brain injury.  

• Family/Caregiver Training: It is extremely important and helpful for family and loved ones to engage in a person’s brain injury recovery. Family members can gain an understanding of how the brain works and the specific nature of the injury. Learning the expected recovery path, as well as potential challenges, can help families prepare for the recovery journey. Caregivers can receive education on safe and effective methods for assisting with movement and transfers, as well as some of the common physical symptoms that can arise following a brain injury. 

What to Look for in a Physical Therapist 

How do you find the best care when you or a loved one has experienced a brain injury? There are some important things to look for when choosing a physical therapist. All physical therapists receive education surrounding brain injuries. However, some have additional training to further understand and address the specific challenges that a person may experience following a brain injury. Below are helpful things to consider when looking to receive physical therapy after brain injury:  

• A physical therapist who specializes in treating people with neurological conditions/injuries: Some physical therapists with a strong interest in brain injury have the credential of Certified Brain Injury Specialist (CBIS) from the Brain Injury Association of America. They may also be a board-certified clinical specialist and use the designation NCS (board-certified clinical specialist in neurologic physical therapy)  

• Seek recommendations from healthcare professionals: Ask your primary care doctor if they have a physical therapist they can vouch for. If you see a specialist who treats a specific physical deficit you have as a result of your brain injury, they might have a recommendation for you as well.

• Check with your insurance company to make sure the physical therapist accepts your insurance, or that you can cover the cost of therapy without insurance.  

• Find a physical therapist you can get along with and who will listen to you and your individual needs. Having a person you connect with and trust enhances the therapeutic relationship and rapport. 

Staying Strong on the Journey to Recovery 

Physical therapy is a fundamental component of brain injury rehabilitation. By relying on a client-focused approach, evidence-based practices, and promoting maximal functional independence, physical therapists can play a critical role in an individual’s brain injury journey.  

Jennifer Gibbs, PT, DPT, AIB-VRC, CBIS, is a physical therapist with Hope Network Neuro Rehabilitation.