Physical Rehabilitation for Traumatic Brain Injury

Welcome to the TBI-HELP Live Chat

Today's topic is: "Physical Rehabilitation for Traumatic Brain Injury"

Our Guest is: Ms. Marilyn Ramos, Chief of Rehabilitation Medicine, Jamaica Hospital Medical Center

[19:02:37] Mod: Good Evening and welcome to our professional moderated chat session. Tonight we are please to have as our guest speaker Ms. Marilyn Ramos, Chief of Rehabilitation Medicine, Jamaica Hospital Medical Center. Ms. Ramos topic of discussion is pertaining to Physical Rehabilitation for Traumatic Brain Injury. Welcome Ms. Ramos!
[19:06:37] Mod: Ms. Ramos how does the physical therapist know what type of ambulation device a patient needs before going home?
[19:06:46] Ms.Ramos: when the patient is demonstrating the ability to stand and take steps with support, the assessment of which device best suits the patient's present status is made. If the patient has one side of his/her body that has minimal active movement, a unilateral device is recommended, example, quad cane, pyramid or hemi cane. If the patient's balance is poor a more supportive device such as a hemiwalker may be used. If there is residual weakness in the lower extremities, or compromised balance, a standard or rolling walker.
[19:12:13] Mod: Amanda: is it still pretty much that pt does lower body and ot takes care of uppr body or have the modalities sort of combined to a joint effort when it comes to ambulating which really takes upper and lower strength.
[19:13:05] Ms.Ramos: Amanda, this is a very good question. I am happy to say that I work in a setting where the P.T.'s and O.T.'s work closely to achieve the common objective, make the patient as functional as possible. Upper extremity strength is of importance for facilitation
[19:14:47] Mod: What is the difference in the care provided by a physical therapist and a physical therapist assistant?
[19:16:03] Ms.Ramos: Both the physical therapist and the assistant provide therapeutic intervention to the patient addressing impairments in function following an injury, surgery etc. The P.T. is responsible for the evaluation of the patient to determine which areas have been impaired. Once these problems are identified, the P.T establishes the goals and plan of care and the P.T. assistant can follow through in the provision of the therapy.
[19:19:18] Mod: Mark: How does the PT arrive at a treatment plan for the patient? And is there any special training that a PT needs to undergo when treating TBI patients?
[19:20:03] Ms.Ramos: Hello, Mark, The physical therapist who works with a patient who has sustained a brain injury should have experience in working with patients who have neurological and musculoskeletal impairments. This includes the ability to work with patients who may have cognitive difficulties and behavioral problems. With the clinical training that occurs as part of our education, exposure to these types of injuries is common. Once you can establish good treatment practices with the neurologically challenged individual, you can definitely feel comfortable treating this special population.
[19:23:23] Mod: Does the physical therapist assistant perform evaluations of the patients?
[19:24:06] Ms.Ramos: The physical therapist assistant does not perform an evaluation of the patient, however, does provide the information on the patient's status at reevaluations, goals which need to be upgraded, progression of the treatment plan according to the patient's progress.
[19:25:53] Mod: Welcome Amanda! Amanda's question is "since most TBI patients are also cognitively as well as physically impaired is there a plan to also work with their cognitive disabilities to further their abilities to physically progress?
[19:26:23] Ms.Ramos: Amanda, the cognitive issues certainly need to be addressed by the P.T. who works with the patient with a TBI. We are fortunate to have members of our rehab team who specialize in cognitive retraining. With their input, we are able to facilitate these adaptations with our treatments as well.
[19:29:18] Mod: What role does a physical therapist play in the treatment of patients in coma?
[19:30:18] Ms.Ramos: When a patient is in a coma, an evaluation by the P.T. is performed to assess the areas of impairments in the neurological, musculoskeletal, and cardiopulmonary systems. The treatment plan is individualized to meet the patients immediate needs as well as the long term projected needs. The main areas or intervention by the therapist are of prevention, support, education and facilitation.
[19:32:03] Mod: Patricia: What kind of excercises would a physical therapist perform to help improve a person's balance?
[19:32:26] Ms.Ramos: Patricia, when there is a disruption in a person's balance due to musculoskeletal/neurological dysfunction, the P.T. incorporates exercises to improve or adapt the patient's ability to maintain the body in equilibrium. If there are disruptions with vision, the P.T. may incorporate compensatory strategies to address the limitations in visual feedback. Exercises may be performed in both the standing and sitting positions, holding on for support or without upper extremity support. The strength of the trunk pelvis, and the lower extremities are also important in the achievement of balance.
[19:36:14] Mod: Carol: How does the PT and OT interface to provide treatment to the patient?
[19:37:04] Ms.Ramos: Carol, the P.T. and the O.T. perform separate evaluations of our patients in the TBI unit. Once our assessments have been made, the disciplines meet as a team to formulate which areas are of the most importance to address to have the patient achieve their maximum functional outcome. The disciplines arrive at team goals and adjust their plan of cares to achieve these goals. There are many situations where co-treatments are of benefit to the patient, i.e.., decreased tolerance, decreased attention span, etc.
[19:39:37] Mod: Amanda: Do you have standing frames and tilt tables in the gym?
[19:40:16] Ms.Ramos: Amanda, in the P.T. gym, we have a tilt table which we use pretty often with patients at different levels of their recovery. For the lower functioning patient, the tilt table can be used to promote weight bearing through the joints, to improve cardiopulmonary functioning, as well as preparing the patient for upright activity. The O.T.'s primarily use the standing table at our facility.
[19:42:27] Mod: What is an orthosis? How does an orthosis aid in ambulation?
[19:43:22] Ms.Ramos: An orthosis is a device or equipment used to support or protect weak or impaired joints or muscles and serve to enhance performance. Orthotic devices include braces, casts, shoe inserts, and splints. When the P.T. and physician recommends an orthotioc device to assist the patient's ability to walk, the intent of the device may be to add more stability to the ankle, knee, and/or hip joint to allow for safer and efficient ambulation.
[19:45:42] Mod: Jeff: How do you work with families so that they can help the patient by doing exercises with them?
[19:46:40] Ms.Ramos: Jeff, this is a good question. The success of any therapeutic program for any individual that has had a disruption in their function, is patient and family education. When the patient returns home, the family and or caregivers should be providing exercises that will keep those skills and or compensatory strategies intact. That is why it is so important to involve the family/significant other in the rehab process from the day of admission to a rehab facility until the day of discharge.
[19:50:41] Mod: Jeff: What are some of the newest treatments for TBI patients that the PT uses?
[19:51:43] Ms.Ramos: Jeff, there has been alot of new research in regards to pharmacological treatments, vestibular and balance retraining with the use of computers and gait aids, and the use of techniques more geared towards alternative medicines, i.e., relaxation therapy, yoga, etc.
[19:52:43] Mod: Amanda: How long is each outpatient rehab session, barring fatigue of the patient?
[19:54:18] Ms.Ramos: Amanda, this may be based on my experiences here with our outpatient facility. In general, the patient's that are referred to outpatient therapy have had some type of rehab therapy in the past, where the time spent with the patient is based on the patient's functional limitations. Our outpatient facility generally treats patients with post-neurological injuries on the average of 30 to 45 minutes.
[19:56:02] Mod: Ralph: When does the PT know that the patient needs to be reevaluated?
[19:56:13] Ms.Ramos: Reevaluation of a patient occurs informally on a day to day basis. The patient varies in presentation very often. It is our policy that patient's are formally reevaluated every two weeks. By then, you would have ample time to determine if the goals were achieved and which goals need to be upgraded.
[19:59:02] Mod: Pat: How do you involve the patient and family in the goal setting process?
[20:00:32] Ms.Ramos: The patient and their families should be involved in the goal setting process as soon as the evaluation of the patient's status post injury is performed. The clinician can receive feedback from the family as to the patient's prior functioning, and the clinician can determine if these impairments can be addressed accordingly. The patient may not be at a level where thety can actively provide you with what their goals for rehab are, so family involvement is very important. The more the family is involved, the better the outcome of the interdisciplinary approach.
[20:02:15] Mod: Well I could see that our time is up for the evening. We would like to thank Ms. Ramos for a very informative session. And we would like to thank the audience for the excellent questions. Good night and be safe!
[20:03:36] Ms.Ramos: To all of you who logged on, thanks! the questions were great. It was truly a pleasure to be here. Thank you and goodnight.