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Physical Changes after Brain Injury: FAQs

Physical Therapy after Brain Injury

By DeAnna Frye, Ph.D. and Denise Bailey, P.T.

Can physical therapy help with balance problems after a brain injury or should you just “learn to live with it”?

Although balance disorders are challenging, there are exercise protocols specifically designed to address our balance/vestibular systems.  This system integrates information from different parts of the body to give us good balance and tolerance to motion.  The programs are highly effective, but good outcomes are strongly correlated with thorough evaluation and a multidisciplinary approach.  Contact your physician to see if physical therapy may be appropriate to treat your balance dysfunction.

Chronic low back pain following an injury can limit one’s participation in exercise as part of a healthy lifestyle.   Is it okay to forget exercise because it can hurt and become a “couch potato”?

Unfortunately, chronic pain (low back or elsewhere), can induce a cycle of pain, decreased activity, increased dysfunction and heightened pain.  This pain disuse-dysfunction cycle must be broken.  By selecting an appropriate exercise modality, you can build a strong, healthy musculoskeletal system to manage pain and reduce the associated dysfunction, without provoking the pre-existing low back pain.  A physical therapist can help identify appropriate ways to accomplish this, along with cardiovascular conditioning to optimize function and reduce the debilitating effects associated with this cycle.

My brother had a brain injury and was in the hospital for three months.  He is home now and going to outpatient therapy.  It still takes him a long time to get dressed in the morning so I help him instead of letting him do it himself.  I figure that he is practicing how to dress himself in therapy, so it is not important that he dress himself at home.  My sister disagrees.  Who is right?

While it is important that your brother participate in outpatient therapy, it is also important that he practice these skills as often as possible.  The purpose of practice is to help the brain re-establish the connections that are needed to complete tasks such as dressing.  The more opportunity your brother has to practice, the more progress he will make in his recovery.  It can be frustrating to watch a loved one struggle to do tasks that used to be so simple.  Sometimes it’s hard for family members to allow the person to do things, as the family member feels it is their responsibility to do it for them.  Try to allow extra time for your brother to complete tasks so that you don’t feel rushed and frustrated.  Remember, encouraging your brother to do things for himself now whenever possible will help him be more independent in the future.

I often feel very tired and dragging, like I’m “out of gas”. It makes it hard for me to start a project or accomplish anything. What’s my problem?

After brain injury, physical deconditioning is prevalent. Your lifestyle may have become more sedentary, medications may cause lethargy, and recovery from injuries may have delayed your return to your daily routine.  All of these factors may contribute to reduced physical stamina/endurance.  In addition, changes in internal drive and motivation, plus initiation of activity, can be problematic following brain trauma due to cognitive impairments

Good, old fashioned physical activity is the best way for improving our physical endurance to combat the feelings of lethargy and deconditioning . A prescribed conditioning program can improve our energy levels and our energy reserves to support a more active and productive lifestyle. Cognitive aspects can be addressed by appropriate team members to support success in your program. A physical therapist can help identify conditioning activates that suit your interests and goals.

After my injury, it was recommended I use a cane for walking. I’d rather not use an “assistive device” to get around. Should I get rid of it?

Without question, we are driven by an inherent desire to be physically independent.  None of us want to feel we need a device to walk or may be uncomfortable with the attention it may create.  However, walking safety is the primary issue. If a device allows you to be independently safe and mobile, then it is well worth it.  We must minimize our risk of a potential fall and the injuries that may be associated.

Walking quality is another consideration; is your walking more energy efficient and even/symmetric using a cane?  Striving for the most normal quality gait is important for good biomechanical joint and muscle function, keeping additional stresses off our body to avoid pain and dysfunction.  Carefully consider these areas and discuss your feelings with your physician to determine if gait training/gait analysis may be of benefit before your decide to leave the cane behind. [Denise Bailey, PT Remed].

Why do doctors and therapists ask me if I lost my sense of smell when they are evaluating me?

Our sense of smell is also one of the functions controlled by the brain.  An individual who has sustained a brain injury can lose the sense of smell due to damage to the part of the brain that controls this ability.  You do not have to have an injury to your nose to lose your sense of smell.

Dr DeAnna Frye has a B.S. in Psychology, M.S. in Counseling Psychology, Ph.D. in Counseling Psychology. She is currently employed by Neurology Neuroscience Associates of Akron. Her special interests are psychotherapy and counseling to patients with neurological disorders with special expertise in brain injury. She is a founding member and the current co-chair of the Summit County Traumatic Brain Injury Collaborative located in Akron, Ohio.

For more information, see:

Daily Living Functional Rehabilitation Activity Manual

By Barbara Messenger, MEd, ABDA and Niki Ziarnek, MS, CCC- SLP/L

Brain injury rehabilitation manual with functional activities on daily living for brain injury programs and adults with disabilities.


Cognition Functional Rehabilitation Activity Manual

By Barbara Messenger, MEd, ABDA and Niki Ziarnek, MS, CCC-SLP/L

Brain injury rehabilitation manual with functional activities on cognition for brain injury programs and persons with disabilities.