Traumatic Brain Injury (TBI) is a complex and multifaceted condition that can profoundly affect an individual's physical, cognitive, and psychological well-being. The brain, the body's control center, is responsible for various vital functions such as movement, language, memory, and emotions. When the brain sustains an injury due to trauma, these functions can be significantly disrupted, leading to a wide range of impairments.

The causes of traumatic brain injuries are diverse, encompassing both accidental and intentional events. Motor vehicle accidents, including car crashes and motorcycle collisions, are a leading cause of TBI, often resulting from the abrupt deceleration or impact of an external physical force. Falls, particularly among older adults and young children, are another common cause of TBI, especially in cases where the head strikes a hard surface.

Sports-related injuries, particularly in contact sports like football and boxing, can also result in TBI, with repeated concussions posing a higher risk. Additionally, acts of violence, such as assaults and gunshot wounds, can lead to severe TBIs.

Physical difficulties following a brain injury may include changes in muscle tone such as increased spasticity, speaking and understanding language, mobility, tremors or uncontrolled movements, seizures, fatigue.

Traumatic Brain Injury (TBI) can profoundly affect speech and language abilities, leading to various communication impairments. These impairments can significantly impact an individual's ability to express themselves, understand others, and communicate effectively.

Motor speech disorders are common consequences of TBI. Dysarthria, a motor speech disorder, occurs when the muscles responsible for speech production, including those involved in articulation, phonation, and respiration, are weakened or impaired. This can result in slurred speech, imprecise articulation, and difficulties with voice control.

Another motor speech disorder associated with TBI is apraxia, which affects the ability to plan and execute the precise movements required for speech. Individuals with apraxia may struggle to coordinate their articulatory muscles, leading to inconsistent speech sound production and difficulty initiating or sequencing speech sounds.

Language impairments are also prevalent in individuals with TBI. Language disorders, such as aphasia, can affect various language components, including comprehension, expression, reading, and writing. Depending on the location and extent of the brain injury, individuals with aphasia may have difficulties finding words (anomia), understanding spoken or written language, formulating sentences, or following conversations.

Cognitive-communication deficits, often associated with TBI, involve impairments in higher-order cognitive skills that impact communication. These deficits can manifest as difficulties with attention, memory, problem-solving, reasoning, and social skills, making it challenging to engage in effective and meaningful conversations.

Voice and resonance disorders can also arise following TBI. TBI-related injuries to the brain or structures involved in voice production can lead to changes in voice quality, pitch, loudness, and resonance. Individuals may experience hoarseness, breathiness, pitch instability, or reduced vocal control. Resonance disorders may occur due to disruptions in the coordination of airflow through the vocal tract, leading to hypernasality (excessive nasal resonance) or hyponasality (insufficient nasal resonance) during speech.

PROBLEMS ASSOCIATED WITH THIS CONDITION

With the brain being such a complex organ, Acquired brain injury will usually affect a particular area of the brain depending upon where the trauma occurs. For instance, damage to the back of the brain can affect vision, planning, organisation and visual perception skills. Below is a summary of the functional effects that damage can evoke.

Sensory Area

The sensory area of the brain is involved in regulating the sensory feedback that your child receives from the world around them. Without this integration of touch, smell, sight, sound and taste, it becomes difficult to navigate and complete the every-day tasks that are required of young children (such as writing, getting dressed and playing). Some examples of sensory damage that an occupational therapist can provide treatment for include:

• Overly sensitive to smells/ unable to smell
• Finds clothes sharp or uncomfortable
• Struggles to identify differences in temperature
• Regulating sensory feedback from body parts
• Loss of sensation
• Trouble getting dressed, tying shoe laces or other fiddly activities
• Finds loud noises over-whelming/ too distracting
• Is under-stimulated by sensory input (feels the need to spin/ overload sensory system as a calming method)

Cognitive Area

The cognitive area of the brain relates to the area involved in completing complex thought processes, such as planning, problem solving, memory and concentration. Damages to the cognitive area have great effects on function at school and at home. Some examples of difficulties an occupational therapist can help with include:

• Struggles to concentrate
• Poor problem solving skills
• Emotional imbalance
• Frequently gets upset, or acts out in new or challenging situations
• Struggles to be creative and imaginative
• Difficulty knowing what to do next in tasks
• Struggles to remember and retain information

Motor function, co-ordination and balance area

The area of the brain responsible for smooth and continuous movement, good balance, posture and co-ordination may be damaged following acquired brain injury. Damage to the motor function area of the brain can have profound effects on a child's ability to complete a wide range of activities, some difficulties include:

• Poor posture
• Difficulty Co-ordinating movements
• Struggles to catch or throw a ball
• Jerky/unwanted movements
• Poor handwriting
• High or low muscle tone
• Poor balance
• Difficulty balancing on one leg/ across a beam

Visual Area

The visual area of the brain is responsible for seeing and interpreting the world around us. Vision is used in most tasks that we complete on a daily basis; any damage to this area can have detrimental effects to a child's learning and development. An occupational therapist can provide effective management and treatment to improve function following visual impairment.

Some examples of how visual impairment affect function:

• Unable to distinguish the difference between 2D and 3D shapes
• Poor form recognition (square or circle, short or long)
• Finds it difficult to pick out information from a crowded page
• Interpreting images
• Poor hand-eye co-ordination
• Poor handwriting

HOW CAN THESE DIFFICULTIES IMPACT ON FUNCTION?

These lists below are not exclusive but are used rather to provide you with some examples and a guide to understand why one behaves the way they are.

Home:

• Difficulty getting dressed
• Dislikes playing with construction based toys
• Difficulty problem solving
• Movement difficulties
• Bumps into objects
• Frequent falls
• Becomes distracted easily
• Struggles to play sports

School:

• Poor handwriting
• Academically behind other classmates
• Finds the sensory feedback from classroom environments overwhelming
• Poor posture at school
• Difficulty completing P.E or sport activities
• Poor concentration
• Difficulty making friends
• Often angers easily

OCCUPATIONAL THERAPY TREATMENT AVAILABLE

Occupational therapists focus on restoring individuals' daily living skills, addressing functional impairments, and facilitating their reintegration into everyday activities. Occupational therapy can help overcome the difficulties faced following an acquired brain injury; some of the treatments we offer are listed below:

• Sensory Integration
• Adaptive equipment
• Fine motor Improvement therapy
• Concentration and Memory improvement therapy
• Gross Motor activity training
• Handwriting improvement therapy
• Confidence Improvement therapy
• Group therapy
• School Visits
• Hydrotherapy

PHYSIOTHERAPY TREATMENT AVAILABLE FOR TRAUMATIC BRAIN INJURY

During initial assessment you will discuss your short and long term rehabilitation goals. These goals will then be at the centre of your rehabilitation.

Physiotherapy will assist regaining as much movement and function as possible. Treatment often focuses on sitting balance, standing balance, walking, using your affected arm / hand and managing any changes in muscle tone, pain or stiffness.

Neurological TBI physiotherapy can help:

• improve balance and walking
• increase ability to roll / move in bed / sit / stand
• reduce muscle spasms, pain and stiffness
• increase strength
• retrain normal patterns of movement
• increase affected arm and leg function
• increase energy levels
• increase independence and quality of life
• decrease risk of falls

After a TBI many people experience difficulties performing tasks that were previously simple. Our Physiotherapists will advise you on the use of walking aids, splints, supports and home equipment to make your life easier.

During treatment sessions our neurological physiotherapists will lead you through a progressive programme of functional exercises to increase your mobility and muscle control. The physiotherapists will usually teach you (and if appropriate your family members / carers) exercises to be continued between treatment sessions.

Our physios will provide manual handling training sessions for carers and families. This training involves teaching safe therapeutic handling and positioning techniques that will promote normal movement and postural alignment to those caring for you. The therapeutic use of specific hoists and slings can also be taught. Where required postural, bed, seating and wheelchair assessments can be carried out by our specialist physiotherapists.

SPEECH THERAPY TREATMENT AVAILABLE

Based on the assessment results, the speech therapist develops tailored treatment plans to address each individual's unique needs and goals. The goals of therapy sessions may include:

• Improving speech clarity and intelligibility.
• Enhancing expressive and receptive language skills.
• Addressing cognitive-communication deficits.
• Facilitating voice and resonance control.