Support from friends and community important for brain injury victims
Our brains control every human function. They interpret the world around us and help to define our mind and soul. So when they sustain injury, the effects are wide-ranging.
Not only can a brain injury affect our ability to move, our co-ordination and sensations, but it can also affect thinking, mood and even personality.
In Bermuda, a large portion of the brain injuries are caused through road traffic accidents.
Kim Watkins, a senior physiotherapist at the Evolution Healing Centre in Paget, works with outpatients with mild to moderate symptoms and occasionally those with more severe symptoms.
“Traumatic brain injury is very individualised. People can present with a range of symptoms depending on the severity, the area of the brain affected and the cause of the injury. These symptoms may last a few days or be for the rest of the client's life,” she explained.
“Some people might struggle with physical symptoms such as movement difficulties which may impact their ability to sit, transfer, stand or walk. There may be issues with weakness or challenges with co-ordination such as ataxia — the loss of ability to co-ordinate a muscular movement.
“Some clients may struggle with balance, proprioception — the body's perception of where it is in space — or have altered sensation. Others may have spasticity, which is abnormal muscle tightness or increased tone in their muscles, while some may struggle with their speech or swallowing.
“Cognition is another area that can be impacted where people may struggle with their thinking, processing or concentration. Symptoms such as headache, irritability, personality changes and fatigue may also be present.”
Brain injuries may be caused by an impact such as in a traffic crash, a fall or sporting injury, or may be caused by internal factors such as a lack of oxygen, exposure to toxins, a stroke or brain tumour.
All the symptoms can have an impact on a survivor’s ability to return to their daily activities and functional tasks. This may hinder their ability to return to work or school but can also affect their relationships with family members, friends and colleagues.
The symptoms are wide-ranging. So are the treatments and therapies.
A multidisciplinary team made up of many healthcare professions will be involved in the rehabilitation journey depending on the needs of the individual. A physiotherapist will focus on movement, daily activities and function, help to reduce pain and look at the body function.
An occupational therapist will help to rehabilitate in a different way focusing on daily activities, occupational needs, and returning to participation activities. OTs also help with cognition and concentration. Speech and language therapists are also important to assist with any difficulties with speech or swallowing.
As a physiotherapist with a neuro-specialisation, Ms Watkins will do an initial neurological assessment of a patient that will explore all the factors having an impact on them.
She will then work with the patient to set goals and determine what they wish to achieve.
She said: “These may be smaller goals to start with such as sitting balance and then progress to larger goals such as returning to daily activities. We use a variety of techniques in the clinic.
“I am trained in the Bobath approach, which is the concept of using a problem-solving approach focusing on helping patients return to normal movement patterns. We also help increase patients' cardiovascular exercise tolerance by monitoring their blood pressure and heart rate and tailoring exercises.
“We also have parallel bars and other equipment that can help you to feel safe when trying to improve your walking and balance during therapy.”
Ms Watkins said healthcare policymakers should prioritise making treatment more accessible and understand the importance of funding rehabilitation through full healthcare coverage.
“People do not need additional stressors such as struggling to pay for services that will have an ongoing benefit to their lives. Investing in rehabilitation is the first step to supporting those in our community. The care pathways and services need to improve to allow clients to find the right plan and treatments that are best suited for them.”
Ms Watkins said that physiotherapy and rehabilitation as a whole helps people to improve their function and begin to return to meaningful lives.
“The journey can be unpredictable depending on the injury but it is important to understand that rehabilitation is an ongoing process and the brain is a wonderful thing. Our brains can recover, adapt and reorganise around the area of damage by recruiting the areas that are not involved in the injury (neuroplasticity).
“It is really important to not compare yourself to others with brain injuries. Everyone is on their own rehabilitation journey. Take it day by day and be kind to yourself.”
Where possible, a survivor of a brain injury must commit to the rehabilitation plan set out for them including exercise and strategies at home.
Those close to survivors and the community at large also have an important role to play.
“Awareness is the key to supporting those who might have challenges in the community,” Ms Watkins said.
“People must be aware of the signs and symptoms of a brain injury and seek medical help as soon as possible so that the person can get treatment and start rehabilitation.
"Your loved one may be different or have changed compared to before their injury. It is important to remember they are still your loved one and to support them the best you can. You must also seek support for yourself if needed.“
* Kim Watkins is a Bobath-trained therapist. She also completed her master of health science endorsed in rehabilitation with a focus on stroke rehabilitation. She is currently in her final year of a Doctor of Physical Therapy programme.