A brain injury can be caused by a traumatic event, such as being involved in a road traffic accident, fall or assault or acquired due to a stroke or infection.
The effects of a brain injury depend on the type of injury, how severe the injury is, and also the location of the injury within the brain.
Survivors of brain injury may have limited function of arms or legs, abnormal speech or language, loss of thinking ability or emotional problems. The range of injuries, and degree of recovery, and varies widely, depending on the individual.
Traumatic - this is typically caused by an external force, but can be compounded by complications of the trauma, such as damage to the brain tissue due to swelling, or increased intra-cranial pressure, or lack of oxygen.
Acquired - this is a brain injury that has occurred since birth. There are many possible causes, including stroke, hemorrhage, infection, hypoxic/anoxic brain injury and medical accidents.
Imaging using CT and MRI can detect injury in the brain.
A neurological examination will be undertaken to determine physical deficits. There will be occupational and speech and language assessments to determine what each patient requires during their rehabilitation.
There will also be cognitive evaluation with neuropsychological testing.
Following initial treatment in an acute setting, a patient will be in rehabilitative care for some time to help them restore their physical and psychological function to its optimum.
Physically, brain injury patients may suffer with strength, balance and posture problems.
The coordination and quality of movement can be affected. They may require help to become upright and more mobile.
In the acute phase of treatment following injury, PRAFOs (pressure relieving ankle foot orthoses) may be prescribed to maintain the range of motion at the foot and ankle while a patient is in hospital. These can also reduce risk of pressure sores.
Many brain injury patients require further more long-term orthotic treatment during their rehabilitation and beyond:
- a helmet may be used to protect the head against falls following a seizure;
- a spinal brace is used to maintain the alignment of the spine;
- Lycra suits are dynamic orthoses that increase proprioception and allow natural muscle movement, but guide weaker or abnormal movement with specifically placed panels, which place pressure and direction on specific muscles. These garments can be gloves, socks or suits;
- lower limb orthoses include AFOs (ankle foot orthoses) and KAFOs (knee ankle foot orthoses), which aim to control the foot, ankle, knee and hip during gait;
- To return a patient’s gait pattern to one that is as near normal as possible, we are increasingly recommending and prescribing the Neuro Swing system. This has a number of advantages over traditional AFOs.
- anti-contracture orthoses are used to stretch out tight muscles during rest such as KAFO's gaitors (for arms or legs) and night AFOs;
- FES (functional electrical stimulation) can be used to stimulate weaker or affected muscles to function in a more normal pattern.
The treatment programme varies hugely between each patient, depending on the severity of the brain injury and the impact it has on the patient’s overall mobility. Each patient must, therefore, be carefully assessed by one of our experienced clinicians to determine what orthotic treatment is best suited to them. This may include a gait assessment in our video vector Gait Lab to accurately assess dynamic movement.