P
Priority
F
Fundamental

New
Level of evidence
A
B
C
M 2.1
C
Any physical treatment approaches provided following traumatic brain injury should take into account any associated orthopaedic or musculoskeletal injuries.
(Adapted from NZGG 2006, 6.1, p. 88)
M 2.2
P
C
Motor therapy programs for individuals with TBI should target the preservation of functional range of motion (ROM) in all phases of care post traumatic brain injury (in the absence of refractory intracranial hypertension), but particularly in the acute and subacute phases, to allow for future motor recovery, functional activities and positioning. Regardless of prognosis, potential for recovery may be adversely affected if contractures are allowed to develop.
(INESSS-ONF, 2015)
REFERENCE:
M 2.3
C
Motor therapy programs should be adapted to accommodate the normal environment and activities of the person with traumatic brain injury as much as possible.
(Adapted from NZGG 2006, 6.1, p. 88)
M 2.4
C
Strength and endurance training with the person with traumatic brain injury should be performed, within the context of functional tasks when possible.
(Adapted from ABIKUS 2007, G54, p. 24)
M 2.5
P
A
Individuals with traumatic brain injury should be given opportunities to practise their motor skills outside of formal therapy.
(ABIKUS 2007, G53, p. 24)
M 2.6
C
As postural control is an essential component of mobility and motor function, individuals with traumatic brain injury should be given the opportunity to experience upright positions regardless of their level of responsiveness or level of severity and recovery, provided they are medically stable. For example, progressive upright sitting or supported standing for head, neck and trunk control should be a part of the postural control interventions.
(INESSS-ONF, 2015)
M 2.7
C
Individuals with traumatic brain injury with complex postural/seating needs should be referred to a specialized interdisciplinary team with expertise in specialized seating.
(Adapted from ABIKUS 2007, G54, p. 24 and NZGG 2006, 6.1.1, p. 90)
M 2.8
P
B
Specific repetitive training interventions to increase functions post traumatic brain injury are recommended, such as sit-to-stand, functional reaching and balance, and gross motor coordination of the lower extremities.
(INESSS-ONF, 2015)
REFERENCE:
M 2.9
P
B
Either virtual-reality-based balance retraining program or a conventional balance retraining program can be used to improve balance post traumatic brain injury.
(INESSS-ONF, 2015)
REFERENCE:
M 2.10
C
Gait re-education is recommended to improve mobility after traumatic brain injury.
(Adapted from ABIKUS 2007, G54, p. 24)
M 2.11
B
Partial body weight supported gait training does NOT provide any added benefit over conventional gait training in ambulation, mobility or balance following traumatic brain injury.
(INESSS-ONF, 2015)
REFERENCE:
M 2.12
C
For individuals with traumatic brain injury who are unable to ambulate over ground, gait training with partial support with a harness and/or hydrotherapy should be considered.
(INESSS-ONF, 2015)
M 2.13
P
B
Functional fine motor control retraining activities should be considered to improve fine motor coordination after traumatic brain injury.
(Adapted from AOTA 2009, p. 82)
M 2.14
C
Constraint-induced therapy should be considered for individuals with traumatic brain injury who have upper extremity motor impairments with some active wrist and finger movements and can cognitively engage in the therapy.
(Adapted from AOTA 2009, p. 82)
M 2.15
C
The following therapies could be considered to improve upper and lower extremity motor and sensory impairments following traumatic brain injury:
Functional electrical stimulation
Contrast baths
Mirror therapy
Cycle ergometry with or without motor assistance depending on the person’s level of functioning.
(INESSS-ONF, 2015)
M 2.16
C
A program must be in place to prevent shoulder trauma for individuals with traumatic brain injury with flaccid upper extremities. This includes bed positioning, arm support in sitting and use of a hemi arm sling for standing and transfers.
(INESSS-ONF, 2015)
M 2.17
C
Orthoses should be individually fitted by a health professional or orthotist with expertise in traumatic brain injury.
(Adapted from NZGG 2006, 6.1.1, p. 90)
M 2.18
B
Casts, splints and passive stretching may be considered for individuals with traumatic brain injury in cases where contracture and deformity are progressive.
(SIGN 2013, 4.2.1, p. 17)
M 2.19
P
A
Exercise training is recommended to promote cardiorespiratory fitness in individuals with traumatic brain injury.
(Adapted from ABIKUS 2007, G54, p. 24)