9.7 Take home messages

• The brain has many areas that contribute to voluntary control of movement. When the brain is injured, the problems or impairments that are seen relate directly to the area that was damaged
• People who have sustained a brain injury commonly have a mixture of the following physical presentations: o Weakness o Muscle length and connective tissue changes o Alterations in tone o Reduction in co-ordination o Other movement disorders such as ataxia, apraxia, involuntary movements and tremors
• The role of physiotherapy in rehabilitation involves understanding the kinematic and kinetics of normal movement, motor control processes and motor leaning. This enables the person relearn their motor tasks.
• Key factors in relearning motor control are: o The elimination of unnecessary muscle activity and prevention of development of muscle imbalances o Timely and specific feedback o Practice o Rrecognition of the relationship between postural adjustment and movement.
• Carers can assist in the implementation of specific physiotherapy programs such as o Motor re-training - for example e.g. sit to stand and walking retraining o Prevention of secondary complications such as reduced range of motion through implementation of stretching and splinting programmes o Fitness training o Participation in regular community physical activities.
• Strategies carers can use to facilitate physiotherapy programmes include: o Use of practice sheets, o structuring regular exercise o Encouraging active lifestyle participation o Incorporating practice into every day tasks o Communicating with others involved in the care of the individual o Avoiding conflict, providing reassurance and not forcing compliance to manage aggression or agitation during physiotherapy sessions.
• There are potential risks that can be minimised when carrying out a physiotherapy programme. These include ensuring the patient is safe at all times, monitoring skin integrity for potential areas of breakdown and alerting other people involved in the care of the individual if their function is deteriorating.