Key Points

  • Constraint induced movement therapy provides benefit for the more affected upper extremity post ABI.
     
  • Overnight hand splinting does not provide clinical benefit for individuals with brain injury.
  • Soft hand splinting may be beneficial for improving spasticity and hand opening.
     
  • Functional dexterity tasks improve fine motor coordination.
     
  • Gesture recognition biofeedback is a simple and effective way of improving fine motor function of the hand.
     
  • Serial casting reduces ankle plantar flexion contractures.
     
  • Serial casting appears to reduce elbow contractures; however, this effect was not sustained.
     
  • A pre-fabricated adjustable ankle foot orthosis reduces ankle plantar flexion contractures; however, the individual should be monitored for skin breakdown and pain.
  • Botulinum toxin A injections reduce localized spasticity and improve range of motion following ABI.
     
  • Patients receiving botulinum toxin type A through a single motor point or through multisite distributed injections both show a reduction in spasticity.
     
  • Phenol blocks of the musculocutaneous nerve may help decrease spasticity and improve range of motion temporarily up to five months post injection.
     
  • Electrical stimulation decreases spasticity for six or more hours.
     
  • Oral baclofen appears to reduce lower extremity spastic hypertonia.
     
  • Oral baclofen did not improve tone, spasm frequency of reflexes in the upper extremity.
     
  • Bolus injections of intrathecal baclofen produce short-term reductions in upper and lower extremity spasticity post ABI.
     
  • Prolonged intrathecal baclofen reduces upper and lower extremity spasticity post ABI.
     
  • Intrathecal baclofen may cause short-term improvements in walking performance in ambulatory patients post ABI.
     
  • Partial body weight supported gait training is not better than conventional gait training for improving ambulation, mobility or balance.
     
  • Exercise programs, both aerobic and weight training post ABI, are effective for improving general fitness.
     
  • Engaging in exercise programs prior to injury increases the likelihood of continuing to exercise post ABI.
     
  • Adherence to an exercise program may be higher when done at a fitness center compared to at home.
     
  • Exercise helps to improve mood, overall general mental health, health promotion and self-esteem post ABI.
     
  • Computer based restitution training has been shown to improve the vision of those who sustain a TBI.
     
  • Base-in prisms and bi-nasal occluders has been shown to be effective in treating ambient vision disturbances.
     
  • Rehabilitation programs directed at improving visual function may improve visual functional outcomes post ABI.
     
  • Aerobic dance, slide and step programs improve balance and coordination post TBI.
     
  • A vestibular rehabilitation program is an effective method for improving symptoms of vertigo in patients following TBI.
     
  • Despite the positive results of the study investigating biofeedback and post traumatic headaches, further research needs to be completed using larger groups and only with those who have moderate and severe TBIs.
     
  • CBT has been found to be useful in managing post-traumatic headaches; however, the pain associated with these headaches was not decreased following treatment.
     
  • Physical therapy, stress management and biofeedback have been shown to reduce post-traumatic headaches in those who have sustained either a TBI or spinal cord injury, allowing individuals to return to work.
     
  • Cold therapy is less effective in reducing post traumatic headaches than manual therapy.
     
  • Divalproex has been found to improve post traumatic headaches in those who sustain a mild TBI.
     
  • Pregabalin has been shown to reduce central neuropathic pain post ABI or spinal cord injury.
     
  • Although antidepressants (i.e., Selective Serotonin Reuptake Inhibitors, tricyclic antidepressants) are often prescribed to treat pain, there is little evidence supporting this practice in general and no evidence supporting this post TBI.
     
  • Oxycodone in modest doses is effective in reducing pain following mild TBI.
     
  • Oxycodone has been found to be successful in reducing pain: however, it remains unclear as to whether or not this medication would be effective and well tolerated in those who sustain a moderate or severe ABI. More research is needed.
     
  • Cannabinoids have been shown to reduce post-traumatic and postsurgical neuropathic pain. More studies are needed investigating its effectiveness in treating pain post TBI.