Our brain controls our ability to move, use and move objects, and our physical responses to things happening in our environment. This is often described as mobility.
Changes in your mobility can affect things like:
- Walking
- Muscle mass/strength
- The ability to play, drive, and generally move under you own control
- The ability to pick things up
- Dexterity and fine motor skills in your hands
- Balance
These changes to mobility may come from the brain injury or from other injuries that may have happened at the same time. These mobility changes can be hard because they impact how you do a lot of things every day. This can also impact your emotional and mental health (especially as you’re getting used to these changes).
It’s important to work with medical professionals like physiotherapists and occupational therapists to address mobility issues and create a goal-oriented rehabilitation plan. It’s also essential to develop a transition plan if your mobility will be impacted long-term.
Let’s talk about:
Balance
Balance problems after a brain injury are common: some studies have demonstrated that 30-65% of people reported some sort of issue with balance [1].
Balance is the ability to keep yourself centred as you walk, sit, and engage in other movements. It allows you to control and adjust your body before, during and after movement to keep from falling. When you are keeping your balance, your brain is continually processing information from your environment and your multiple senses and body parts. The brain then sends directions out to your body’s motor and sensory system (muscles in the arms, legs, core, and eyes) to keep you centred.
Common causes of balance problems after an acquired brain injury include:
- Changes in blood pressure
- The actual injury to the brain
- Medications
- Mental health issues like depression, anxiety, fear of falling, or fear of moving
- Sensory impairments
- Impairments in motor control
- Dizziness, which is a sensation of light-headedness, spinning, or nausea.
Balance is essential not only for walking but for doing all daily activities. Poor balance can keep you from taking part in activities such as sports, driving or extracurriculars. Issues with balance and dizziness can increase the risk of falls and injuries, including another head injury.
How can I improve my balance?
Balance problems will usually improve over time with activity and exercises. You may be referred to a physiotherapist or another specialist who can help you with your balance.
If you’re struggling, you can try to improve your balance by focusing on the elements of balance you can control. For example, make sure you have good shoes and good lighting when you walk to avoid possible tripping hazards.
Other ways to cope with balance problems include:
- Use mobility aids such as canes and walkers, if recommended by a health care professional.
- Hold onto someone’s arm if you feel unsteady.
- Wear proper footwear (closed-toe, well-fitting, secured heel, and flat).
- Work with an occupational therapist to make changes to your home environment such as railings on stairs, installing railings and safety chairs in the bathroom, and removing rugs or other tripping hazards.
- Clear high-traffic areas in your home: move furniture and other obstacles in your path
Use good lighting and nightlights (for example, smart lights that can be controlled by voice or by phone) to help you see clearly. - Avoid substances that can impair your sense of balance.
Endurance
Endurance is having the strength, energy, and ability to perform an action over an extended period of time. It can be measured by how well you perform an activity or how much you can increase the intensity or the length of the activity. For example, first, you walk further, then you walk faster.
It takes time, patience, and practice to build up your endurance. A health care professional may recommend exercises using small weights or resistance bands. They may also get you to focus on form and repetition to help your endurance and other aspects of mobility such as posture and how you walk.
You can actually see your endurance build by keeping track of it. For example, if your goal is to walk 100 metres on the treadmill in a set time, track that progress. Achieving goals can encourage you throughout your recovery.
Gross & fine motor skills
Mobility refers to the ability to move your limbs. This includes gross motor skills such as walking and fine motor skills such as picking things up and writing. Physiotherapy and occupational therapy can help with strengthening or regaining motor skills as well as learning new ways to accomplish tasks. This could include activities such as:
- Working with your fingers on small, detailed tasks such as writing or crafting
- Range of motion and strengthening exercises
Certain exercises and activities will be recommended based on your needs.
Muscle tone, strength and coordination
Muscle tone is the amount of tension in a muscle when it’s not being actively used. For example, your arm when you are not flexing your biceps. When muscle tone is normal, your limbs and body feel easy to move – you don’t even think about it. A brain injury may damage muscle tone. Your limbs may feel floppy and heavy to move instead of easy and light (also called flaccid). It could also cause an increase in muscle tone, where your limbs feel stiff and tight (also called spasticity). Both affect the ability to control movement.
After a brain injury, muscles may show different degrees of weakness. Some muscles may be stronger in one limb than another. Damage to certain parts of the brain may result in slow, jerky, or uncontrolled movements. You may hear the terms:
- Hemiparesis: muscle weakness on one side of the body only
- Hemiplegia: muscle paralysis (no movement) on one side of the body only
Ways to improve muscle tone depend on whether you are experiencing spasticity or flaccid muscles. If you are experiencing spasticity, your doctor may recommend medication along with stretching and range of motion (ROM) exercises overseen by a therapist. If you are experiencing flaccid muscle tone, treatment can include working on proper positioning, exercises, and joint-positioning devices [2].
This process requires patience as it can take a long time. Your treatment plan will need to be adapted as your mobility changes and you may never fully regain the mobility that you had before the injury.
Coordination
You need coordination for every movement you make. Improving coordination involves a lot of time and patience, like improving muscle tone and strength. While exercises will vary, they will contain several key components, including but not limited to:
- Repetition
- The goal of increasing speed and accuracy
- Proper form
Posture
Your head and neck give your eyes, mouth, and tongue a stable base. Your trunk (the area of your body between the shoulders and hips) provides stability so you can use your arms and legs. To move normally, the head, neck, and trunk need to be properly positioned when standing and sitting.
A brain injury can affect the muscles that control head, neck, and trunk positions. It can also affect your sense of what’s straight up and down. For example, you may be leaning left or right because the muscles that hold your posture are affected. This may be caused by wrong information coming from the senses about position, limited range of motion, abnormal muscle tone, or pain.
Physiotherapy can be useful in helping you work on your posture when sitting and standing. Therapists will use specific exercises and gait training (which is how you walk) to help make improvements. Along with these exercises, you can work on your posture by:
- Rolling your shoulders back.
- Using a wall to help straighten your posture. Your ears should line up with the middle of your shoulders.
- Sitting all the way back in your chairs and choosing chairs with high backs.
- Wearing shoes that provide proper support.
- Using a mattress that properly supports the spine.
If you have poor posture, you can create a list of visual checks to make when you’re sitting or standing. You can also ask a parent, sibling, or friend for help.
There are also some simple yoga stretches and positions to help with your posture and your flexibility. You should first consult with your therapists and doctors about whether you should perform yoga. If you are coping with balance issues, there are some forms of chair yoga that can be done from a seated position. We have a video with some chair yoga you can try.
Sensations
Sensations tell us how we are moving, what we are feeling, and what’s going on around us. Forms of sensation include;
- Light touch
- Pain
- Temperature
- Moving joints and muscles
- Sight
- Sound
Changes to the way you experience sensation can affect your ability to sense movement or position, to feel changes in temperature, or to feel touch to the affected part of the body.
Losing sensation can be a serious safety issue because you may not be able to feel an injury or be aware of that part of your body anymore. It’s essential to know what types of sensations have changed to help keep yourself safe. For example, if you cannot feel hot or cold temperatures in a part of your body, use an unaffected body part to check the water temperature before a shower.
Managing changes in sensations can be challenging, but your health care team can help you learn ways to cope. Your treatment plan will depend on the sensation changes you are experiencing.
Getting help from parents & caregivers
If you need help with any part of mobility, it’s important that your parents/guardians, siblings, caregivers, or anyone else who spends a lot of time with you are trained in how to do so safely.
Mobility assistance can include:
- Transferring you from a bed to a chair
- Helping you use the restroom
- Walking
- Getting you in and out of vehicles
The people who help you need to know how to safely lift, position, and move you. This is important for everyone’s safety as proper training reduces the risk of injury.
If needed, parents/guardians can get this kind of training from health care professionals. These resources will be talked about during your discharge planning.
Physical rehabilitation
When a brain injury affects mobility and movement, a physiotherapist will assess your physical status and abilities. After the assessment, a treatment program is created that fits your needs. Rehabilitation programs are goal-oriented, meaning the therapists work with you to develop a treatment plan that not only addresses areas of need but will help you work towards your goals. These goals and plans require ongoing reassessment and adjustment as the treatment progresses and your goals change.
Physical rehabilitation may include activities such as:
- Strengthening exercises focused on building endurance and muscle
- Range of motion (ROM) stretches, which often focus on specific joints
- Balance exercises which will target challenge areas
- Gait training to improve walking
- Visual/perception retraining (seeing and making sense of what you see)
Physiotherapy can be a short or long-term process and requires active participation. You may be given activities or exercises to do between appointments. Doctors may also recommend that you work with an occupational therapist to help meet goals surrounding activities of daily living (ADLs), school, and play. This could include brushing your teeth, taking the bus to school, bouncing a basketball, and more.
Information for this section sourced in part by the ABI Partnership Project and My Health Alberta
[1] msktc.org
