Tale of a TBI survivor: From ventilation to Ambulation with Physical Therapy

Traumatic brain injury is a type of injury that often results from an accident. It involves a long recovery process way past physical healing. This type of brain injury requires a lot of patience as well as persistence from all parties involved. 

This is a case of 64-year-old Traumatic Brain Injury(TBI) survivor who made significant progress to achieve his near normal function with aggressive rehabilitation, nursing, and respiratory therapy.  

History and Examination :

A 64-year-old male was admitted to my facility in March 2015 from a recent hospitalization with a change in mental status and traumatic brain injury. Due to HIPAA, we are going to address him as a patient (Pt) or Mr. M.

At the time of evaluation, he was on a ventilator at night. His cuff was inflated at all time, unable to tolerate deflation of the cuff, or unable to tolerate capping or PMV. Due to this, he was not able to communicate at the time of evaluation.  During PT and OT evaluations, he demonstrated hypotonicity on bilateral upper and lower extremities. He was unable to perform any active movement, unable to follow one-step simple commands verbally, visually or with tactile cues.

He was unable to communicate with any device or unable to mouth words. Functionally, he was totally dependent for all daily activities. His sitting balance was poor and unable to tolerate any weight-bearing activities like standing or weight shifting. One of the major concerns was a potential flexion contracture development in the right wrist, fingers and right knee.

Mr. M’s past medical history was significant for intracranial hemorrhage s/p left craniectomy in 11/2014, multiple hospitalizations with aspiration pneumonia, hypertension, anemia, and tachycardia. At the hospital, he was intubated due to lung abscess. Due to his multiple aspirations, his PEG tube was converted into J tube in hospital. 

Treatment Approach TBI:

He received PT, OT, and ST five days a week since his evaluation in the facility. The plan of care for PT and OT included increasing or normalizing tone, increasing strength, improving balance, contracture management and improve his participation in the functional task. He was receiving proper nursing and respiratory care along with regular rehab for his medical needs.  The treatment approach included bracing/splinting, mat exercise, bed mobility, and transfer training, gait training, electrical stimulation and functional electrical stimulation for neuro reeducation, swallowing techniques, etc…

Outcomes for TBI:

Currently, Mr. M. is independent in functional tasks like bed mobility, transfer, short-distance ambulation (20 feet), wheelchair mobility, dressing, hygiene, grooming, and feeding! He requires supervision for stair climbing and for long-distance uneven surface ambulation.  Thus, we saw amazing treatment results with Mr. M with just consistent rehabilitation and very good teamwork which included nursing as well as the respiratory department.


functional task

At evaluation

After 6 months of rehab

Current  status

Bed mobility total dependent Min A Independent
sit to stand unable Mod A Independent
functional transfer total dependent Mod A Independent
ambulation unable Min A Independent for short distance, supervision for long-distance
diet NPO puree trials Regular
liquid NPO honey-thick trials Thin
communication unable unable to speak/can communicate via  gestures or facial expression   Able to communicate independently
participation poor moderate No skilled services required
feeding NPO total dependent Independent
UE dressing total dependent Mod A Independent
LB dressing total dependent Max A Independent  



This case seems like very slow progress, but we are talking about traumatic brain injury here! It’s like teaching an infant or baby to sit up, stand and to walk!! As kids take around 11 months to a year to learn to walk and so do TBI patients!!  Slow, steady and consistent rehab is the key.  This is one of my favorite cases so far as it is a successful example of the importance of working as a team. Together, we can achieve amazing results and a near-normal life for our patients.

We physical therapists usually do not give enough credit to ourselves.  Physical Therapists are usually the one who helps people to walk, take their first step after surgeries like total hip and total knee replacement.  We are the one spreading smiles across the patient’s face after relieving pain through therapy.  It’s the physical therapist who listens to patients like their own family members and suggests a variety of treatment methods to “fix the problems”. Additionally, We are the last finishing workers without whom the full outcome of results will never be the same – just like a cherry on top!



1. Injury Prevention & Control: Traumatic Brain Injury & Concussion. Centers for Disease Control and Prevention. January 22, 2016. Available at: http://www.cdc.gov/traumaticbraininjury/get_the_facts.html. Accessed February 13, 2016.
2. Office of Communications and Public Liaison. NINDS Traumatic Brain Injury Information Page. NINDS. February 11, 2016. Available at: http://www.ninds.nih.gov/disorders/tbi/tbi.htm.
3. Get the Stats on Traumatic Brain Injury. Injury Prevention & Control: Traumatic Brain Injury & Concussion. January 22, 2016. http://www.cdc.gov/traumaticbraininjury/pdf/bluebook_factsheet-a.pdf. Accessed February 13, 2016.
4. Starosta M, Niwald M, Miller E. The effectiveness of comprehensive rehabilitation after the first episode of ischemic stroke. Polish Medical Journal. 2015; XXXVII(227):254-257.
5. Guoqing Y, Huiying L, Tiebin Y. Functional electrical stimulation early after stroke improves lower limb motor functional and ability in activities of daily living. NeuroRehabilition. 2014(35):381-389.
6. Kawahira K, Shimodozono M, Etoh S, Kamada K, Noma T, Tanaka N. Effects of intensive repetition of a new facilitation technique on motor functional recovery of the hemiplegic upper limb and hand. Brain Injury. 2010;24(10):1202-1213.
7. Mang C, Campbell K, Ross C, Boyd L. Promoting Neuroplasticity for Motor Rehabilitation After Stroke: Considering the Effects of Aerobic Exercise and Genetic Variation on Brain-Derived Neurotropic Factor. Physical Therapy. 2013;93(12):1707-1716.
8. Lannin N, Herbert R. Is Hand splinting effective for adults following stroke? A systematic review and methodological critique of published research. Clinical Rehabilitation. 2003;17:807-816.
9. Lannin N, Horsley S, Herbert R, McCluskey A, Cusick A. Splinting the Hand in the Functional Position After Brain Impairment: A Randomized, Controlled Trial. Archives of Physical Medicine and Rehabilitation. 2003(84):297-302.
10. Accelerated Care Plus. Available at: http://www.acplus.com/sports/Pages/Products.aspx. Accessed February 14, 2016.
11. Bakas T, Clark P, Kelly-Hayes M, King R, Lutz B, Miller E. Evidence for Stroke Family Caregiver and Dyad Interventions – A Statement for Healthcare Professionals From the American Heart Association and American Stroke Association. Stroke. 2014;45:2836-2852.
12. Lannin N, Cusick A, McCluskey A, Herbert R. Effects of Splinting on Wrist Contracture After Stroke A Randomized Controlled Trial. Stroke. 2007;38:111-116.
13. Koh G, Ong P. Caregiver Factors in Stroke: Are they the Missing Piece of the Puzzle? Archives of Physical Medicine and Rehabilitation. February 2016(10.106).




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