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Brain injury rehabilitation in adults
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Adverse effects noted in both drugs include drowsiness, dizziness, dry mouth, gastrointestinal disturbances
and hypotension. 20 The efficacy and dosing schedules for these drugs vary unpredictably from patient to
patient.
D oral baclofen or tizanidine may be considered for treatment of spasticity.
4.2.4 ELECTRICAL STIMULATION AND FUNCTIONAL ELECTRICAL STIMULATION
Functional electrical stimulation is a technique to correct for muscular imbalance at a joint by stimulating,
and thereby strengthening the weaker of the opposing muscle groups. No evidence regarding the use of
functional electrical stimulation interventions in patients with brain injuries was identified. There is weak
evidence that electrical stimulation may be effective for decreasing lower extremity spasticity for up to 24
hours. 50
4.2.5 SURGERy
Surgical intervention is generally a last resort in spasticity management. Techniques developed from
orthopaedic surgical work on patients with cerebral palsy are sometimes applied in TBI. Only one relevant
case series was identified comparing two tendon transfer procedures for ankle spasticity which showed
decrease in the use of ambulatory aids and improvement in ambulatory status following both procedures. 71
4.2.6 OTHER INTERVENTIONS
One case series of patients with ABI and muscle hypertonia (n=28) showed an inconclusive effect of intrathecal
baclofen on range of motion of lower extremities. 72 No evidence was identified for specific occupational
therapy interventions for the reduction in spasticity. Further research into therapy modalities is required.
4.3 PHySICAl THERAPEuTIC INTERVENTIoNS
A significant proportion of patients who sustain a TBI are left with physical function problems. It is therefore
important to establish whether any therapeutic interventions are effective in regaining physical function
in these patients.
4.3.1 UPPER LIMB FUNCTION
There are limited studies which address the effect of upper limb recovery following TBI. One RCT assigned
patients with ABI to either experimental (five one-hour sessions of individualised task-specific motor therapy
in addition to 30 minutes of usual motor control therapy to shoulder and elbow five times per week) or
control (10 minutes of individualised task specific motor therapy three times a week plus 30 minutes of
usual motor control therapy). Hand and overall arm function of all participants improved over the six-week
period, however there was not a clear benefit from providing additional hand therapy. 73
A systematic review found insufficient evidence to support or refute the effectiveness of any one specific
rehabilitation intervention to improve upper limb function. 74 No evidence directly related to brain injury
was identified concerning the effect of constraint induced therapy on measurable components of physical
function.
4.3.2 GENERAL THERAPEUTIC INTERVENTIONS
A Cochrane review investigated music therapy delivered using a number of different therapeutic
interventions. 75 It suggested that rhythmic auditory stimulation may be beneficial in improving elements of
gait, although the relevant trials were carried out on a stroke population. Further RCTs need to be undertaken
before recommendations for clinical practice can be made.
An RCT on motor imagery effectiveness came to no conclusion about the effectiveness of this intervention
due to low levels of compliance of both patients and therapists. 76
There is no clear evidence that any specific therapeutic interventions in patients with TBI, other than those
involving task-specific and repetitive task training (see section 4.1.3) or for managing spasticity (see section
4.2) improve measurable components of physical function.
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