A person may:
Run into walls or other people with one side of their body
Be unaware of nearby objects
Be unable to judge distance
Experience problems maneuvering around objects
Become dizzy when turning their head
Lose their balance when turning their head
Lose their balance when walking on uneven surfaces
The degree to which mobility is affected by a brain injury varies from person to person. Some mobility areas the patient may have difficulty with include:
Bed Mobility: Rolling, scooting up in bed, sitting up or lying down in bed
Transfers: Sitting down or getting up from one surface and moving to another surface (wheelchair, bed, chair, couch, toilet, tub, car, or floor)
Ambulation: Walking inside and outside, on smooth surfaces and uneven terrain, on ramps, curbs and stairs. It also includes walking in the community or in areas with obstacles, and distractions
Wheelchair Mobility: Being able to move the wheelchair from one place to another; manage the brakes, footrest, and armrests, and manage barriers such as doors, carpet, and obstacles
Balance Activities: Higher level walking and recreational activities, including walking on a narrow surface, jogging, skipping, jumping, and ball handling activities such as throwing, catching, and kicking
How Brain Injury Affects Mobility
Physical, perceptual, and cognitive deficits affect a person’s ability to perform mobility skills including bed mobility, transfers, walking or wheelchair mobility and balance activities. Physical deficits may include muscle weakness, poor muscle coordination, increased muscle tone causing abnormal movement patterns, limited joint movement, and impaired balance.
Visual and perceptual deficits may include difficulty seeing and distinguishing objects. For example, impaired depth perception may cause steps to look close together or further apart, or bigger or smaller than they are. Inattention or neglect may cause a person to run into objects on one side of their body. Double vision may cause difficulty in locating obstacles.
Cognitive difficulties include impaired planning, safety, and judgment. For example, a person may be physically able to do a task, but unable to put all of the steps together in the right order. A person may overestimate what they are able to safely do, or may be impulsive (move too fast), or become distracted by the environment so that they are no longer safe. A patient may be able to physically walk without difficulty, but become disoriented or lost ,and have increased difficulty if in unfamiliar surroundings. Memory, attention, and concentration also have a great impact on a person’s ability to perform mobility skills safely.
Depending on the severity of the physical, perceptual, and cognitive problems, the patient may have to use a wheelchair to assist with mobility. As improvements are made, the patient may progress from using a wheelchair to using a walker, a cane, or to no assistive device at all. They may require someone to be with them to ensure safety, and to assist them with balance during walking. They may be able to walk for short distances, but require a wheelchair for longer distances.
Some people may require the use of a wheelchair for longer periods of time.
Treatment for Mobility Impairments
The physical therapist addresses areas of physical impairment that have an impact on mobility. Weak muscles are strengthened through exercise. The abnormal stiffness in muscles (increased muscle tone) may be reduced by stretching, positioning, or serial casting. Stiff joints that impair mobility may be stretched. Sitting and standing balance may be improved by specific exercises and activities. Finally, mobility skills (bed mobility, transfers, walking, wheelchair mobility, and balance activities) are practiced in the presence of a therapist who attempts to correct the movement errors and help retrain the movement skills.
There are some physical limitations that require special attention to improve mobility. Serial casting may be necessary to increase joint mobility or reduce the muscle tone (to allow normal movement) in an arm or a leg. Serial casting involves the application of a series of plaster or fiberglass casts over a period of time. A splint or brace may be used to prevent the loss of movement at a joint or to assist weak muscles. A therapist will monitor the brace fit and establish a wearing schedule.
Wheelchair modifications may be necessary to accommodate certain physical problems and to allow for a proper wheelchair fit.
The Role of the Family in Mobility
The family plays an important role in the recovery process. As the patient progresses, the physical therapist will teach the family the proper way to assist with bed mobility, transfers, wheelchair mobility, walking, and/or balance activities.