Do patients with severe brain injury benefit from physiotherapy? A review of the evidence

Severe traumatic brain injury is a serious and frequently disabling condition with major and long-standing consequences, both for the patient and his/her therapy services. A significant proportion of adult sufferers will sustain physical problems, which will require physiotherapy input. A literature review was undertaken to identify the extent to which the effectiveness of this area of physiotherapy has been investigated. English language studies were located that described relevant controlled studies, including n-of-l designs. Identified studies were categorized as: exercise/fitness training; sensory stimulation and coma arousal; therapeutic schools and approaches; functional skills training; behavioural modification; casting, splinting and associated therapies; respiratory physiotherapy; rehabilitation; miscellaneous 'mixed bag'. Overall, a reasonable body of evidence was identified, although stronger in some areas than others. There was a noticeable shortage of studies investigating the effectiveness of functional skills training, i.e. physiotherapy to reinstate functional motor activity. The implications of the results of this review are briefly discussed.