A guide to therapies after brain injury
This section looks at the different kinds of therapy and what each hopes to achieve.The different forms of therapy and their aims for your child are rich and varied. At its most basic, a therapy is a discipline, a group of techniques designed to help your child improve in a particular aspect of their lives. Many of us have an idea about what physiotherapy entails, but perhaps something like play therapy is new to you. Some children will have a programme that focuses only on the kinds of therapy it has been decided they need. Others might have a more varied range of therapies. If your child is at a specialist centre they may have many different therapies – what’s called a “multidisciplinary approach”.1
All of these approaches can help bring about real improvements to a child’s independence and wellbeing.
Nevertheless, it’s important to be realistic about what can be achieved and the hard work it takes on the part of child, family and therapists.2
You might like to explore the different kinds of therapy in the guide that follows here.
What are its aims?:Although it starts with the movement of the body, physiotherapy aims to improve children’s wellbeing, comfort, and a sense of their own independence. Crucially, physiotherapy can also be fun, as children take part in exercises, games and activities to help them fulfil their potential.
What does it involve?:As well as moving the muscles to encourage greater movement and flexibility, it may take the form of specific exercise, or managing posture. Each child’s goals in physiotherapy will be very different.
Give me an example:Evie could not walk after her accident. After a long time in hospital, her muscles were weak and stiff and she was having difficulty moving her legs at all. She found that hydrotherapy (water therapy) helped, and she enjoyed it too. The support of water in a pool helped Evie to move and exercise more easily.
Who does it?:Before they qualify, physiotherapists will need to have done a particular number of practical hours to demonstrate their competence. They will be a member of a professional body like the Chartered Society of Physiotherapists. Like lots of healthcare professionals, some will have a speciality in working with children.
Occupational therapy (or OT)5
What are its aims?:To allow children to better perform everyday activities, some of which they may have lost the ability to do because of their injury.6 Crucially, occupational therapy is about giving children greater independence in their lives. “Occupation” means any activity a person undertakes, either through need or enjoyment. More importantly, everything we do – our daily occupations – help to define our identity and role. If an individual is unable to do what is important to them, their health and wellbeing may suffer.
What does it involve?:Children with an acquired brain injury might struggle with the ‘sequencing’ of a task – the right order in which to do practical, everyday things.7 Occupational therapists (or OTs), working with the child, develop ways of helping them structure tasks like cleaning their teeth, or getting ready for school. It’s about building on the child’s ‘life skills’ and these therapists talk about enhancing someone’s ‘participation’ in the world around them. For young people, occupational therapists might make job skills the focus. OTs will assess for and prescribe adaptive equipment to enable independence and participation.
Give me an example:Jordan could not remember how to get dressed by himself, and found the whole process too much. His occupational therapist helped him to break down the process into detailed steps. Together they worked on the sensory skills needed to pick clothes, and then the movements and organisational skill in getting the clothes in the right order. They used fun activities to improve coordination and balance which are also involved in getting dressed. This helped Jordan at home, and to do more for himself when he went back to school. Read a blog about getting a child dressed after an ABI here.
Who does it?:Occupational therapists train in their subject up to degree level. Like other therapists, many will have completed postgraduate diplomas or master’s degrees in the subject.
Speech and language therapy (or SLT)5
What are its aims?:To help children in the way they communicate after an acquired brain injury. It could be that the child has difficulty with certain speech sounds, finding the right words, or saying things which are socially appropriate.8, 9 Children might also have difficulties understanding the language they hear, or keeping up with what people are saying to them. Speech and language therapists also help children with eating and drinking after brain injury as the muscles that control swallowing may have been affected.
What does it involve?:Therapists carry out thorough assessments to establish just what a child’s needs are. For some children, it may be a case of practising the formation of words. For children with more profound speech difficulties, a therapist may help them find other ways of expressing themselves, perhaps through signs or even electronic devices.
Give me an example:Emma had difficulty with forming sounds and choosing the right words. Her speech and language therapist helped her to practise her oral skills, and used word games to help with word finding. All these therapy tasks helped Emma to develop communication skills she can use in the wider world.
Who does it?:Speech and language therapists qualifying today will have a degree. They then receive a practice certificate. As with many of the other therapists here, some will specialise in working with children.
What are its aims?:Most children find it difficult to talk through their problems and concerns in the same way an adult would. And speech and language difficulties might make this yet more difficult.8, 9 Play therapy gives children a private, confidential space to work through anything that’s troubling them. Play is important to all children, in that it’s a big part of their emotional development. Ultimately, the aim of play therapy is to reduce children’s anxieties and strengthen their resilience. Play therapy may also be useful for siblings.11
What does it involve?:Children have access to all kinds of toys, arts and crafts and play materials. They may act out something that’s bothering them, they might draw something that’s on their mind, or they may simply make the most of the opportunity to express themselves through play.
Give me an example:Kitty was staying at a rehabilitation centre after her brain injury. But this involved her being away from home for many months. She found this difficult, and not easy to talk about. She was angry and unhappy. But play therapy in a private space helped her to express her feelings and helped her to feel better. It also helped the adults around her to understand her better.
Who does it?:Play therapists have extensive training and experience in child development, and will have completed a postgraduate course in play therapy. They come from a variety of backgrounds, such as teaching.
What are its aims?:We’re only just beginning to understand the enormous potential of music as a form of therapy. Music can be a powerful form of self-expression for children, but it also gives them a chance to interact with others.
What does it involve?:By improvising music and taking turns to make noise on instruments (or even singing), children build on their ability to interact. It’s less about developing musical ability and more about helping children take turns in conversation and make choices.9 Music therapy is often used with children who have language difficulties after an injury.12
Give me an example:Kasim had hearing difficulties after his brain injury. But using a simple resonance board allowed him to feel the vibrations of sounds with his body. In this way, he was able to practise taking turns to make and listen to sounds with his music therapist. This helped him to re-learn the social-interaction skills needed for having a conversation.
Who does it?:Music therapists are accomplished musicians first. They will hold a degree in music before they go on to train as music therapists. Click here to find out how Catherine was helped through music therapy.
What are its aims?:These professionals can be a key ally to families in difficult times. Their principal role is to make sure everyone in a family is ticking over, and that they’re getting the help and services they need.
What does it involve?:Social workers may co-ordinate discharge planning, refer children to services in the community and answer questions about any issues that come up. A social worker might help steer a family towards appropriate services in the community after discharge from hospital. They also offer crucial emotional support to child and family.
Give me an example:Maria’s brain injury meant that her father had to stop working full-time to help to care for her and her brothers and sisters. The family’s social worker helped them with advice on their entitlement to benefits.
Who does it?:Since 2003, all social workers need to have a degree in social work. This qualification includes 200 days of on-the-job assessment.
What are it aims?:The aims of clinical psychology are wide-ranging. These professionals may give children emotional support as they go through stressful medical procedures. They might help children with emotional difficulties or give advice about how children can talk about their condition with friends and family.
What does it involve?:The primary role of a clinical psychologist is to talk things over with children. They will have clinically-designed ways of assessing children. The sessions are sometimes confidential, and children will set goals and aims with their psychologist.
Give me an example:A clinical psychologist assessed Billy after his brain injury. She looked at his thinking skills, including reasoning and memory. Through observation and discussion in a confidential space, she helped Billy to work out ways of talking to his friends and family about his needs and abilities. She also provided support and advice to Billy’s teachers and family members.
Who does it?:Clinical psychologists are qualified up to PhD level. Most psychologists who talk with children will specialise in this area.
What are its aims?:Neuropsychologists work specifically with people who have brain injuries or other difficulties with their nervous system. As well as knowing about mental health difficulties, neurospsychologists understand the relationship these difficulties have with the biological processes that go on in the brain.
What does it involve?Neuropsychologists often work in acute settings – when an illness or injury needs the most attention. They also work in rehabilitation, providing post-acute assessment.
Give me an example:After her brain injury, Natasha had specialised training and support from her neuropsychologist. He used assessments to try to understand Natasha’s difficulties with cognition.
Who does it?:Neuropsychology is a post-qualification discipline. They first need to be Chartered Psychologists within the field of clinical or educational psychology.
Educational psychologist (or EP)
What are its aims?:This branch of psychology looks at the way children learn and their individual strengths and difficulties. As with all children, the broad aim for those with ABI is to support those who may be experiencing problems in their education.15 This involves working with teachers and families to help them understand the difficulties a child may experience.
What does it involve?:Educational psychologists (sometimes called EPs) support school staff in addressing children’s learning and behaviour difficulties. They may carry out an assessment of a child’s educational needs and make recommendations. This assessment may include working with other key people in the child’s life. There may be more assessments over time as a child’s needs change. For children with more complex needs, the EP is part of the team that advises the local authority about the ‘statutory assessment’ process.
Give me an example:Polly had an acquired brain injury following a road accident, and went to a specialist centre on a three-month rehabilitation programme. The EP supported the family through the planning and discharge process for Polly’s return to school. The EP liaised with the school and the local authority, offering advice on Polly’s changed needs.
Who does it?:Educational psychologists often have experience of working with children and young people, before moving on to a doctorate-level degree specialising in educational psychology. Many are employed by local authorities as part of a children’s services department.
What are its aims?:A child’s brain injury affects their whole family.17 Family Therapy provides a safe and supportive space for individuals, couples and family groups to think about their situation. It enables family members to express and explore the difficulties they face. Bringing people and ideas together in this way can improve communication, allow better understanding as well as aid the rehabilitation process.
What does it involve?:Family therapists sometimes work with whole families, sometimes on a one-to-one basis, and almost everything in between. They might help by talking things through. They may also suggest strategies and ways of dealing with any difficulties.
Give me an example:Nathan’s family was under a lot of pressure after his injury. As well as being very worried about him, his parents and sister had made big changes to care for him when he came home. Family therapy helped his family to find space to consider how their roles had changed, and to discuss their feelings about the future.
Who does it?:Family therapists will usually have a postgraduate degree.
The therapists above will be registered with the Health Professions Council. This is an independent body that holds professionals to a set of standards. Visit its site here.
Family and friends18Although you may not have the medical know-how of all the people mentioned above, a supportive family is a crucial piece of the rehabilitation puzzle.19 Families have a unique role in rehabilitation.
They know how the child was before their injury, and they’ve been there at every stage of a child’s care. Perhaps most importantly, families will have their child’s interests at heart in a way that only they can. They offer emotional support and can have an enormous impact on a child’s progress.20 The British Society of Rehabilitation Medicine describes family members as a ‘crucial asset’ in the healing process.18 The family has a special rapport with their child and can provide valuable insight into their character. You might even find the professionals consulting you about some things. Some parents like to become involved in setting goals and targets for their children. They may have practical knowledge about how to make therapy more meaningful or appealing to their child. And on an everyday level, having parents sit in on therapy and teaching sessions may help calm any anxieties their child has.21 Siblings may like to sit in on sessions. This may help them understand what their brother or sister is experiencing.22 Parents may well pick up skills and strategies they can take home.21
Some children may require medication following an acquired brain injury. It is commonly used to treat effects of brain injury like:
- Seizures and epilepsy
- Difficulties with concentration
- Difficulties with muscles
- Difficulties with mood – depression and anxiety