Describe the physiotherapy treatment plan for a patient with gunshot brain injury who has received conservative treatment.
Retrospective case report – observation of the effectiveness of physical therapy using Bobath, PNF, and task-specific training concepts.
Treatment: Rehabilitation activities were conducted 3 times per week, including sessions with a speech therapist and physical therapist. Physiotherapy began with learning to transfer from bed to wheelchair, wheelchair to floor, and back, as well as sitting on the edge of bed without support. Stretching exercises were used to reduce spasticity. After 3 weeks, the patient had learned to walk with support from 1 person, stand up from floor, transfer to bed and wheelchair without assistance.
Outcome: Patient mobility, as measured by the ICU mobility scale, improved from 3 to 8. Gait also improved, with the patient able to walk 6 consecutive steps with assistance. Spasticity in the arm decreased from 3 points on the Ashworth scale to 1. Muscle strength increased in the shoulder from 3 points to 4, in the elbow from 2 points to 4 and in the hand from 2 to 3 points as measured by the MRC scale.
After 5 weeks of rehabilitation, the patient discontinued regular treatment.
Seven months later, the patient can now walk without assistance. However, extrapyramidal symptoms remain in the right hand, including involuntary movements and stiffness. A council of neurosurgeons and neurologists has recommended removing the bullet.
Physiotherapy is an effective and safe treatment for patients with traumatic brain injuries. Early intervention can prevent complications and promote a higher level of independence in daily activities.
Physical therapists should begin the process of physical rehabilitation for individuals who have suffered air gun shot brain injuries, even if they have not had surgery to remove the bullet.
air gun shot wound
childhood trauma
