Brain Waves: UAB Traumatic Brain Injury Model System Newsletter Volume 14 | Number 1 | Page 3

Chronic pain may be another
problem issue. It is hard to cope with
pain, so people often get agitated or
frustrated easier. You might think it
is better to avoid ADLs if you are in
pain. If you avoid ADLs, you are no
longer as independent as possible.
PT and OT can be helpful in managing
pain. Treatment options might include
electrical nerve stimulation, traction,
ultrasound, moist heat, interferential
current, iontophoresis, stretching,
manual therapy, and exercise.
Loss of ROM, Strength or Stamina
Losing strength and ROM makes it
harder for you to do ADLs. There are
a number of reasons that you might
lose ROM, strength and stamina.
If you develop a pressure ulcer, for
example, you may need prolonged
bed rest to allow the pressure ulcer
to heal. Here are a few other common
problems that can lead to a loss of
ROM, strength and stamina.
• Muscle spasticity is resistance
to passive movement. For
example, arms or legs may
appear to jump or move in
an odd pattern. If there is too
much spasticity, it can lead to
contractures, or limitations in
joint ROM.
• Heterotrophic Ossification (HO)
is an abnormal build-up of
calcium in and around joints,
which can limit ROM and cause
contractures.

PT and OT can help you find
the best option to manage joint
contractures.
• Serial casting is the process of
applying and removing a series
of lightweight, fiberglass casts
on an arm or leg. Every 1 to 2
weeks, the angle of the cast is
changed to slightly stretch the
muscles and move the joint
a little closer to the correct
position.
• A splint is a piece of medical
equipment used to keep an
injured body part from moving
and to protect it from any further
damage. A splint is often used
to stabilize a broken bone while
the injured person is taken to
the hospital for more advanced
treatment.
• Orthotic devices are medical
equipment that supports
and improves the function of
weakened joints or limbs.
If your doctor prescribes spasticity
medications and/or Botox injections
to manage contractures, serial
casting, splints and orthotic devices
can also be used. If the spasticity or
HO becomes severe, PT and OT may
be needed to reevaluate mobility and
determine appropriate techniques
for safe and independent functional
mobility.
PT and OT can evaluate your
strength and stamina weaknesses.
Then, your therapy team can tailor

specific activities and exercises to
help you regain strength and stamina.
Your team can also re-assess your
activities from time to time to increase
or decrease your activities and
exercises as needed.
Family Matters
Your family can be very supportive
in helping you reduce stress,
confusion, and manage problem
issues. PT and OT can teach them the
best ways to help you. For example, if
you have problems with learning new
information and solving problems,
your family can learn step-by-step
ways to help you gain new skills and
how to use those skills in a “realworld” setting.
How do I get services?
You may have problem issues
throughout your life after TBI, but you
and your family can get help. This
article only offers a few examples of
how PT and OT can help. There are
many other ways therapy can help
manage issues and continue to get
the most out of life.
Ask your doctor to prescribe a
PT and OT evaluation if you have
any problem issues. Most therapy
services are covered by insurance.
Written by Liz Wylie, PT, DPT, NCS,
Anna Kathryn Hackney, OTR/L, and
Phil Klebine, MA

Questions and Answers: Ticket to Work
What is Ticket to Work?
Ticket to Work is a federal program that helps people
between the ages of 18 and 64 who are getting Social
Security Disability Insurance (SSDI) or Supplemental
Security Income (SSI) go to work.
Will I lose any money or medical benefits if I sign up
for the program?
It is a free program, so you pay no money to sign up.
You also continue to receive your benefits and keep your
Medicare or Medicaid and Social Security benefits that
you have because of your disability.
Do I lose my benefits when I get a job?
Most people want to work, but they do not try to
get a job because they are afraid of losing benefits.

This program aims to help you get a job and become
financially independent without risking your benefits.
There are many “work incentives” that act as a safety
net to protect you. A few of these incentives include
helping you get job skills training, paying for a college
or university education, and trying various jobs to find
the best job for you