Effects of Pain Neuroscience Education and Physiotherapy on Chronic Low Back Pain, Fear of Movement and Functional Status: A Randomised Pilot Study

Background: Chronic non-specific low back pain is a non-harmous condition often found in the general population. It is one of the most significant disabilities and needs different treatment modalities. This study investigates the effects of pain neuroscience education and physiotherapy on pain intensity, fear of movement and functional status in a Lithuanian cohort with non-specific low back pain. Methods: The study was performed at the primary health care unit in Kaunas, Lithuania. The key inclusion criterion was persistent non-specific low back pain longer than three months and which affects daily life functions. Thirty participants (mean 33.47, SD 4.38 years age, 70% women) were randomised into two training groups with and without pain neuroscience education (for a total of 60 min of teaching). Physiotherapy was performed twice per week during 45 min/session for a period of 10 weeks with exercises which strengthen, stabilize, and stretch the spinal cord muscles. Outcomes included pain intensity, kinesiophobia and disability and these were measured by self-scored questionnaires (numeric rating scale, Tampa scale for kinesiophobia-11, Oswestry disability index and the Roland-Morris questionnaire, respectively). Results: The results indicate that both groups improved in the measured outcomes, with the only difference between them being a better improvement in kinesiophobia in the group receiving physiotherapy and pain neuroscience education. Conclusions: The results of this study confirm that a relatively short intervention of pain neuroscience education enhances the effects of physiotherapy and should be implemented in clinical practice.

Physiotherapy on the Biodex Balance System Device is More Effective Than Wobble Board Exercises for Regaining Balance, but not the Lower Limb Muscle Strength, in Stroke Patients

Background. Balance control and restoration of movements are among the most important rehabilitation goals for stroke survivors. There are many techniques used to restore lost function, but there is little research demonstrating the effectiveness of specific equipment in improving balance. The aim. To compare balance and lower limb muscle strength in stroke patients when applying different methods of physiotherapy. Methods. The study included 40 stroke patients with hemiparesis and impaired balance. The subjects were divided into two groups: the first group (n=20) underwent physiotherapy on the Biodex balance system device (with visual feedback), the second group (n=20) – wobble board exercises. Both groups underwent 45-minute physiotherapy sessions 5 times a week (in total, 20 procedures). The subjects were tested at baseline and after physiotherapy. Balance was evaluated by applying the Best Evaluation Systems Test (BEST), and lower limb muscle strength – by using the Oxford muscle strength scale. Results. Physiotherapy on the Biodex balance system device as well as wobble board exercises improved balance and muscle strength in stroke patients. Furthermore, the balance results of the first group (Biodex) was significantly greater than those of the second group (wobble board). No difference in muscle strength parameters was found between the groups. Conclusion. Physiotherapy using the Biodex balance system device (with visual feedback) was superior to wobble board exercises for improving the balance abilities, but not the lower limb muscle strength, in stroke patients. Keywords: stroke, physiotherapy, Biodex, balance, muscle strength, lower limb.

Kineziterapijos su vizualiu grįžtamuoju ryšiu ir be jo poveikis sergančiųjų kaklinės stuburo dalies radikulopatija skausmo intensyvumui, motyvacijai ir funkcijai

Tyrimo pagrindimas. Vizualus grįžtamasis ryšys yra svarbus judesių mokymosi procesui, kuris reabilitacijos srityje naudojamas esant įvairiems funkciniams sutrikimams, tačiau trūksta tyrimų, analizuojančių kineziterapijos su vizualiu grįžtamuoju ryšiu ir be jo poveikį sergančiųjų kaklinės stuburo dalies radikulopatija skausmo intensyvumui, funkcinei būklei ir motyvacijai. Tikslas – įvertinti sergančiųjų kaklinės stuburo dalies radikulopatija skausmo intensyvumo, motyvacijos ir funkcinių rodiklių kaitą taikant kineziterapiją su grįžtamuoju ryšiu ir be jo. Metodai. Buvo tirta 18 asmenų, kuriems diagnozuota kaklinės stuburo dalies radikulopatija. Jie buvo suskirstyti į dvi grupes. Pirmai grupei (n = 9) buvo taikoma kineziterapija be vizualaus grįžtamojo ryšio, antrai (n = 9) – kineziterpija su vizualiu grįžtamuoju ryšiu atliekant pratimus prieš veidrodį ir naudojant „Stabilizer“ slėgio matavimo prietaisą. Prieš intervenciją ir po jos buvo vertintas skausmo intensyvumas, galvos ir kaklo judesių amplitudės, kaklo lenkiamųjų raumenų funkcija bei tiriamųjų motyvacija. Rezultatai. Abiejose tiriamosiose grupėse sumažėjo skausmo intensyvumas (p < 0,05). Po kineziterapijos abiejų grupių tiriamųjų aktyvios galvos ir kaklo judesių amplitudės statistiškai reikšmingai padidėjo (p  <  0,05) ir atitiko normas. Giliųjų galvos ir kaklo lenkiamųjų raumenų ištvermė abiejose grupėse reikšmingai nepakito (p > 0,05). Po kineziterapijos su vizualiu grįžtamuoju ryšiu padidėjo tiriamųjų vidinės motyvacijos rodikliai (p < 0,05). Išvados. Taikant kineziterapiją su vizualiu grįžtamuoju ryšiu ir be jo, sumažėjo sergančiųjų kaklinės stuburo dalies radikulopatija skausmo intensyvumas ir pagerėjo judesių amplitudė. Kineziterapija su vizualiu grįžtamuoju ryšiu buvo veiksmingesnė gerinant motyvaciją. Raktažodžiai: radikulopatija, kaklo skausmas, kineziterapija, vizualus grįžtamasis ryšys, motyvacija.

The Effects of Occupational Therapy Intervention on the Independence of Children with Cerebral Palsy

Background. Cerebral palsy (CP) is a condition of impaired movement or positioning arising from the immature brain defect or subsequent damage. Occupational therapy can be defined as a broad method of support enabling the affected person to get through the everyday situations independently and responsibly. Research aim. The aim of the research was to assess the requirements and impact of occupational therapy on the independence of children with cerebral palsy. Methods. The study was conducted at children’s rehabilitation sanatorium in “Palanga Amber”, Palanga. Researched sample consisted of 30 children (and their parents/guardians) with cerebral palsy who were at the second stage of their rehabilitation treatment. The average age of the researched group was 9.3 ± 3.9 years. Both girls and boys were of the same age on average, i.e. the age across both genders was distributed evenly. Children who participated in the research were selected at random. Children’s independence was assessed using standardised Taxonomy Test before and after the occupational therapy. A questionnaire, devised by the author of this study, was used to capture parents’ (guardians’) opinions on the occupational therapy. The questionnaire was filled in during the last session of occupational therapy. Results. At the very start of the occupational therapy the average score on Taxonomy test was 78.7 ± 20.5 points, whilst at the end of the treatment it increased to 87 ± 21.5 points. Children’s independence levels significantly improved across the entire researched sample (p < 0.05) (with the statistical confidence level of 95 per cent). After the occupational therapy the average of girls’ points increased significant by 7.5 ± 3.6 points (p < 0.05) and at the end of occupational therapy reached 83.8 ± 22.8 points. Assessment of the alteration/changes of boys’ independence was statistically significant as well and during the occupational therapy increased by 8.8 ± 4.5 points (p < 0.05) reaching 80.4 ± 20.2 points. Questioned 11 (37%) parents of the girls with cerebral palsy told that the independence skills of their children increased after the occupational therapy and 1 (%) parent told that the occupational therapy had no positive influence to the child. Parents of boys with cerebral palsy indicated that independence skills for 17 (57%) of boys increased and had no positive influence to 1 (3%) child. Parent questionnaire results revealed that the occupational therapy had a significant impact on the independence of children with cerebral palsy. Conclusions. We suggest that occupational therapy had a significant impact on children with cerebral palsy independently of their gender, age, condition, etc. Parents were of the opinion that their children readily participated in occupational therapy sessions and applied their learned skills in their everyday activity. Most parents (94%) told that occupational therapy was necessary to their children and it led to the improvement of children’s independence skills.Keywords: cerebral palsy, occupational therapy, independence.

Evaluation of Surface Hygiene of the Surrounding Objects in a University Hospital

Research background. Hygiene of the surfaces means a clean environment of a hospital, especially that of a patient, which consists of constant basic cleaning and disinfection. The registration, analysis and storage of data on cleaning, disinfecting the surrounding objects is a successful stage in ensuring clean surfaces. The registration of documents and the cleaning and disinfecting schedule help to determine the tender spots in the surface cleaning. It makes easy to establish the surface hygiene violations, participation of the nursing and auxiliary staff in disinfecting the surfaces, problems related to the surface disinfection, and make the analysis of the mistakes made easier. The aim of the study. To assess a 2009–2011 hygienic preparation of medical surfaces, which have an effect on the transmission of the hospital-acquired infection, and the efficiency of the preventative measures. Methods. The survey was conducted in university hospital in 2009–2011. To evaluate the surface hygiene of the environmental objects the test of the remains of biological contamination was chosen using the chemical means HemoCheck-S™. The accuracy of the test is 0.1 µq of the remains of biological contamination on the surfaces under investigation. The results are evaluated by calculating the amount of denatured biological contamination from the highest concentration to 0. The surface contamination is evaluated in points from “0” to “5”, where “0” is no contamination (medical surface is fully prepared for a procedure), and “5” is maximum contamination (100 µq, maximum contamination shown by the HemoCheck-S™ test). Results. Investigation shows that the surfaces belonging to the low-risk group are contaminated most heavily. The analysis of the investigations carried out during three years leads us to the conclusion that during the time of cleaning the surface, the staff fails to observe the sequence and do not change soft inventory (napkins) intended for cleaning. This is testified by presence of biological contamination in the low-risk group: switch-boards on the patients’ beds, cupboards and drip mounts. Conclusions. Insufficient hygiene of high, medium risk and often touched surfaces and surfaces of nursing measures was established. The inadequate preparation of the medical surfaces was most often made in the Intensive Care Intensive Therapy units.Keywords: hygienic preparation; medical surfaces; the hospital-acquired infection.

Cognitive and Movement Functional Change for a Patient with Huntington`s Disease Using a Video Exercise Program at Home

Background. Huntington’s disease (HD) is a neurodegenerative, progressive central nervous system disease. Physiotherapy can affect the course of the disease, so it is important to determine the effects of physical exercises on the movement and cognitive function. Aim of the study was to evaluate the effectiveness of video exercise program at home, applied simultaneously and separately to physiotherapy, to the cognitive and motor function of a patient with HD. Methods. A 39-year-old man with HD was studied. Firstly, the patient performed a video exercise program at home. Then he did the same and participated in individual physiotherapy. The risk of falls was assessed using the “Timed up and go test”, balance was assessed using the “Berg Balance Assessment Scale” and the “Biodex” system, the gait was assessed using the “Zebris” system, cognitive functions was assessed using the “Mini-mental state examination test” and motor function was assessed using “Unifed Huntington‘s disease rating scale”. Results. After applying the video home exercise program, the risk of falls was reduced, the patient’s balance improved, posture stability, the length and width of the step have increased. The use of video home exercise program with physiotherapy signifcantly improved cognitive function. Conclusions. A structured exercise program at home is effective for balancing, improving posture stability, improving step length, width, decreasing the risk of falls, and it combined with individual physiotherapy, effectively improves the cognitive function of HD patient.Keywords: Huntington’s disease, video exercise program at home, cognitive and movement functions.

The Influence of Preparatory Boxing Exercises on the Postural Stability and Hands Psychomotor Ability in Patients with Parkinson`s Disease

Research background. Parkinson’s disease is the second most common neurodegenerative disease. As the incidence of Parkinson’s disease is increasing, more and more new and exciting physical therapy methods are being sought to help reduce the symptoms of the disease. Currently, training sessions for preparatory boxing exercises are becoming increasingly popular. The aim. In this study our goal was to determine the influence of preparatory boxing exercises in physical therapy on the postural stability and hands psychomotor ability in patients with Parkinson’s disease. Methods. 22 volunteers with Parkinson’s disease participated in this research. Patients were divided into 2 groups: intervention group (n = 11) and control group (n = 11). Intervention group had preparatory boxing exercise for twice every week, for four months. No intervention was applied for control group. The Biodex Balance System was chosen to evaluate the postural stability and the RA-1 Reactiometer was used to assess the hand psychomotor reaction. Results. The four-month preparatory boxing exercises in physical therapy have signifcantly improved the statistical parameters of postural stability and hand psychomotor reaction in people with Parkinson’s disease (p < 0.05). In subjects with Parkinson’s disease, the indicators in the non-attendance program did not change. Conclusions. According to the results, along with the knowledge that all volunteers had completed the research, we can state that preparatory boxing exercise in physiotherapy is safe and effective for patients with Parkinson’s disease, thus the inclusion of boxing excercise to be included in the physical therapy course is recommended.Keywords: Parkinson’s disease, preparatory boxing exercises, postural stability, hand psychomotor reaction.

Relationship between Sensory Integration, Postural Stability and Fall Risk Assessment Parameters Using Physical Therapy for Individuals after Traumatic Brain Injury

Research background. Equilibrium and posture impairment is a common cause of collapse in individuals experiencing traumatic brain injury, which limits patient autonomy and independence in daily activities. Therefore, the recovery of balance is one of the primary goals of rehabilitation for individuals following the traumatic brain injury (Llorens et al., 2013). The aim was to determine the relationship between sensory integration, postural stability and fall risk assessment parameters using physiotherapy for individuals with traumatic brain injury. Methods. The study involved 16 people with traumatic brain injury. The subjects were divided into two groups – the frst one (n = 8) and the second one (n = 8). The frst group was taking 30 minutes regular physiotherapy and 30 minutes balance training with Biodex Balance System, second group – 30 min. regular physiotherapy and 30 minutes regular exercises for balance. Results. Changes in the postural stability index, anterior /posterior and medial/ lateral fluctuation indexes, fall risk stability index and clinical sensory integration test index in both groups did not change statistically signifcant (p > 0.05). A strong, statistically signifcant direct relationship was found in the frst study group between the postural stability index and the fluctuation of the anterior /posterior index changes (r = 0.922; p = 0.001). Conclusions. Physiotherapy using the Biodex Balance System and the usual physiotherapy is equally effective in developing postural stability, sensory integration, and fall risk. The link between many of the studied indicators shows that postural stability, sensory integration and the risk of falls are related.Keywords: traumatic brain injury, sensory integration, postural stability, fall risk, physiotherapy.

Methods for Improving Quadriceps Femoris Strength after Total Knee Arthroplasty

Research background. The recovery of quadriceps femoris muscle strength after total knee arthroplasty is suboptimal. Quadriceps weakness is associated with decreased gait speed, balance, stair–climbing and chair rise ability, as well as increased risk for falls. Scientifc data about the impact of physiotherapy methods for quadriceps strength is ambiguous. The goal of research was to review and analyse studies evaluating effectiveness of physiotherapy for quadriceps femoris strength after total knee arthroplasty. Methods. Fourteen full articles in English, published in 2006–2016, were selected and analysed; the articles met the following criteria: randomised controlled trials were reviewed if they assessed quadriceps strength, and compared two or more physiotherapy methods after primary total knee arthroplasty for osteoarthritis. Results. In total 1011 people after total knee arthroplasty participated in the analysed studies. The impact of progressive strength training, aquatic physical therapy, and resistance exercises using vibration plate, neuromuscular electrical stimulation, preoperative physiotherapy, traditional physiotherapy and telerehabilitation were assessed. It has been specifed that quadriceps strength significantly increases and functional status improves using various physiotherapy methods, but the most effcient methods are unclear, the data of the studies are ambiguous. Conclusions. Various physiotherapy methods are used for the improvement of the quadriceps muscle strength after total knee arthroplasty: preoperative physiotherapy, resistance exercises, aquatic physiotherapy, whole body vibration, neuromuscular electrical stimulation. Telerehabilitation is as effective as traditional rehabilitation in patients after total knee arthroplasty. There is a lack of scientific research that would deny or confrm the advantages of less frequently used physiotherapy methods against traditional physiotherapy, as well as the recommendations of their use after total knee arthroplasty.Keywords: total knee arthroplasty, physiotherapy, quadriceps femoris, muscle strength.

Effect of Kinesio Taping on Arm Function in Stroke Patients in the Early Stage of Rehabilitation

Substantiation of the study. There is a lack of literature about the efficiency of Kinesio Taping methods which improve recovery of arm functions for patients after stroke in the early stage of rehabilitation. The aim of the study was to determine the effect of Kinesio Taping on the recovery of the affected arm function in stroke patients during the early stage of rehabilitation. Subjects and methods. Forty stroke patients were divided into two groups. Inclusion criteria for the subjects were: age under 75 years, affected arm muscle strength – at least 2 points, and cognitive function – at least 11 points according Mini mental state exam (moderate cognitive impairment). The patients of the frst group had only exercise therapy, while to the patients of the second group exercised together with the applied Kinesio Taping method. Patients’ affected hand strength was measured using a dynamometer, arm function was assessed by Wolf Motor test, a modifed Motor Assessment Scale and modifed Fugl-Meyer motor function impairment test. Results. After physiotherapy procedures, the evaluation of arm function with Wolf and Fugl-Meyer tests showed signifcant improvement in the both groups: in the frst group of patients, Wolf test results indicated the change and the estimated values were 49.4 ± 1.3 points, in the second group – 23.1 ± 2.0 points, Fugl-Meyer test – 31.3 ± 0.3 and 21.9 ± 0 6 points (p < 0.05). In the frst group of patients, hand muscle strength improved signifcantly by 26.2 ± 2.2 kg, in the second group – 12.2 ± 1.8 kg (p < 0.05). In the frst group of patients, shoulder motion recovery by JVS improved by 3.0 ± 0.1 points, in the second group – 2.1 ± 0.1 points, hand movements recovery – by 2.6 ± 0.1 and 1.7 ± 0.1 points, complex hand movements – by 2.8 ± 0.1 and 1.4 ± 0.1 points (p < 0.05). Conclusions. The effect of exercises with Kinesio Taping on the affected arm function in stroke patients was signifcantly more pronounced (p < 0.05) than the effect of exercises only.Keywords: stroke, arm function, Kinesio Taping, physiotherapy

The Impact of Behaviour and Emotions of Children with Cerebral Palsy on their Skills of Daily Activities as well as their Parent`s Quality of Life

Reseach background. Cerebral palsy is a disorder of movement or position resulting from the immature encephalon defect or damage. Level of independence, behavioural and emotional skills of children with cerebral palsy are some of the main parameters of social development. Psychological factor is very important, too. Independent movement disorders and lack of professional help cause a lot of psychological problems in adolescence – depression, nervous excitement, at the time when they begin to understand that they are different from their peers. On the other hand, diffculties which they experience are not short-term, which can be overcome by mobilization of forces and the available internal resources, therefore child’s adequacy also highly depends on the parents’ quality of life. The goal of research was to evaluate behavioural and emotional impact on children’s with cerebral palsy skills of daily activities as well as their parents’ quality of life. Methods. The survey was conducted from May 2014 till April 2015 in Kaunas medical institutions which provided rehabilitation services for children. 30 children with cerebral palsy and their parents participated in the study. Average age of children who participated in the study did not differ signifcantly depending on gender and was 11.6 ± 2.1 years. Results. After the assessment of behavioural and emotional functions of children with cerebral palsy it became clear that they were the most successful in not talking back and swearing near adults. After the assessment of daily activity skills for children with cerebral palsy, it was obtained that the task which was performed the best by the children was communication, and the worst – cooking, bathing and taking the shower, as well as housework. Assessment of parents’ quality of life showed that the best evaluated by parents was their ability to perform what, in their opinion, was necessary in everyday activities, the worst – favourable physical environment for their health. Assessing the impact of behaviour and emotions on children’s with cerebral palsy skills of daily activities, statistically signifcant association was obtained (p < 0.05) between the scales of emotional and behavioural functions and parents’ quality of life among children with cerebral palsy. The study did not show statistically signifcant difference between children’s gender, age, and form of the disease. Conclusions. Children’s with cerebral palsy behaviour and emotions had signifcant influence on their daily living skills (p < 0.005). Children’s with cerebral palsy behaviour and emotions were mostly connected to their ability to use the toilet; the least connection was related to preparation / dressing skills. Children’s with cerebral palsy behaviour and emotions had a signifcant influence on their parent’s quality of life (p < 0.005). Children’s with cerebral palsy behaviour and emotions affected their parent’s environment and health the most, and the least they affected parent’s negative emotions.Keywords: cerebral palsy, behaviour, emotions, quality of life.

Balance evaluation techniques and physical therapy in post-stroke patients: A literature review

A stroke (cerebrovascular accident - CVA) is a significant social-economic issue. Approximately 15-30% of all patients develop life-long disability, 20% require over 3 months of specialized care in healthcare institutions, and the majority of the patients never recover the ability to maintain a proper vertical position. Such CVA sequelae as balance disturbances not only negatively affect patients' daily physical activity, but also result in social isolation. A number of standardized clinical scales, tests, and instrumental examination techniques have been proposed for evaluating not only post-CVA balance function, but also any changes in this function following various interventions. Even though scientific literature lists numerous methods and instruments for the improvement of balance after a CVA, not all of them are equally effective, and there have been rather controversial evaluations of some techniques. Nevertheless, the application of the majority of the techniques as complementary or alternative measures to traditional physical therapy (PT) frequently yields better results.

The impact of physical therapy in patients with severe traumatic brain injury during acute and post-acute rehabilitation according to coma duration

[Purpose] The aim of study was to evaluate the impact of physical therapy on the recovery of motor and mental status in patients who sustained a severe traumatic brain injury, according to coma duration in acute and post-acute rehabilitation. [Subjects and Methods] The study population comprised patients with levels of consciousness ranging from 3 to 8 according to Glasgow Coma Scale score. The patients were divided into 2 groups based on coma duration as follows: group 1, those who were in a coma up to 1 week, and group 2, those who were in a coma for more than 2 weeks. The recovery of the patients’ motor function was evaluated according to the Motor Assessment Scale and the recovery of mental status according to the Mini-Mental State Examination. [Results] The evaluation of motor and mental status recovery revealed that the patients who were in a coma up to 1 week recovered significantly better after physical therapy during the acute rehabilitation than those who were in a coma for longer than 2 weeks. [Conclusion] The recovery of motor and mental status of the patients in acute rehabilitation was significantly better for those in a coma for a shorter period.

The relationship between pain catastrophizing, kinesiophobia and subjective knee function during rehabilitation following anterior cruciate ligament reconstruction and meniscectomy: A pilot study

BACKGROUND AND OBJECTIVE

Psychological responses to the initial injury and rehabilitation might be an important additional determinant of functional level outcomes after knee surgery. The objectives of this study were (1) to measure pain catastrophizing and kinesiophobia levels and (2) determine their association with self-reported subjective knee function during rehabilitation, following anterior cruciate ligament reconstruction (ACLR) and meniscectomy.

MATERIALS AND METHODS

The study involved 41 participants. The levels of catastrophizing (Pain Catastrophizing Scale [PCS]), kinesiophobia (Tampa Scale of Kinesiophobia [TSK-11]), pain (Numeric Pain Rating Scale [NRS]), and subjective knee function (the Knee Injury and Osteoarthritis Outcome Score [KOOS]) were assessed before and after completion of 14-session rehabilitation program.

RESULTS

The mean level of catastrophizing changed from 5.8 (SD, 0.9) to 4.2 (SD, 0.5) during rehabilitation (P<0.05). The mean level of kinesiophobia changed from 22.7 (SD, 0.7) to 18.4 (SD, 0.6) (P<0.05). There was a moderate negative correlation between the PCS and the KOOS pain, function in daily living, knee-related quality of life subscales before and after rehabilitation (P<0.05). There was a moderate negative correlation between the TSK-11 score and the KOOS function in daily living subscale before and after rehabilitation (P<0.05).

CONCLUSIONS

Pain catastrophizing and kinesiophobia decreased during rehabilitation. A higher pain catastrophizing level correlated with a greater level of knee pain during activities, more difficulties experienced during daily activities before and after rehabilitation. A high level of kinesiophobia correlated with more difficulties experienced in daily activities and poorer knee-related quality of life before and after rehabilitation.

[Physical therapy for persons with traumatic brain injury]

Traumatic brain injury is a major public health problem and may result in significant impairment of an individual's physical, cognitive, and psychosocial functioning. Therefore, special attention must be paid to physical therapy that plays an important role in early rehabilitation. Physical therapists have the opportunity to apply various scales and tests for assessment of the functional status of patients with traumatic brain injury and effectiveness of physical therapy: Functional Independence Measure, Disability Rating Scale, Barthel Index, Glasgow Coma Scale, Glasgow Outcome Scale, Rancho Los Amigos Scale, Mini-Mental State Examination, etc. This review presents the analysis of morbidity and mortality after traumatic brain injury, possibilities to assess patients' functional status, characteristics of physical therapy, and factors influencing the efficiency of physical therapy. Complications such as contractures, spasticity, sleep disturbances, impaired balance, as well as the attention and behavior disorders, lack of motivation, depression make difficulties in application of physical therapy and rehabilitation for the persons with traumatic brain injury.