A review of physical modalities and the potential to expand the treatment of patients with traumatic brain injury.

Traumatic brain injuries (TBIs) and hemiplegia often involve alterations in cortical function that are often widespread and may not be confined to the peri-infarct regions. Rehabilitation of these injuries may therefore require extensive and innovative physical modalities and exercise activities that enhance mobility. Disuse in limbs can occur in any brain injury derived from different etiologies and advances in rehabilitation indicate that neuromuscular stimulation of both the nerve supply and muscle groups involved impacts plasticity and prepares the limbs for stronger muscle responses during functional activities. Combined therapies are apparently more productive than monotherapies and this may include electroacupuncture and functional electrical stimulation to expedite recovery. The combination of mixed physiotherapeutic interventions also encourages biokinetics, hydrotherapy and robotic rehabilitation over a prolonged period to enable the patient to achieve functional goals. Recovery may not be achieved within a period of 6 months post injury as has previously been accepted and may even require lifelong participation.