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When do physical therapists try standing with brain injury patients? Only when they are fully talking or mobile?

What are the criteria for the next level of care getting so patients don't lose muscle strength? Especially since some brain injury patients can't move their bodies fully.

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Senior physical therapist

Answer transcribed from Brightway's interview with Dr. Cristen Gordon (pt.2):


That's a very subjective question. I'll say that because one of the things we talk about in the therapy world is that therapy is like an art and a science. It’s highly scientifically grounded but you've got to be really creative and think on your feet in order to reach some of the goals that we're trying to reach here. For that question, I would say the criteria are no issues with blood pressure. Sometimes when you've been in bed for a long time and we suddenly get you standing, your blood pressure can be an issue so that has to be assessed. Also no issues with bone density. If you're not on your feet a lot and you're laying in the bed mostly, your bones become thin and could be susceptible to damage if you suddenly are standing all the way. I have worked in outpatient clinics, inpatient rehab, and acute rehab, and I have seen some patients stand that you did not think would stand. I have seen five therapists work together to help a patient stand. It's important to get people on their feet and even patients that may not have the muscle tone or can't move their bodies themselves, we have devices to help manage that. Again, if we need to get multiple people in on standing, we do that. 


One of the reasons that it's so important is because standing is a reflexive thing for humans. Sometimes, just having that gravity through the legs triggers muscles to turn on where maybe we couldn't volitionally get them to turn on. The other thing is getting weight-bearing in the legs helps maintain bone density and circulation. There's something called a standing frame. If I had a patient who was able to engage with me in some way, or in other words they are able to tell me if they do or don't feel good, whether that is verbally saying it, through facial expression, or any other method of communication, I could put them in a standing frame and support them. The machines have all sorts of straps, clips, and buckles to help keep people in place. The standing frame goes from a seated position up to standing and anywhere in between. There's also a device called a tilt table, which is just a table like a bed that you would lay on that can tilt up into the standing position and anywhere in between. From my perspective and my experience, and I've gotten to work with some really awesome therapists in my career, we get patients up as soon as humanly possible.