Abstract
The patient in this case study was a 46-year-old male who sustained a severe Traumatic Brain Injury (TBI) due to a fall from a 40-foot ladder 4 weeks prior to physical therapy evaluation in inpatient rehabilitation. The patient initially presented to the emergency department with a Glasgow Coma Scale score of 8. At the time of inpatient rehabilitation evaluation, his cognitive and behavioral functioning was classified as level IV on the 8-level Rancho Los Amigos Cognitive Function Scale. He had impairments in attention, functional mobility, and balance, all of which limited his ability to participate in activities of daily living. Physical therapy was provided in inpatient rehabilitation for 4 weeks by a student physical therapist under the supervision of a licensed physical therapist. Interventions included task specific functional mobility training, conventional strength training, power training, balance training and dual task training in an open environment. The patient achieved goals in improved strength, improved functional mobility, improved postural control and improved ability to participate in community outings. The patient was discharged to home with family providing supervision due to cognitive deficits. The patient was referred to outpatient physical therapy for continued improvements in power, endurance, neuromuscular control and high-level mobility.