Written By: John Gwilliam, PT, MPT, MHA, CWS, Cert DN



Summertime! A season for many of us that indicates a time to relax, to unwind, and to spend more time with family and friends. Anecdotally, the beginning of summer also includes an increase in the number of trauma events as many across the country are out and about. These trauma events will lead to various combinations of injuries and recovery periods, including minor sprains and strain, fractured femurs and ribs, and severe brain injury. The combination of these patient presentations places additional responsibility on healthcare providers to provide a comprehensive treatment plan for efficient and effective recovery. This care starts with the trauma team providing stabilizing and lifesaving care, specialty surgeons stepping in to help with orthopedic, cardiovascular, and neurological care, exceptional care from our nursing colleagues, and early intervention from the rehabilitation team.

To deliver optimal care the rehabilitation team should have a firm understanding of how a patient on trauma service is initially assessed and also be aware of latent patient presentations that may develop. These latent or occult presentations are typically masked by the initial primary pathology, may not be related to direct injury, and often include contributing factors of advanced age (>50 years old), alcohol consumption, history of coagulopathy, and a polytrauma event. Many of these occult injuries or presentations fall into the following categories with key indicators of a potential injury:

Brain Injury
– Mental status changes
– Nausea and vomiting
– Difficulty breathing

Spinal Injury
– Loss of muscle tone and strength
– Bowel and bladder dysfunction
– Paresthesia

– Thoracic insult or injury, including rib fracture
– Shortness of breath, elevated heart rate, and respiratory rate
– Increased potential with the female population

– Significant calf pain
– Edema
– Venous distention

– Dyspnea
– Pleural pain
– Increased respiratory rate
– Cough and/or hemoptysis
– Fatigue

– High-velocity fractures (falls, MVC
– Pain with movement of the extremity
– Increased pain with weight-bearing


These injuries may not present until the patient begins to participate in mobility and therapeutic interventions. Subsequently, it is essential that any therapist providing care to these patients is aware of the potential of these occult presentations and be aware of the typical signs and symptoms for each category. The care of trauma patients is a challenging situation, but ultimately tremendously rewarding as you assist these patients in their recovery process.



Explore online continuing education courses from John below:

A Therapist’s Evidence-Based Approach to Acute and ICU Care Rehab

COVID-19: Clinical Interventions for Therapy

Dry Needling Evidence-Based Concepts and Essential Skills

Early Mobility in Acute Care

Fall Risk Assessment in Acute Care

Medically Complex Patient Care

Pharmacology in the ICU

The Latest Ethical Standards in Physical Therapy

Trauma Care and Recovery in Acute Care

Wound Care Essentials


Visit summit-education.com for more information.



Coles, S.J., et al., (2020). Impact of an early mobilization protocol on outcomes in trauma patients admitted to the intensive care unit: A retrospective pre-post study. Journal of Trauma Acute Care Surgery, 88 (4), 515-521

Resnick, B., et al (2016). Feasibility and Efficacy of Function Focused Care for Orthopedic Trauma Patients. Journal of Trauma Nursing, 23(3), 144-155.

Southerland,  L., et al. (2017). Early geriatric consultation increases adherence to TQIP Geriatric Traum Management Guidelines. Journal of Surgical Research. 216, 56-64