Thanks Fyzzio,

Some well considered comments, this is really useful stuff thank you so much for taking the time. I think I will try to book an appointment with a neurologist to get an opinion - good idea.
I certainly think what you said about trunk control is true, as James trunk control is very weak. The pushing exercises sound good also. Do you think something like hand cycling with resistance might be beneficial? I can see what you are saying about movements in space. I think this is the problem with eating - it is all movement in space and James really struggles with this.
Also agree we need a specialist but neuro physios are so hard to find and specialist physio is such an important role, well any type of physio is - I wish there were more of you out there!!!
Can I just ask about the degenerative process if I may - James accident was just over three years ago and we did not see any shaking for the first year and for the last year it has got much worse. I thought with TBI it was progressive (as in you get better, however slow it is) not degenerative - is this not the case? or is it not as black and white as that?