Spatiotemporal Deficits and Kinematic Classification of Gait Following a Traumatic Brain Injury

Cardiorespiratory fitness assessment and training in the early sub-acute phase of recovery following traumatic brain injury: a systematic review

OBJECTIVES

To examine the safety of cardiorespiratory fitness (CRF) assessment and training in the early sub-acute phase of recovery (≤3 months) following moderate-to-extremely severe traumatic brain injury (TBI).

METHODS

A systematic review was completed in accordance with the PRISMA guidelines. Studies investigating adults and adolescents ≥15 years with moderate-to-extremely severe TBI were considered for inclusion. The methodological quality of the included studies was evaluated according to the McMaster Guidelines for Critical Review Form - Quantitative Studies.

RESULTS

Eleven studies with a total of 380 participants were included in the review. Adverse events (AEs) and symptom monitoring were poorly reported. Only four studies reported on the occurrence of AEs, with a total of eight AEs reported. Three of the reported AEs were concussion-like symptoms with no further exercise-induced symptom exacerbation reported. No serious AEs were reported.

CONCLUSION

There is no evidence to suggest that CRF assessment and training is unsafe in the early sub-acute phase of recovery following moderate-to-extremely severe TBI. However, despite the low AE and symptom exacerbation rates identified, a timeframe for safe commencement was unable to be established due to poor reporting and/or monitoring of exercise-induced symptoms and AEs in the current literature.

An integrated approach to the assessment of balance and functional mobility in individuals with history of severe traumatic brain injury

Individuals who experienced severe Traumatic Brain Injury (sTBI) are often characterized by relevant motor dysfunctions which are likely to negatively affect activities of daily living and quality of life and often persist for years. However, detailed objective information about their magnitude are scarce. The aim of this study was to quantitatively assess the extent of motor deficits in terms of postural control effectiveness under static and dynamic conditions and to investigate the existence of possible correlations between the results of clinical tests and instrumental measures. Postural sway and functional mobility (i.e., instrumented Timed Up and Go test, iTUG) were objectively measured in 18 individuals with sTBI and 18 healthy controls using a pressure plate and a wearable inertial sensor. Additionally, participants with history of sTBI completed the Rivermead Mobility Index (RMI). One-way ANOVA and Spearman's rank correlation analysis were employed to examine differences between the two groups and determine potential correlations between the instrumental tests and clinical scales. The results show that people with sTBI were characterized by larger sway area and longer iTUG walking sub-phase. Significant correlations were also detected between RMI scores and iTUG total duration, as well as the walking phase. Taken together, these findings suggest that, even years after the initial injury, individuals with sTBI appear characterized by impaired postural control and functional mobility, which appears correlated with the RMI score. The integration of instrumental measures with clinical scales in the routine assessment and treatment of individuals with sTBI would result in more comprehensive, objective, and sensitive evaluations, thus improving precision in treatment planning, enabling ongoing progress monitoring, and highlighting the presence of motor deficits even years after the initial injury. Such integration is of importance for enhancing the long-term quality of life for individuals with sTBI.

Screening for Brain Injury Sustained in the Context of Intimate Partner Violence (IPV): Measure Development and Preliminary Utility of the Brain Injury Screening Questionnaire IPV Module

Abstract Intimate partner violence (IPV) is associated with risk for multi-etiology brain injury (BI), including repetitive head impacts, isolated traumatic brain injuries (TBI), and anoxic/hypoxic injury secondary to nonfatal strangulation (NFS). IPV-related injuries are often unreported, but evidence suggests that survivors are more likely to report when asked directly. There are currently no validated tools for screening of brain injury related to IPV that meet World Health Organization guidelines for this population. Here, we describe measure development methods and preliminary utility of the Brain Injury Screening Questionnaire IPV (BISQ-IPV) module. We culled items from existing IPV and TBI screening tools and sought two rounds of stakeholder feedback regarding content coverage, terminology, and safety of administration. The resulting stakeholder-informed BISQ-IPV module is a seven-item self-report measure that uses contextual cues (e.g., being shoved, shaken, strangled) to query lifetime history of IPV-related head/neck injury. We introduced the BISQ-IPV module into the Late Effects of TBI (LETBI) study to investigate rates of violent and IPV-specific head/neck injury reporting in a TBI sample. Among those who completed the BISQ-IPV module (n = 142), 8% of the sample (and 20% of women) reported IPV-related TBI, and 15% of the sample (34% of women) reported IPV-related head or neck injury events that did not result in loss or alteration of consciousness. No men reported NFS; one woman reported inferred BI secondary to NFS, and 6% of women reported NFS events. Those who endorsed IPV-BI were all women, many were highly educated, and many reported low incomes. We then compared reporting of violent TBIs and head/neck injury events among individuals who completed the core BISQ wherein IPV is not specifically queried (administered from 2015-2018; n = 156) to that of individuals who completed the core BISQ preceded by the BISQ-IPV module (BISQ+IPV, administered from 2019-2021; n = 142). We found that 9% of those who completed the core BISQ reported violent TBI (e.g., abuse, assault), whereas 19% of those who completed the BISQ+IPV immediately preceding the core BISQ reported non-IPV-related violent TBI on the core BISQ. These findings suggest that standard TBI screening tools are inadequate for identifying IPV-BI and structured cueing of IPV-related contexts yields greater reporting of both IPV- and non-IPV-related violent BI. When not queried directly, IPV-BI remains a hidden variable in TBI research studies.

Does Music Therapy Improve Gait after Traumatic Brain Injury and Spinal Cord Injury? A Mini Systematic Review and Meta-Analysis

There is a growing body of research examining the potential benefits of music therapy-based auditory stimulation (MT) for individuals with movement disorders in improving gait performance. However, there is limited knowledge about the effects of MT on gait outcomes in individuals with traumatic brain injury (TBI) or spinal cord injury (SCI). A previous review of MT's impact on gait in TBI had limitations, and there are no studies on its effects on gait in SCI. In this study, we conducted a meta-analysis to more thoroughly evaluate the impact of MT on gait outcomes in individuals with TBI and SCI. We systematically searched through eight databases and found six studies on MT in TBI and four on SCI. Our meta-analysis showed that MT has positive medium effect improvements on spatiotemporal aspects of gait in individuals with TBI (Hedge's g: 0.52) and SCI (0.53). These findings suggest that MT could be a practical intervention for enhancing different aspects of gait in these populations, although the limited number and "fair" quality of the studies included in the meta-analysis may affect the generalizability of the outcomes. Further research is needed to fully understand the mechanisms by which MT may influence gait and determine the optimal parameters for its use.

Mild traumatic brain injury and sports-related concussion

Mild traumatic brain injury (mTBI) and concussion are equivalent terms for the sequela of injury to the head that disrupts brain functioning. Various forces may be causative from seemingly innocuous bumps to the head resulting from sports-related injuries to more severe blows to the head. However, the postconcussive motor, cognitive, emotional, and psychosocial sequelae can be just as devastating and long lasting, leading to loss of independent function and safe performance of activities. Taken together, they pose a significant challenge to recovery, requiring a multifaceted dynamic rehabilitative strategy. The current systems of health care pose challenges to suboptimal management of sports-related concussion (SRC) that goes beyond the acute injury, and into the school setting, failing to be identified by school staff, and inconsistencies in communicating medical information regarding school modifications, follow-up health services, or concussion-related educational services. Children who sustain SRC at different ages face different challenges. Young children face increased vulnerability due to SRC that coincides with periods of brain motor maturation and development.

Impact of Constraint-Induced Movement Therapy (CIMT) on Functional Ambulation in Stroke Patients-A Systematic Review and Meta-Analysis

Constraint-induced movement therapy (CIMT) has been delivered in the stroke population to improve lower-extremity functions. However, its efficacy on prime components of functional ambulation, such as gait speed, balance, and cardiovascular outcomes, is ambiguous. The present review aims to delineate the effect of various lower-extremity CIMT (LECIMT) protocols on gait speed, balance, and cardiovascular outcomes. Material and methods: The databases used to collect relevant articles were EBSCO, PubMed, PEDro, Science Direct, Scopus, MEDLINE, CINAHL, and Web of Science. For this analysis, clinical trials involving stroke populations in different stages of recovery, >18 years old, and treated with LECIMT were considered. Only ten studies were included in this review, as they fulfilled the inclusion criteria. The effect of CIMT on gait speed and balance outcomes was accomplished using a random or fixed-effect model. CIMT, when compared to controlled interventions, showed superior or similar effects. The effect of LECIMT on gait speed and balance were non-significant, with mean differences (SMDs) of 0.13 and 4.94 and at 95% confidence intervals (Cis) of (-0.18-0.44) and (-2.48-12.37), respectively. In this meta-analysis, we observed that despite the fact that several trials claimed the efficacy of LECIMT in improving lower-extremity functions, gait speed and balance did not demonstrate a significant effect size favoring LECIMT. Therefore, CIMT treatment protocols should consider the patient's functional requirements, cardinal principles of CIMT, and cardiorespiratory parameters.

The Development of Hindlimb Postural Asymmetry Induced by Focal Traumatic Brain Injury Is Not Related to Serotonin 2A/C Receptor Expression in the Spinal Cord

Brain injury and stroke are leading causes of adult disability. Motor deficits are common problems, and their underlying pathological mechanisms remain poorly understood. The serotoninergic system is implicated in both functional recovery from and the occurrence of spasticity after injuries to the central nervous system. This study, which was conducted on rats, investigated the development of limb postural changes and their relationship to the expression of serotonin (5-HT) 2A and 2C receptors in the spinal cord in the 4 weeks after focal traumatic brain injury (TBI) to the right hindlimb sensorimotor cortex. The limb motor deficits were assessed by measuring gait pattern changes during walking and hindlimb postural asymmetry at different time intervals (3−28 days) after surgery. The expressions of the 5-HT2A and 2C receptors in the lumbar spinal cord were investigated using immunohistochemistry. The results showed that all the rats with TBI, independently of the duration of the interval, displayed postural asymmetry with flexion on the contralateral (left) side (>2 mm), while the sham-operated rats showed no apparent postural asymmetry. The TBI rats also had longer stride lengths during walking in both their hindlimbs and their forelimbs compared with the sham rats. For both the TBI and the sham rats, the hind-paw placement angles were larger on the contralateral side in some of the groups. Compared to the sham-operated rats, the 5-HT2A and 2C receptor expression did not significantly change on either side of the lumbar spinal cords of the TBI rats in any of the groups. These results suggest that focal TBI can induce motor deficits lasting a relatively long time, and that these deficits are not related to the expression of the 5-HT2A and 2C receptors in the spinal cord.

Individuals with Chronic Mild-to-Moderate Traumatic Brain Injury Exhibit Decreased Neuromuscular Complexity During Gait

BACKGROUND

Synergy analysis provides a means of quantifying the complexity of neuromuscular control during gait. Prior studies have shown evidence of reduced neuromuscular complexity during gait in individuals with neurological disorders associated with stroke, cerebral palsy, and Parkinson's disease.

OBJECTIVE

The purpose of this study was to investigate neuromuscular complexity during gait in individuals who experienced a prior traumatic brain injury (TBI) that resulted in chronic balance deficits.

METHODS

We measured and analyzed lower extremity electromyographic data during treadmill and overground walking for 44 individuals with residual balance deficits from a mild-to-moderate TBI at least 1 year prior. We also tested 20 unimpaired controls as a comparison. Muscle synergies were calculated for each limb using non-negative matrix factorization of the activation patterns for 6 leg muscles. We quantified neuromuscular complexity using Walk-DMC, a normalized metric of the total variance accounted for by a single synergy, in which a Walk-DMC score of 100 represents normal variance accounted for. We compared group average synergy structures and inter-limb similarity using cosine similarity. We also quantified each individual's gait and balance using the Sensory Organization Test, the Dynamic Gait Index, and the Six-Minute Walk Test.

RESULTS

Neuromuscular complexity was diminished for individuals with a prior TBI. Walk-DMC averaged 92.8 ± 12.3 for the TBI group during overground walking, which was significantly less than seen in controls (100.0 ± 10.0). Individuals with a prior TBI exhibited 13% slower overground walking speeds than controls and reduced performance on the Dynamic Gait Index (18.5 ± 4.7 out of 24). However, Walk-DMC measures were insufficient to stratify variations in assessments of gait and balance performance. Group average synergy structures were similar between groups, although there were considerable between-group differences in the inter-limb similarity of the synergy activation vectors.

CONCLUSIONS

Individuals with gait and balance deficits due to a prior TBI exhibit evidence of decreased neuromuscular complexity during gait. Our results suggest that individuals with TBI exhibit similar muscle synergy weightings as controls, but altered control of the temporal activation of these muscle weightings.

Improvement in postural alignment is associated with recovery of mobility after complex acquired brain injury: An observational study

PURPOSE

Determine how mobility changes over 6 months in people unable to walk at 8-weeks post-Acquired Brain Injury (ABI); if there is an association over time between postural alignment and mobility post-ABI; and if alignment after ABI becomes closer to healthy alignment over time.

METHODS

Fourteen adults with ABI, evaluated over 6 months, and a reference sample of 30 healthy adults were studied. The primary measure for changes in mobility was the Clinical Outcome Variables Scale (COVS). Secondary measures were sit-to-stand, timed standing holding rails, independent walking speed and number of testing conditions achieved. The Functional Independence Measure (FIM) was scored at rehabilitation admission and discharge. To analyze postural alignment, participants were recorded in sitting and standing, each repeated holding rails, and walking if able. Three-dimensional kinematic data were used to quantify whole-body postural alignment, equal to mean segment displacements from the base of support in the transverse plane. Associations between three-dimensional kinematic alignment scores and COVS scores were calculated using Linear Mixed-Effects Models.

RESULTS

Participants made significant improvements in COVS scores, most secondary mobility scores, and FIM scores over time (p ≤ .001). Relationships between increasing COVS scores and decreasing sitting and standing mal-alignment scores were statistically significant. Visual analysis of graphed segment positions indicated that sitting and standing alignment became more similar to healthy alignment over time; this was not clear for walking.

CONCLUSION

Improvement in postural alignment may be a factor for improving mobility in people with severe impairments after ABI.

Rhythm and Music-Based Interventions in Motor Rehabilitation: Current Evidence and Future Perspectives

Research in basic and clinical neuroscience of music conducted over the past decades has begun to uncover music’s high potential as a tool for rehabilitation. Advances in our understanding of how music engages parallel brain networks underpinning sensory and motor processes, arousal, reward, and affective regulation, have laid a sound neuroscientific foundation for the development of theory-driven music interventions that have been systematically tested in clinical settings. Of particular significance in the context of motor rehabilitation is the notion that musical rhythms can entrain movement patterns in patients with movement-related disorders, serving as a continuous time reference that can help regulate movement timing and pace. To date, a significant number of clinical and experimental studies have tested the application of rhythm- and music-based interventions to improve motor functions following central nervous injury and/or degeneration. The goal of this review is to appraise the current state of knowledge on the effectiveness of music and rhythm to modulate movement spatiotemporal patterns and restore motor function. By organizing and providing a critical appraisal of a large body of research, we hope to provide a revised framework for future research on the effectiveness of rhythm- and music-based interventions to restore and (re)train motor function.

Relationship Between Cognition and Gait at 2- and 12-Months Post-Traumatic Brain Injury

Background: A common and debilitating challenge experienced by people with TBI is gait-associated mobility impairment and persisting cognitive impairments. Cognitive and physical impairments are often addressed independently during rehabilitation, however, increasing evidence links cognitive and motor processes more closely. Objectives: (1) To determine if correlations exist between measures of cognitive and gait recovery, post-TBI. (2) To investigate the predictive power of cognition at 2-months on gait outcomes at 12-months post-TBI. Methods: In this secondary, longitudinal study of cognitive and neural recovery, data from 93 participants admitted to an inpatient neurorehabilitation program were analyzed. Spatiotemporal gait variables [velocity, step time variability (STV), step length variability (SLV)] were collected along with cognitive variables [Trail Making Test-B (TMT-B), Digit Span-Forward (DS-F)]. Spearman's correlation coefficients were calculated between gait and cognitive variables. Multilinear and step wise regression analyses were calculated to determine predictive value of cognitive variables at 2-months on gait performance at 12-months-post TBI. Results: At 2-months post-injury, TMT-B was significantly correlated with gait velocity and STV; and DS-F was significantly correlated with velocity. At 12-months post-injury, TMT-B and DS-F was still significant correlated with velocity. TMT-B at 2-months was correlated with SLV and STV at 12-months; and DS-F correlated significantly with velocity. Regression models showed TMT-B at 2-months predicting STV, SLV, and velocity at 12-months. Conclusions: Significant associations and predictions between physical and cognitive recovery post-TBI were observed in this study. Future directions may consider a "neural internetwork" model as a salient rehabilitation approach in TBI that integrates physical and cognitive functions.

The timeframe for safe resumption of high-level mobility following traumatic brain injury is currently unknown: a systematic review

PURPOSE

To examine the safety of high-level mobility (HLM) prescription in the early sub-acute phase of recovery following moderate-to-extremely severe traumatic brain injury (TBI) with specific focus on provocation of concussion-like symptoms.

DESIGN

Systematic review. PROSPERO ID: CRD42017069369.

MAIN MEASURES

Extracted data included study design, brain injury severity, time to commence HLM, type of HLM, physiological and symptom monitoring, and rate of adverse events.

RESULTS

Nineteen studies were included in the review. Fifteen studies included participants who commenced HLM within 6 weeks of injury, with the earliest time to commencement being 3 days. Overall, adverse events and symptom monitoring were poorly reported. A total of six adverse events were reported across three studies. One of the six adverse events was a concussion-like symptom. No falls were reported. No studies monitored concussion-like symptom provocation in direct relation to HLM.

CONCLUSION

A safe timeframe for return to HLM after moderate-to-extremely severe TBI could not be determined due to insufficient reporting of symptom monitoring and adverse events. Further research into the safety of HLM in the early sub-acute rehabilitative stage after moderate-to-extremely severe TBI is required in order to better understand potential sequelae in this population.IMPLICATIONS FOR REHABILITATIONHigh-level mobility assessment and training is commonly reported in the early sub-acute phase of recovery following moderate-to-extremely severe traumatic brain injury.There is no consensus on a safe timeframe to commence high-level mobility assessment or training after moderate-to-extremely severe traumatic brain injury.High-level mobility assessment and training appears to be safe in the early sub-acute phase following moderate-to-extremely severe traumatic brain injury, however, adverse events and symptoms are poorly reported.Clinicians should continue to proceed with caution when assessing and prescribing high-level mobility for patients with moderate-to-extremely severe traumatic brain injury in the early sub-acute phase of recovery and monitor for risks such as falls and exacerbation of concussion-like symptoms.

Gait analysis in a rat model of traumatic brain injury

Gait disruptions following traumatic brain injury (TBI) are noted in the clinical population. To date, thorough analysis of gait changes in animal models of TBI to allow for correlation of pathological alterations and utilization of this as a therapeutic outcome have been limited. We therefore assessed gait using the DigiGait analysis system as well as overall locomotion using the Beam Walk test in adult male Sprague-Dawley rats following a commonly used model of TBI, parietal lobe controlled cortical impact (CCI). Rats underwent DigiGait baseline analysis 24 h prior to injury, followed by a moderate CCI in the left parietal lobe. Performance on the DigiGait was then assessed at 1, 3, 7, and 14 days post-injury, followed by histological analysis of brain tissue. Beam walk analysis showed a transient but significant impairment acutely after injury. Despite observance of gait disturbance in the clinical population, TBI in the parietal lobe of rats resulted in limited alterations in hind or forelimb function. General hindlimb locomotion showed significant but transient impairment. Significant changes in gait were observed to last through the sub-acute period, including right hindpaw angle of rotation and left forelimb and right hindlimb swing phase duration. Slight changes that did not reach statistical significant but may reflect subtle impacts of TBI on gait were reflected in several other measures, such as stride duration, stance duration and stance width. These results demonstrate that moderate-severe injury to the parietal cortex and underlying structures including corpus callosum, hippocampus, thalamus and basal ganglia result in slight changes to gait that can be detected using the Digigait analysis system.

Kinematic cluster analysis of the crouch gait pattern in children with spastic diplegic cerebral palsy using sparse K-means method

BACKGROUND

Crouch gait pattern is a common gait pattern in children with diplegic cerebral palsy with excessive knee flexion throughout stance phase. Few studies have grouped this pattern of gait and usually have examined only the features of gait in the sagittal plane and mostly lower extremities without considering pelvis and trunk behavior. Studies usually categorize the gait pattern according to important variables from the researcher's point of view. Sparse K-means is high dimensional clustering methods that perform clustering and variable selection simultaneously even with low sample size and large number of variables. Our aim was to define existing clusters of crouch gait pattern in children with spastic diplegic cerebral palsy.

METHODS

Cluster analysis was applied on the lower extremity, pelvis and trunk gait kinematics data of 64 limbs of children with crouch gait pattern and 64 limbs of typically developing children. Eighty-nine kinematic variables were used as input variables for clustering.

FINDINGS

Four clusters of crouch gait pattern were defined. Sparse K-means identified influential variables and identified the knee and hip flexion as a major factor in clustering. Kinematic of the trunk, pelvis and ankle was determined in each cluster. Trunk and pelvis kinematic features were strongly correlated with the knee and hip joint flexion severity.

INTERPRETATION

Obtained clusters were confirmed observationally. With increasing knee flexion, the kinematic of the trunk and pelvis were further away from the patterns of typically developing individuals. The clusters ranking appear to be reasonable based on the crouch severity.

Identification of predictive MRI and functional biomarkers in a pediatric piglet traumatic brain injury model

Traumatic brain injury (TBI) at a young age can lead to the development of long-term functional impairments. Severity of injury is well demonstrated to have a strong influence on the extent of functional impairments; however, identification of specific magnetic resonance imaging (MRI) biomarkers that are most reflective of injury severity and functional prognosis remain elusive. Therefore, the objective of this study was to utilize advanced statistical approaches to identify clinically relevant MRI biomarkers and predict functional outcomes using MRI metrics in a translational large animal piglet TBI model. TBI was induced via controlled cortical impact and multiparametric MRI was performed at 24 hours and 12 weeks post-TBI using T1-weighted, T2-weighted, T2-weighted fluid attenuated inversion recovery, diffusion-weighted imaging, and diffusion tensor imaging. Changes in spatiotemporal gait parameters were also assessed using an automated gait mat at 24 hours and 12 weeks post-TBI. Principal component analysis was performed to determine the MRI metrics and spatiotemporal gait parameters that explain the largest sources of variation within the datasets. We found that linear combinations of lesion size and midline shift acquired using T2-weighted imaging explained most of the variability of the data at both 24 hours and 12 weeks post-TBI. In addition, linear combinations of velocity, cadence, and stride length were found to explain most of the gait data variability at 24 hours and 12 weeks post-TBI. Linear regression analysis was performed to determine if MRI metrics are predictive of changes in gait. We found that both lesion size and midline shift are significantly correlated with decreases in stride and step length. These results from this study provide an important first step at identifying relevant MRI and functional biomarkers that are predictive of functional outcomes in a clinically relevant piglet TBI model. This study was approved by the University of Georgia Institutional Animal Care and Use Committee (AUP: A2015 11-001) on December 22, 2015.

Xenon treatment after severe traumatic brain injury improves locomotor outcome, reduces acute neuronal loss and enhances early beneficial neuroinflammation: a randomized, blinded, controlled animal study

BACKGROUND

Traumatic brain injury (TBI) is a major cause of morbidity and mortality, but there are no clinically proven treatments that specifically target neuronal loss and secondary injury development following TBI. In this study, we evaluate the effect of xenon treatment on functional outcome, lesion volume, neuronal loss and neuroinflammation after severe TBI in rats.

METHODS

Young adult male Sprague Dawley rats were subjected to controlled cortical impact (CCI) brain trauma or sham surgery followed by treatment with either 50% xenon:25% oxygen balance nitrogen, or control gas 75% nitrogen:25% oxygen. Locomotor function was assessed using Catwalk-XT automated gait analysis at baseline and 24 h after injury. Histological outcomes were assessed following perfusion fixation at 15 min or 24 h after injury or sham procedure.

RESULTS

Xenon treatment reduced lesion volume, reduced early locomotor deficits, and attenuated neuronal loss in clinically relevant cortical and subcortical areas. Xenon treatment resulted in significant increases in Iba1-positive microglia and GFAP-positive reactive astrocytes that was associated with neuronal preservation.

CONCLUSIONS

Our findings demonstrate that xenon improves functional outcome and reduces neuronal loss after brain trauma in rats. Neuronal preservation was associated with a xenon-induced enhancement of microglial cell numbers and astrocyte activation, consistent with a role for early beneficial neuroinflammation in xenon's neuroprotective effect. These findings suggest that xenon may be a first-line clinical treatment for brain trauma.

The influence of concurrent cognitive tasks on motor performance in people with traumatic brain injury: a pilot study

Background: Performing dual-tasks is often required for completing activities of daily living. Limited research investigated the effects of dual-tasking on gait in people with Traumatic Brain Injury (TBI).Purpose: To investigate the effects of cognitive tasks on gait in people with TBI Methods: Seven individuals with TBI and nine controls completed walking under three conditions; usual walking, walking with questions and answers, and walking with word generation while 3D motion analysis system captured gait.Results: Significant group x condition interactions were found in which TBI group showed greater changes in speed (p < .01), cadence (p = .07), and ankle kinematics (p = .03) as cognitive task became more complex from usual walking to walking with word generation. TBI group decreased speed (p = .02), stride length (p = .01), and hip kinematics (p = .03) as concurrent task became more complex. The control showed decreases in speed (p = .01), stride length (p = .01), and joint kinematics in the hip (p = .03) and knee (p = .01) as the complexity of concurrent cognitive task increased.Conclusion: People with TBI have greater difficulty walking with a cognitive task and show greater compromises in gait performance as the task complexity increases when compared to those without TBI. Clinicians should consider the use of progression in cognitive tasks for dual-task gait training.

Rhythmic Auditory Stimulation and Gait Training in Traumatic Brain Injury: A Pilot Study

Rhythmic auditory stimulation (RAS) has been well researched with stroke survivors and individuals who have Parkinson’s disease, but little research exists on RAS with people who have experienced traumatic brain injury (TBI). This pilot study aimed to (1) assess the feasibility of the study design and (2) explore potential benefits. This single-arm clinical trial included 10 participants who had a 2-week control period between baseline and pretreatment. Participants had RAS daily for a 2-week treatment period and immediately completed post-treatment assessments. Participants then had a 1-week control period and completed follow-up assessment. The starting cadence was evaluated each day of the intervention period due to the variation in daily functioning in this population. All 10 participants were 1–20 years post-TBI with notable deviations in spatial-temporal aspects of gait including decreased velocity, step symmetry, and cadence. All participants had a high risk of falling as defined by achieving less than 22 on the Functional Gait Assessment (FGA). The outcome measures included the 10-m walk test, spatial and temporal gait parameters, FGA, and Physical Activity Enjoyment Scale. There were no adverse events during the study and gait parameters improved. After the intervention, half of the participants achieved a score of more than 22 on the FGA, indicating that they were no longer at high risk of experiencing falls.

Gait Quality Assessment in Survivors from Severe Traumatic Brain Injury: An Instrumented Approach Based on Inertial Sensors

Despite existing evidence that gait disorders are a common consequence of severe traumatic brain injury (sTBI), the literature describing gait instability in sTBI survivors is scant. Thus, the present study aims at quantifying gait patterns in sTBI through wearable inertial sensors and investigating the association of sensor-based gait quality indices with the scores of commonly administered clinical scales. Twenty healthy adults (control group, CG) and 20 people who suffered from a sTBI were recruited. The Berg balance scale, community balance and mobility scale, and dynamic gait index (DGI) were administered to sTBI participants, who were further divided into two subgroups, severe and very severe, according to their score in the DGI. Participants performed the 10 m walk, the Figure-of-8 walk, and the Fukuda stepping tests, while wearing five inertial sensors. Significant differences were found among the three groups, discriminating not only between CG and sTBI, but also for walking ability levels. Several indices displayed a significant correlation with clinical scales scores, especially in the 10 m walking and Figure-of-8 walk tests. Results show that the use of wearable sensors allows the obtainment of quantitative information about a patient’s gait disorders and discrimination between different levels of walking abilities, supporting the rehabilitative staff in designing tailored therapeutic interventions.

Physical Performance and Fall Risk in Persons With Traumatic Brain Injury

Injuries sustained from traumatic brain injury (TBI) culminate in both cognitive and neuromuscular deficits. Patients often progress to higher functioning on the Rancho continuum even while mobility deficits persist. Although prior studies have examined physical performance among persons with chronic symptoms of TBI, less is known about the relatively acute phase of TBI as patients prepare for rehabilitation discharge. The aims of this cross-sectional study were to (a) compare balance and gait performance in 20 ambulant persons with moderate to severe TBI who were nearing rehabilitation discharge with their age-matched controls and (b) describe performance with thresholds for fall risk and community navigation. During a designed task circuit, 40 participants (20 persons with TBI and 20 controls) performed the Timed Up and Go (TUG), gait velocity, and Walking and Remembering tests. Balance testing included the Fullerton Advanced Balance Scale (FABS) and instrumented Modified Clinical Test for Sensory Interaction in Balance (MCTSIB). Statistical analyses included analysis of covariance for group comparisons and a multivariate analysis of covariance for MCTSIB sway velocities with anthropometric controls. The TBI group (mean [ M] age = 42, standard deviation [ SD] =19.5 years; 70% males) performed significantly more poorly on all mobility tests ( p < .05) and their scores reflected a potential fall risk. Gait velocity was significantly slower for the TBI versus control group ( M = .96, SD = 2.6 vs. M = 1.5, SD = 2.2 m/s; p < .001), including TUG times ( M = 13.5, SD = 4.9 vs. M = 7.7, SD = 1.4; p < .001). TBI participants also demonstrated significantly greater sway velocity on all MCTSIB conditions ( p < .01) and lower performance on the FABS ( p < .001). Performance indices indicate potential fall risk and community navigation compromise for individuals with moderate to severe TBI. Physical performance scores support the need for continued interventions to optimize functional mobility upon discharge.

Effect of Dual-Task Conditions on Gait Performance during Timed Up and Go Test in Children with Traumatic Brain Injury

Background

Tasks requiring simultaneous mobility and cognition (dual tasks) have been associated with incidence of falls. Although these deficits have been documented in individuals with neurologic disorder, the effect of dual task in children with traumatic brain injury has not been fully explored.

Objective

To investigate the effect of dual-task (dual-motor and dual-cognitive task) conditions on spatiotemporal gait parameters during timed up and go test in children with traumatic brain injury.

Methods and Material

A total of 14 children with traumatic brain injury and 21 typically developing children participated in this case-control study. Functional balance was assessed before the actual testing to predict the risk of falls. Timed up and go test was performed under single-task and dual-task (dual-motor and dual-cognitive task) conditions. Spatiotemporal gait parameters were determined using the APDM Mobility Lab system. The descriptive statistics and t-test were used to analyze demographic characteristics and repeated measure ANOVA test was used to analyze the gait parameters.

Results

Under dual-task (dual-motor and dual-cognitive task) conditions during the timed up and go test, gait performance significantly deteriorated. Furthermore, the total time to complete the timed up and go test, stride velocity, cadence, and step time during turning were significantly different between children with traumatic brain injury and typically developing children.

Conclusions

These findings suggest that gait parameters were compromised under dual-task conditions in children with traumatic brain injury. Dual-task conditions may become a component of gait training to ensure a complete and comprehensive rehabilitation program.

Abnormal muscle activation patterns are associated with chronic gait deficits following traumatic brain injury

BACKGROUND

Gait and balance disorders are common among individuals who have experienced a mild to moderate traumatic brain injury (TBI). However, little is known about how the neuromuscular control of gait is altered following a TBI.

RESEARCH QUESTION

Investigate the relationship between lower limb muscle activation patterns and chronic gait deficits in individuals who previously experienced a mild to moderate TBI.

METHODS

Lower extremity electromyographic (EMG) signals were collected bilaterally during treadmill and overground walking in 44 ambulatory individuals with a TBI >1 year prior and 20 unimpaired controls. Activation patterns of TBI muscles were cross-correlated with normative data from control subjects to assess temporal phasing of muscle recruitment. Clinical assessments of gait and balance were performed using dynamic posturography, the dynamic gait index, six-minute walk test, and preferred walking speed.

RESULTS

TBI subjects exhibited abnormal activation patterns in the tibialis anterior, medial gastrocnemius, and rectus femoris muscles during both overground and treadmill walking. Activation patterns of the vastus lateralis and soleus muscles did not differ from normal. There was considerable heterogeneity in performance on clinical balance and gait assessments. Abnormal muscle activation patterns were significantly correlated with variations in the dynamic gait index among the TBI subjects.

SIGNIFICANCE

Individuals who have experienced a prior TBI do exhibit characteristic changes in the temporal coordination of select lower extremity muscles, which may contribute to impairments during challenging walking tasks.

Immediate effect of scalp acupuncture on the gait of patients with subacute intracerebral haemorrhage analysed by three-dimensional motion: secondary analysis of a randomised controlled trial

OBJECTIVE

To investigate the immediate effect of scalp acupuncture on walking pattern, using three-dimensional gait analysis (3D-GA), among patients in the subacute stage of intracerebral haemorrhage (ICH).

METHODS

A subset of 30 patients with subacute ICH participating in a recently published randomised controlled trial who were able to walk independently were assessed by 3D-GA before and immediately after scalp acupuncture treatment (treatment group) or no intervention (control group) and the results presented here as a secondary analysis. The acupuncture manipulation was repeated three times with an interval of 5 min. Spatiotemporal and kinematic parameters during walking were collected and analysed using a 3D motion analysis system.

RESULTS

After treatment, there were significant differences between the treatment and control groups in the spatiotemporal parameters of step length, velocity and cadence (p<0.05) and double-limb support. No significant difference was found in step width. When kinematic parameters were evaluated, the treatment group showed a significantly decreased peak pelvic anterior tilt angle and an increased hip extension angle after scalp acupuncture treatment, whereas the control group demonstrated no temporal changes. There were no significant changes in any other kinematic parameters in either group.

CONCLUSIONS

As the first exploratory study to investigate the effect of the scalp acupuncture on gait performance in patients with subacute ICH, this secondary analysis of a recent randomised trial suggested an immediate effect of treatment on spatiotemporal parameters. Improvement in gait pattern may be associated with a decreased anterior tilt of the pelvis and augmented hip joint motion during walking.

TRIAL REGISTRATION NUMBER

ChiCTR-TRC-08000225; Post-results.

Home-based circuit training program for an adolescent female with severe traumatic brain injury: A case report

Adolescents with traumatic brain injury (TBI) are often discharged from physical therapy (PT) services without transitioning into exertional conditioning programs. Active participation in physical activities with peers at school is essential to achieve a sense of accomplishment and acceptance. Factors such as reduced aerobic fitness and residual gait impairments can lead to limited participation and peer interaction. The purpose of this case report was to describe the impact of home-based circuit training (HBCT) focusing on strength and balance on gait speed (GS), energy expenditure, and functional performance in a 17-year-old female with severe TBI. The participant sustained a TBI from a motor vehicle crash. Although she was ambulatory and independent with the basic activities of daily living following two years of rehabilitation, she presented with activity limitations and participation restrictions at school. The participant performed a 4-week HBCT program developed by a school physical therapist that focused on strength and balance. At the end of 4 weeks, improvements were observed in 6 MWT (change = 79.7 m), GS (change = 0.22 m/s), and the COPM scores (performance score change = 2.8, satisfaction score change = 2.2, MCID = 2). Improvements in functional performance, gait speed, and self-perception of occupational performance were observed following 4-week HBCT. Future clinical trials on short duration, HBCT program for children and young adults with TBI are recommended in order to establish effectiveness of HBCT.

Is there a relationship between postural alignment and mobility for adults after acquired brain injury? A systematic review

PRIMARY OBJECTIVE

To examine the relationship between postural alignment and mobility skills for adults after acquired brain injury (ABI).

METHODS

Systematic review of the literature. Seven electronic databases, grey literature and reference lists of the shortlisted publications were searched. Studies were included if participants were adults with ABI, both postural alignment and mobility were measured and analysis included a relationship between alignment and mobility. Those that met the inclusion criteria were assessed with a critical appraisal tool. The review was registered with PROSPERO, registration number CRD42015019867.

RESULTS

Seven observational studies were included that had examined a relationship between postural alignment and mobility after ABI. Critical appraisal scores were moderate to strong. While some studies reported that improved postural alignment was related to improved mobility after ABI, results varied and there was insufficient evidence to answer the primary question. Heterogeneous study designs did not allow meta-regression.

CONCLUSIONS

A small amount of observational evidence exists for a relationship between postural alignment and mobility after ABI. Results vary, with some studies reporting that a more stable, upright trunk correlates with better mobility, and others providing conflicting or ambiguous results. Further research is needed to establish the relationship between postural alignment and mobility skills after ABI.

Validity of a Wireless Gait Analysis Tool (Wi-GAT) in assessing spatio-temporal gait parameters at slow, preferred and fast walking speeds

BACKGROUND

The wireless gait assessment tool (Wi-GAT) measures have been shown to have good to excellent concurrent validity with preferred walking speeds, however, the validity of the Wi-GAT measures at slow and fast walking speeds is unknown.

OBJECTIVE

To establish validity of the Wi-GAT spatio-temporal gait measures at slow, fast, and preferred walking speeds.

METHODS

Twenty two healthy adult volunteers, with a mean age of 25.7 (± 5.3) participated in this study. The spatio-temporal gait variables of each participant were concurrently recorded using the GAITrite and the Wi-GAT system, while the participants performed 3 trials for each walking speed in a randomized order. Intraclass correlation analyses were performed to establish the agreement between the measures recorded by the GAITrite and Wi-GAT systems.

RESULTS

Walking speed measured both by the Wi-GAT and the GAITrite systems showed excellent agreement for preferred (ICC = 0.979 p< 0.001), slow (ICC = 0.989 p< 0.001) and fast (ICC = 0.967 p< 0.001) walking speeds. Most gait parameters recorded at slow walking speed showed good (ICC > 0.70) to excellent (ICC > 0.85) agreement.

CONCLUSIONS

Gait parameters recorded by the Wi-GAT system showed fair to excellent validity for preferred and slow walking speeds.

Predictors of physical activity levels of individuals following traumatic brain injury remain unclear: A systematic review

OBJECTIVE

To identify factors which influence physical activity levels (PALs) of people with traumatic brain injury (TBI).

DATA SOURCES

Eight electronic databases.

STUDY SELECTION

A systematic search was performed to identify articles that reported the measurement (quantity) of PALs of individuals with TBI.

DATA EXTRACTION/SYNTHESIS

Two authors reviewed andextracted the data independently. Article quality was evaluated using the Law critical review tool.

RESULTS

Six studies were identified that met the inclusion criteria. All studies found that PALs of participants with TBI were below those recommended for health benefits. Although a number of environmental and personal barriers restricted PA participation, motivation and exercise self-efficacy were the most frequently identified facilitators of PA in the TBI population. Despite apparent links, the relationship between mobility capacity and PALs was unclear from the results of this systematic review.

CONCLUSION

The results of this systematic review demonstrated that little is known about PALs of individuals with TBI. PALs of participants with TBI were less than required for health maintenance. Self-efficacy to exercise and motivation were the most frequently identified facilitators of PA in the TBI population.

Xenon improves neurologic outcome and reduces secondary injury following trauma in an in vivo model of traumatic brain injury

OBJECTIVES

To determine the neuroprotective efficacy of the inert gas xenon following traumatic brain injury and to determine whether application of xenon has a clinically relevant therapeutic time window.

DESIGN

Controlled animal study.

SETTING

University research laboratory.

SUBJECTS

Male C57BL/6N mice (n = 196).

INTERVENTIONS

Seventy-five percent xenon, 50% xenon, or 30% xenon, with 25% oxygen (balance nitrogen) treatment following mechanical brain lesion by controlled cortical impact.

MEASUREMENTS AND MAIN RESULTS

Outcome following trauma was measured using 1) functional neurologic outcome score, 2) histological measurement of contusion volume, and 3) analysis of locomotor function and gait. Our study shows that xenon treatment improves outcome following traumatic brain injury. Neurologic outcome scores were significantly (p < 0.05) better in xenon-treated groups in the early phase (24 hr) and up to 4 days after injury. Contusion volume was significantly (p < 0.05) reduced in the xenon-treated groups. Xenon treatment significantly (p < 0.05) reduced contusion volume when xenon was given 15 minutes after injury or when treatment was delayed 1 or 3 hours after injury. Neurologic outcome was significantly (p < 0.05) improved when xenon treatment was given 15 minutes or 1 hour after injury. Improvements in locomotor function (p < 0.05) were observed in the xenon-treated group, 1 month after trauma.

CONCLUSIONS

These results show for the first time that xenon improves neurologic outcome and reduces contusion volume following traumatic brain injury in mice. In this model, xenon application has a therapeutic time window of up to at least 3 hours. These findings support the idea that xenon may be of benefit as a neuroprotective treatment in patients with brain trauma.

Effects of traumatic brain injury on locomotor adaptation

BACKGROUND AND PURPOSE

Locomotor adaptation is a form of short-term learning that enables gait modifications and reduces movement errors when the environment changes. This adaptation is critical for community ambulation for example, when walking on different surfaces. While many individuals with traumatic brain injury (TBI) recover basic ambulation, less is known about recovery of more complex locomotor skills, like adaptation. The purpose of this study was to investigate how TBI affects locomotor adaptation.

METHODS

Fourteen adults with TBI and 11 nondisabled comparison participants walked for 15 minutes on a split-belt treadmill with 1 belt moving at 0.7 m/s, and the other at 1.4 m/s. Subsequently, aftereffects were assessed and de-adapted during 15 minutes of tied-belt walking (both belts at 0.7 m/s).

RESULTS

Participants with TBI showed greater asymmetry in interlimb coordination on split-belts than the comparison group. Those with TBI did not adapt back to baseline symmetry, and some individuals did not store significant aftereffects. Greater asymmetry on split-belts and smaller aftereffects were associated with greater ataxia.

DISCUSSION

Participants with TBI were more perturbed by walking on split-belts and showed some impairment in adaptation. This suggests a reduced ability to learn a new form of coordination to compensate for environmental changes. Multiple interacting factors, including cerebellar damage and impairments in higher-level cognitive processes, may influence adaptation post-TBI.

CONCLUSIONS

Gait adaptation to novel environment demands is impaired in persons with chronic TBI and may be an important skill to target in rehabilitation.

VIDEO ABSTRACT AVAILABLE

(See Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A74) for more insights from the authors.

Reflex control of robotic gait using human walking data

Control of human walking is not thoroughly understood, which has implications in developing suitable strategies for the retraining of a functional gait following neurological injuries such as spinal cord injury (SCI). Bipedal robots allow us to investigate simple elements of the complex nervous system to quantify their contribution to motor control. RunBot is a bipedal robot which operates through reflexes without using central pattern generators or trajectory planning algorithms. Ground contact information from the feet is used to activate motors in the legs, generating a gait cycle visually similar to that of humans. Rather than developing a more complicated biologically realistic neural system to control the robot's stepping, we have instead further simplified our model by measuring the correlation between heel contact and leg muscle activity (EMG) in human subjects during walking and from this data created filter functions transferring the sensory data into motor actions. Adaptive filtering was used to identify the unknown transfer functions which translate the contact information into muscle activation signals. Our results show a causal relationship between ground contact information from the heel and EMG, which allows us to create a minimal, linear, analogue control system for controlling walking. The derived transfer functions were applied to RunBot II as a proof of concept. The gait cycle produced was stable and controlled, which is a positive indication that the transfer functions have potential for use in the control of assistive devices for the retraining of an efficient and effective gait with potential applications in SCI rehabilitation.

The impacts of injury at the individual, community and societal levels: a systematic meta-review

OBJECTIVES

Injury is a major public health problem. While the impacts of injury on the injured person are well documented, there is relatively little knowledge about the impacts of injury on those individuals and groups in the community connected to the injured person. This study seeks to describe this breadth of research using a meta-review methodology.

STUDY DESIGN

Systematic meta-review.

METHODS

To gain a better understanding of the known impacts of injury on family, community and society, a systematic meta-review of injury outcomes research literature was conducted. Seventy-eight peer-reviewed published literature reviews were included in the meta-review.

RESULTS

Of these, 70 reported outcomes at the level of the injured person including mortality, body functions, activity and participation limitations. Nine reviews reported impacts at the level of the community including impacts on family members, work colleagues and carers. Six studies reported impacts at the societal level including economic, health system and injury compensation system impacts.

CONCLUSIONS

In summary, the meta-review identified a substantial body of knowledge at the individual level outcomes of injury, and a relative lack of information regarding the community and societal impacts of injury. An injury outcome framework is proposed on the basis of the findings of the meta-review to guide future research activity, particularly with regard to injury outcome domains where there is currently limited evidence. A comprehensive framework that takes account of all levels of impact is necessary for effective policies, systems and strategies to support recovery following injury.

Could local dynamic stability serve as an early predictor of falls in patients with moderate neurological gait disorders? A reliability and comparison study in healthy individuals and in patients with paresis of the lower extremities

Falls while walking are frequent in patients with muscular dysfunction resulting from neurological disorders. Falls induce injuries that may lead to deconditioning and disabilities, which further increase the risk of falling. Therefore, an early gait stability index would be useful to evaluate patients in order to prevent the occurrence of future falls. Derived from chaos theory, local dynamic stability (LDS), defined by the maximal Lyapunov exponent, assesses the sensitivity of a dynamic system to small perturbations. LDS has already been used for fall risk prediction in elderly people. The aim of the present study was to provide information to facilitate future researches regarding gait stability in patients with neurological gait disorders. The main objectives were 1) to evaluate the intra-session repeatability of LDS in patients and 2) to assess the discriminative power of LDS to differentiate between healthy individuals and neurological patients. Eighty-three patients with mild to moderate neurological disorders associated with paresis of the lower extremities and 40 healthy controls participated in the study. The participants performed 2×30 s walking wearing a 3D accelerometer attached to the lower back, from which 2×35 steps were extracted. LDS was defined as the average exponential rate of divergence among trajectories in a reconstructed state-space that reflected the gait dynamics. LDS assessed along the medio-lateral axis offered the highest repeatability and discriminative power. Intra-session repeatability (intraclass correlation coefficient between the two repetitions) in the patients was 0.89 and the smallest detectable difference was 16%. LDS was substantially lower in the patients than in the controls (33% relative difference, standardized effect size 2.3). LDS measured in short over-ground walking tests seems sufficiently reliable. LDS exhibits good discriminative power to differentiate fall-prone individuals and opens up the possibility of future clinical applications for better prediction of fall risk in neurological patients.

Reliability of the timed 10-metre walk test during inpatient rehabilitation in ambulatory adults with traumatic brain injury

OBJECTIVE

To determine the test-re-test reliability of the timed 10-metre walk test (10MWT) among adults with traumatic brain injury (TBI) enrolled in inpatient rehabilitation.

DESIGN

Prospective reliability study using a correlational design.

SETTING

Inpatient rehabilitation unit of a rehabilitation hospital.

PARTICIPANTS

Twenty-three consecutive adults with acute TBI, mean age = 35.87, SD = 14.2 years (range = 18-64 years). This study tested 22 males and one female, who were 15.6 (SD = 9.1) days in inpatient rehabilitation at time of gait testing.

METHOD

Repeated, timed 10-metre gait test within a 1-hour testing period with six trials at self-selected pace (SSP) and six trials at fastest pace (FP), recorded to the nearest 1/10 second with a hand-held stopwatch.

RESULT

Gait speed measurements for SSP and FP were shown to have excellent test-re-test reliability (Intra Class Correlation coefficient = 0.964 and 0.961, respectively).

CONCLUSIONS

These results add to the literature that the timed 10MWT is a reliable measure of gait velocity in adults with acute TBI for both FP and SSP.

Gait disturbances in patients with stroke

Poststroke hemiplegic gait is a mixture of deviations and compensatory motion dictated by residual functions, and thus each patient must be examined and his/her unique gait pattern identified and documented. Quantitative 3-dimensional gait analysis is the best way to understand the complex multifactorial gait dysfunction in hemiparetic patients. The goals of the present work are to (1) review the temporospatial, kinematic, kinetic, and electromyographic deviations from normal gait that commonly occur after stroke and are of clinical significance, along with the most likely causes of these deviations, and (2) differentiate the departures from normal gait parameters that arise as a direct consequence of poststroke motor problems and those that arise as learned or adaptive compensations for poststroke motor problems.

Development and validation of a low-cost, portable and wireless gait assessment tool

BACKGROUND

Performing gait analysis in a clinical setting can often be challenging due to time, cost and the availability of sophisticated three-dimensional (3D) gait analysis systems. This study has developed and tested a portable wireless gait assessment tool (wi-GAT) to address these challenges.

AIM

To investigate the concurrent validity of the wi-GAT in measuring spatio-temporal gait parameters such as stride length, stride duration, cadence, double support time (DST), stance and swing time compared to a 3D Vicon motion analysis system.

METHODS

Ten healthy volunteers participated in the study (age range 23-30 years). Spatio-temporal gait parameters were recorded simultaneously by the Vicon and the wi-GAT systems as each subject walked at their self-selected speed.

RESULTS

The stride length and duration, cadence, stance duration and walking speed recorded using the wi-GAT showed strong agreement with those same parameters recorded by the Vicon (ICC of 0.94-0.996). A difference between the systems in registering "toe off" resulted in less agreement (ICC of 0.299-0.847) in gait parameters such as %stance and %swing and DST.

DISCUSSION AND CONCLUSION

The study demonstrated good concurrent validity for the wi-GAT system. The wi-GAT has the potential to be a useful assessment tool for clinicians.

Traumatic injury to the immature frontal lobe: a new murine model of long-term motor impairment in the absence of psychosocial or cognitive deficits

Traumatic brain injury in children commonly involves the frontal lobes and is associated with distinct structural and behavioral changes. Despite the clinical significance of injuries localized to this region during brain development, the mechanisms underlying secondary damage and long-term recovery are poorly understood. Here, we have characterized the first model of unilateral focal traumatic injury to the developing frontal lobe. Male C57Bl/6J mice at postnatal day (p)21, an age approximating a toddler-aged child, received a controlled cortical impact or sham surgery to the left frontal lobe and were euthanized 1 or 7 days later. A necrotic cavity and local inflammatory response were largely confined to the unilateral frontal lobe, dorsal corpus callosum and striatum anterior to the bregma. While cell death and accumulated β-amyloid precursor protein were characteristic features of the pericontusional motor cortex, corpus callosum, cingulum and dorsal striatum, underlying structures including the hippocampus showed no overt pathology. To determine the long-term functional consequences of injury at p21, two additional cohorts were subjected to a battery of behavioral tests in adolescence (p35-45) or adulthood (p70-80). In both cohorts, brain-injured mice showed normal levels of anxiety, sociability, spatial learning and memory. The signature phenotypic features were deficits in motor function and motor learning, coincident with a reduction in ipsilateral cortical brain volumes. Together, these findings demonstrate classic morphological features of a focal traumatic injury, including early cell death and axonal injury, and long-term volumetric loss of cortical volumes. The presence of deficits in sensorimotor function and coordination in the absence of abnormal findings related to anxiety, sociability and memory likely reflects several variables, including the unique location of the injury and the emergence of favorable compensatory mechanisms during subsequent brain development.

Feasibility of gaming console exercise and its effect on endurance, gait and balance in people with an acquired brain injury

OBJECTIVE

To determine feasibility of gaming console exercise and its effect on endurance, gait and balance in people following acquired brain injury (ABI).

METHOD

Twenty-one people following ABI were recruited to an 8-week randomized cross-over trial where 4 weeks of gaming console exercise in addition to usual therapy and 4 weeks of usual therapy alone were received. Feasibility measures included compliance, session duration and adverse events. Measures included endurance measured using a 6-minute walk test, spatiotemporal gait parameters (GAITRite) and balance using Balance Outcome Measure for Elder Rehabilitation (BOOMER). Motivation was measured using the Change Assessment Questionnaire.

RESULTS

Compliance with gaming console exercise was high (99%), the majority of sessions reached duration target (82%) and there were no adverse events. There were small, though non-significant increases in 6-minute walk distance (18 metres, 95% CI = -33 to 69), gait speed (0.11 m s(-1), 95% CI = -0.18 to 0.29) and balance compared to after usual therapy after gaming console exercise.

CONCLUSIONS

Gaming console exercise appears feasible in people with ABI. Four weeks of gaming console exercise in addition to usual therapy appears to result in similar improvements in endurance, gait and balance compared to usual therapy alone and may enhance active engagement in therapy.