Background/Purpose: This case study and review of current available evidence aims to determine whether patients with chronic (>6 months post injury) traumatic brain injury (TBI) can make functional gains in ambulation with therapist directed gait training. This analysis also aims to determine which gait training methods lead to the most functional gains within this patient population. Case Description: Patient is a 48 year old male who sustained a TBI in September of 2010. He is referred to outpatient physical therapy on January 13, 2014, after having a cerebral spinal fluid (CSF) shunt placement on November 14, 2013. Outcomes: No single gait training intervention within the scope of physical therapy is superior to any other method. The various methods of gait training are each good at targeting and improving a specific deficit involved in the activity of gait. Body weight supported treadmill training is best for increasing self-selected velocity (SSV), and should be done without upper limb support for the most carry over. Robotic assisted treadmill training is best for improving the mobility domain of the Stroke Impact Scale (SIS), Functional independence measures (FIM), including FIM transfer and FIM ambulation items, and the Rivermead Motor Assessment (RMA) gross function subscale. Non-aerobic exercise interventions significantly decrease step length asymmetry when compared to over-ground gait training. Discussion: Because of the nature of chronic TBI, it is difficult to obtain a large sample size of homogenous subjects to participate in a study. Further, and more targeted, research is necessary to gain a solid conclusion as to which gait training methods lead to the most functional gains for chronic TBI patients. Based on the current available evidence, all methods improve overall gait for patients with chronic TBI, while some target more specific areas involved in gait. Therefore, tailoring a gait training program to a specific chronic TBI patients areas of weakness, and using more than one intervention, will provide the best outcomes. All studies taken together suggest that gait training should be intensive, repetitious, and task oriented.
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Traumatic Brain Injury, TBI, Gait training, Gait, Brain injury
Schoenherr, Joy Iris. "Gait Training Strategies to Optimize Functional Ambulation in Adults with Chronic Traumatic Brain Injury: A Review of the Evidence." (2014). http://digitalrepository.unm.edu/dpt/93