Delayed regaining of gait ability in a patient with brain injury

Abstract

Background:Little is known about delay in regaining gait ability at a chronic stage after brain injury. In this study, we report on a single patient who regained the gait ability during 2 months of intensive rehabilitation starting 2 years after a brain injury.Methods and results:A 40-year-old male patient diagnosed with viral encephalitis underwent comprehensive rehabilitation until 2 years after onset. However, he could not even sit independently and presented with severe physical deconditioning and severe ataxia. To understand his neurological state, 4 neural tracts related to gait function were reconstructed, and based on the state of these neural tracts, we decided that the patient had the neurological potential to walk independently. Therefore, we assumed that the main reasons for gait inability in this patient were severe physical deconditioning and truncal ataxia. Consequently, the patient underwent the following intensive rehabilitative therapy: administration of drugs for control of ataxia (topiramate, clonazepam, and propranolol) and movement therapy for physical conditioning and gait training. As a result, after 2 months of rehabilitation, he was able to walk independently on an even floor, with improvement of severe physical deconditioning and truncal ataxia.Conclusion:We described the rehabilitation program in a single patient who regained the gait ability during 2 months of intensive rehabilitation starting 2 years after a brain injury.

Surgical Intervention for Spastic Upper Extremity Improves Lower Extremity Kinematics in Spastic Adults: A Collection of Case Studies

“…This is in agreement with previous studies (Teasdale et al, 1979;Authier et al, 1995) suggesting that there is a plausible effect of age and functional recovery, as youth plays a prominent factor in neuroplasticity following brain injury (Uswatte and Taub, 2010;Rutović et al, 2019). Additionally, other studies have shown that, depending on the severity of spasticity, some patients might demonstrate significant gait recovery levels (e.g., increased walking velocity) while other might show minimal improvements (Knutsson and Richards, 1979;Kuhtz-Buschbeck et al, 2003;Watson and Hitchcock, 2004;Tilson et al, 2010;Jang and Kwon, 2016;Marque et al, 2019), as observed postoperatively in SP1. Even though the joint kinematic parameters of the lower limbs in SP1 didn't show outstanding improvements over time, at 12 months postoperatively the patient was able to ambulate comfortably with a cane; no longer relying on a wheelchair.…”

Delayed gait recovery by resolution of limb-kinetic apraxia in a chronic hemiparetic stroke patient

“…[4][5][6][7][8][9] As a result, detailed knowledge of gait could aid in the recovery of gait ability in stroke patients. [10,11] Gait requires coordination of various brain functions related to motor sensory, execution, attention, and visuospatial functions to achieve stepping movements, adequate leg and trunk muscle power and tone, maintenance of equilibrium, and interlimb coordination. [1,[12][13][14] Recent studies have reported that stroke patients regained their gait ability after the gait recovery phase of stroke.…”

“…Gait function is more likely to recover than hand function because leg motor function is less dependent on the lateral corticospinal tract (CST) than hand function [4–9] . As a result, detailed knowledge of gait could aid in the recovery of gait ability in stroke patients [10,11] . Gait requires coordination of various brain functions related to motor sensory, execution, attention, and visuospatial functions to achieve stepping movements, adequate leg and trunk muscle power and tone, maintenance of equilibrium, and interlimb coordination [1,12–14] .…”

“…Gait requires coordination of various brain functions related to motor sensory, execution, attention, and visuospatial functions to achieve stepping movements, adequate leg and trunk muscle power and tone, maintenance of equilibrium, and interlimb coordination [1,12–14] . Recent studies have reported that stroke patients regained their gait ability after the gait recovery phase of stroke [10,11,15–17] . These studies suggested that delayed gait recovery was achieved by the recovery of motor weakness, relief of severe spasticity and joint contracture, control of truncal ataxia, resolution of limb-kinetic apraxia (LKA), or improvement of postural control [10,11,15–17] .…”

Gait Recovery Characteristic According to the Injury Aspect of Descending Motor Pathway in a Chronic Stroke Patient: a Case Study

“…Several studies have reported on the association between the neural tracts related to walking and gait recovery in stroke pa-J KPT tients. [21][22][23][24][25] However, little is known about characteristics of spatio-temporal and kinematic parameter of gait according to the injury aspect of the descending motor pathway by stroke. In this study, using a three-dimensional gait analysis and DTT, we investigate characteristics of recovered gait pattern according to the injury aspect of the CST, CRP, and VST in a patent with a chronic stroke.…”