Measuring High-Level Mobility After Traumatic Brain Injury

Abstract

High-level mobility is important for participation in many pre-accident activities after traumatic brain injury (TBI). This review examined which measures are used to quantify physical status and mobility after TBI to determine their appropriateness for measuring high-level mobility. Electronic databases, hand searching of several TBI journals, and citation tracking from retrieved articles were used to identify all TBI outcome studies from 1990 through to May 2004. Preliminary screening identified articles that either reported on physical outcome or mobility after TBI or utilized measurement tools with a physical component. Studies were selected for detailed analysis if they reported on mobility or physical outcomes after TBI. The search identified 175 studies that met the inclusion criteria for further analysis. The FIM instrument is the most frequently used outcome measure, highlighting a trend toward using inpatient measures to evaluate long-term outcomes. Only one study used a measurement tool that incorporated a mobility item beyond independent walking and stairs. High-level mobility is seldom measured using standardized outcome measures after TBI, despite independent mobility being one of the major goals of rehabilitation. A high-level mobility scale is needed to address the ceiling effect of outcome scales currently used in TBI rehabilitation and to extend mobility to age-appropriate levels for return to leisure and sporting activities.

Motor impairment after severe traumatic brain injury: A longitudinal multicenter study

“…Published TBI outcome studies are skewed toward global measures and/ or measures within the behavioral and cognitive rather than physical domains. A recent literature review of all TBI outcome studies from 1990 to 2004 by Williams et al found only 175 articles that reported on mobility or physical outcome after TBI [6]. In virtually all of these studies, the mobility and physical domains were assessed by functional or disability instruments, without the inclusion of impairment measures.…”

Objectively assessing balance deficits after TBI: Role of computerized posturography

“…Standardized functional measures commonly used in TBI rehabilitation, such as the Functional Independence Measure (FIM), do not specifically assess balance [7]. Quantitative tests to assess balance that have been described for the TBI population include variations of the Romberg test [8], the test of sway [9], the Berg Balance Scale [10], and other more subjective tests.…”

High-level mobility outcomes following acquired brain injury: A preliminary evaluation

“…The quantification of mobility following acquired brain injury (ABI) and particularly traumatic brain injury (TBI) has primarily focused on motor performance during the inpatient stage of movement rehabilitation [1]. There has been little attempt to quantify higher levels of mobility, such as running, jumping and hopping in the post-acute phase.…”

“…Until recently, existing scales used in neurological rehabilitation are not able to quantify mobility at the level required for participation in physically demanding employment roles, leisure activities, social roles and sporting activities [1]. The High-level Mobility Assessment Tool (HiMAT) was developed to quantify high-level mobility outcomes following TBI [13,14].…”