Partial weight-bearing gait retraining for persons following traumatic brain injury: preliminary report and proposed assessment scale

Wilson, Daniel J.; Swaboda, Jason L.

doi:10.1080/02699050110103922

Cited by 22 publications

(15 citation statements)

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“…Treatment of spasticity should be multimodal and include therapeutic interventions and medications. A detailed assessment of the distribution (focal vs global), severity, and functional impact is crucial [44].…”

Section: Spasticitymentioning

confidence: 99%

Minimizing the effect of TBI-related physical sequelae on vocational return

McNamee

Walker²,

Cifu³

et al. 2009

JRRD

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Abstract-This article evaluated the common physical sequelae that affect return to work (RTW) after traumatic brain injury (TBI). We performed a Medline search and evaluation of current TBI rehabilitation texts. The information presented is a combination of published literature and clinical guidelines. The limitations faced by many patients with TBI can best be overcome through clever job search, job redesign, and community linkages with business and industry that are willing to partner in helping the patient with TBI regain employment. The physician plays a key role in communicating suggestions to the vocational specialist. The comorbidities described represent challenges to successful RTW. These problems are recurrent, long-term, and clearly affect job procurement, nature of job, level of required support, and likelihood of job retention. Conversely, these challenges should not be viewed as impenetrable obstacles. With appropriate supports such as compensatory strategies, job coaching, assistive technology, medical management, and job restructuring, successful RTW is viable option. Physicians must focus on employment outcomes in real jobs and not settle for volunteer work, sheltered work, or assessment and planning. Individuals should be placed in real work for real pay. Through close collaboration between the survivor of TBI, the physician, the vocational specialist, and community resources, successful employment for survivors of TBI is possible and must be prescribed a high value.

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Section: Spasticitymentioning

confidence: 99%

Minimizing the effect of TBI-related physical sequelae on vocational return

McNamee

Walker²,

Cifu³

et al. 2009

JRRD

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“…Our search identified four small RCTs [25, 27, 38, 42], eight prospective cohort studies [28, 30, 31, 33, 34, 37, 39, 41], and eight case studies [26, 29, 32, 35, 36, 40, 43, 44]. The sample size ranged from 14–38 subjects in the RCTs, and 5–152 in the prospective studies.…”

Section: Resultsmentioning

confidence: 99%

“…In regards to time elapsed since injury, six studies focused on individuals primarily in the acute phase (< six months) of TBI [29, 35, 38, 41, 42, 44], and ten were labeled as being in the chronic phase of TBI (> six months) [25, 27, 28, 31–34, 37, 39, 40]. Two others were not specified as to time since injury [26, 30], and two case studies included an acute and a chronic patient each [36, 43]. …”

Section: Resultsmentioning

confidence: 99%

“…For example, there were seven gait intervention studies reporting gait outcomes only [26, 27, 33–36, 40], two balance intervention studies with only balance outcomes [31, 32], and six studies with both gait and balance interventions and outcomes [29, 30, 37–39, 41]. However, two of the gait intervention studies [42, 43] and two of the balance intervention studies [25, 44] evaluated effects on both gait and balance, while one study using both gait and balance interventions measured the effects on balance alone [28]. Validity and reliability of outcome measures were not reported in any studies.…”

Section: Resultsmentioning

confidence: 99%

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Effectiveness of physical therapy for improving gait and balance in individuals with traumatic brain injury: A systematic review

2011

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Primary objective Given the major impact of traumatic brain injury (TBI) on society and the fact that effective therapies for common deficits in balance and gait are not known, the purpose of this review was to investigate the efficacy or effectiveness of non-aerobic exercise interventions to improve balance and gait in functionally mild to moderate individuals with TBI (those who demonstrate the ability or capacity to ambulate) and to provide evidence-based guidelines for clinical practice. Methods We searched eight databases (limits: January 1980 to December 2009) for papers including exercise interventions to improve gait and balance post TBI. Out of 984 unique citations, 20 fully met inclusion criteria. The methodological quality of studies was determined by the Physiotherapy Evidence Database (PEDro) scale and strength by Sackett's Levels of Evidence. Results We found limited evidence of the positive effects of balance, gait, or the combination of both interventions, in TBI rehabilitation. Most studies included small sample sizes with heterogeneous groups, and the interventions were variable and lacked standardization. The outcome measures were variable and low in quality. These limitations make it difficult to draw useful evidence-based recommendations for clinical practice. Conclusions The state of evidence for gait and balance interventions in patients with mild to moderate TBI is surprisingly poor. Greater consideration and conformity in the choice of outcome measures and attention in the design and standardization treatment approaches are essential in future research to advance practice.

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“…Body-weight-supported (BWS) gait devices and knee-ankle-foot orthotics can be used with manual assistance to initiate standing postures. BWS devices can lead to improved cardiovascular function and assist with the beginning of walk training (Mossberg, Orlander, and Norcross, 2008;Wilson and Swaboda, 2002).…”

Section: Effectiveness Of Physical Rehabilitationmentioning

confidence: 99%

Prospective study of myelin water fraction changes after mild traumatic brain injury in collegiate contact sports

Spader

Dean

LaFrance

et al. 2019

Journal of Neurosurgery

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OBJECTIVEMild traumatic brain injury (mTBI) in athletes, including concussion, is increasingly being found to have long-term sequelae. Current imaging techniques have not been able to identify early damage caused by mTBI that is predictive of long-term symptoms or chronic traumatic encephalopathy. In this preliminary feasibility study, the authors investigated the use of an emerging magnetic resonance imaging (MRI) technique, multicomponent driven equilibrium single pulse observation of T1 and T2 (mcDESPOT), in visualizing acute and chronic white matter changes after mTBI in collegiate football and rugby players.METHODSThis study was a nonrandomized, nonblinded prospective trial designed to quantify changes in the myelin water fraction (MWF), used as a surrogate MRI measure of myelin content, in a group of male collegiate football and rugby players, classified here as a contact sport player (CSP) cohort, at the time of mTBI diagnosis and 3 months after injury when the acute symptoms of the injury had resolved. In addition, differences in the MWF between the CSP cohort and a control cohort of noncontact sport players (NCSPs) were quantified. T-tests and a threshold-free cluster enhancement (TFCE) statistical analysis technique were used to identify brain structures with significant changes in the MWF between the CSP and NCSP cohorts and between immediately postinjury and follow-up images obtained in the CSP cohort.RESULTSBrain MR images of 12 right-handed male CSPs were analyzed and compared with brain images of 10 right-handed male NCSPs from the same institution. A comparison of CSP and NCSP baseline images using TFCE showed significantly higher MWFs in the bilateral basal ganglia, anterior and posterior corpora callosa, left corticospinal tract, and left anterior and superior temporal lobe (p < 0.05). At the 3-month follow-up examination, images from the CSP cohort still showed significantly higher MWFs than those identified on baseline images from the NCSP cohort in the bilateral basal ganglia, anterior and posterior corpora callosa, and left anterior temporal lobe, and also in the bilateral corticospinal tracts, parahippocampal gyrus, and bilateral juxtapositional (previously known as supplemental motor) areas (p < 0.05). In the CSP cohort, a t-test comparing the MWF at the time of injury and 3 months later showed a significant increase in the overall MWF at follow-up (p < 0.005). These increases were greatest in the bilateral basal ganglia and deep white matter. MWF decreases were seen in more superficial white matter (p < 0.005).CONCLUSIONSIn this preliminary study, MWF was found to be increased in the brains of CSPs compared with the brains of controls, suggesting acute/chronic MWF alterations in CSPs from previous injuries. Increases in the MWF were also demonstrated in the brains of CSPs 3 months after the players sustained an mTBI. The full clinical significance of an increased MWF and whether this reflects axon neuropathology or disorderly remyelination leading to hypermyelination has yet to be determined.

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Partial weight-bearing gait retraining for persons following traumatic brain injury: preliminary report and proposed assessment scale

Cited by 22 publications

References 15 publications

Minimizing the effect of TBI-related physical sequelae on vocational return

Minimizing the effect of TBI-related physical sequelae on vocational return

Effectiveness of physical therapy for improving gait and balance in individuals with traumatic brain injury: A systematic review

Prospective study of myelin water fraction changes after mild traumatic brain injury in collegiate contact sports

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