Research Reports - Mobility after traumatic brain injury: relationships with ankle joint power generation and motor skill level

J Head Trauma Rehabil. 2013 Sep-Oct;28(5):371-8

Williams GP, Schache AG, Morris ME

BACKGROUND: Reduced balance, spasticity, contractures, muscle weakness, and motor
skill levels may all contribute to mobility limitations after traumatic brain
injury (TBI), yet the key physical impairments that contribute to mobility
limitations remain unclear.
OBJECTIVE: The aim of this study was to determine which physical impairments best
predict mobility performance after a period of 6 months of rehabilitation.
PARTICIPANTS: Participants with TBI were selected if they were receiving therapy
for mobility limitations but were able to walk without physical assistance.
OUTCOME MEASURES: The clinical assessment included measures of balance,
spasticity, and contracture, and 3-dimensional quantitative gait analysis was
used to quantify joint power generation and motor skill level on 31 adults with
severe TBI. Mobility outcome was quantified with the high-level mobility
assessment tool.
RESULTS: Two variables, ankle joint power generation during the push-off phase of
gait and motor skill level, explained 66.5% of the variability in mobility
outcome. Balance, strength, and mobility performance, all improved significantly
over the 6 months of rehabilitation. Only 2 participants had contractures, which
affected mobility. Balance disorders were prevalent and improved with
rehabilitation, yet they contributed to only a limited extent to the level of
recovery in mobility.
CONCLUSION: Ankle joint power generation at push-off was the strongest predictor
of mobility outcome after 6 months of rehabilitation in ambulant people with TBI.

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