Changes in Gait Kinematic Parameters after Severe Traumatic Brain Injury during Post-Acute Rehabilitation

Abstract

Changes in gait after traumatic brain injury (TBI) are very important for evaluation, clinical reasoning and forintervention programs. Most studies analyze gait during acute phase, but there is lack of information during post-acute period. The aim of the research was to determine gait biomechanical joint angles and centre of mass displacement changes during post-acute TBI rehabilitation. Participant was a 21-year-old male, after severe TBI, 2 years after trauma. Biomechanical joints angles and centre of mass displacement changes were observed during 3D gait analysis. The subject was asked to walk straight 6 meters, 18 times at his preferred comfortable pace. During walking 1–2 minute breaks were made. Intensive 5 week program was composed of physiotherapy (3 times per week) and yoga (2 times per week). Physiotherapy included stretching, coordination, balance and weight-bearing exercises. Yoga was performed to built core stability, train flexibility and diminish muscle tone. After 5 week rehabilitation statistically significant changes were observed in the centre of mass displacement and in lower extremities and lumbar biomechanics (p < 0.05). After procedures trunk flexion and trunk lateral flexion, lateral pelvic tilt increased, while anterior pelvic tilt decreased (p < 0.05). Hip extension at terminal stance increased, as well while hip adduction in stance phase decreased (p < 0.05). Statistically significant reduction was observed in knee flexion at initial contact, mid-stance and midswing phase (p < 0.05). Prevalent knee flexion at initial contact, observed before rehabilitation, decreased after it (p < 0.05). After the procedure lateral centre of mass displacement decreased and vertical centre of mass displacement increased (p < 0.05). Five weeks of rehabilitation composed of traditional physiotherapy and yoga is effective for gait quality treatment. However, further research is necessary to determine gait biomechanical joint angles and dynamic balance improvements during severe post-acute TBI.

Keywords: head injury, walking, balance.