Individuals with chronic traumatic brain injury improve walking speed and mobility with intensive mobility training

Abstract

Objective: To determine the feasibility and impact of different dosages of Intensive Mobility Training (IMT) on mobility, balance, and gait speed in individuals with chronic traumatic brain injury (TBI).

Design: Prospective, single group design with 3-month follow-up.

Setting: University research laboratory.

Participants: Volunteer sample of participants with chronic TBI (N=10; ≥3 mo post-TBI; able to ambulate 3.05 m with or without assistance; median age, 35.4 y; interquartile range, 23.5-46 y; median time post-TBI, 9.91 y; interquartile range, 6.3-14.2 y). Follow-up data were collected for all participants.

Interventions: Twenty days (5 d/wk for 4 wk), with 150 min/d of repetitive, task-specific training equally divided among balance; gait training; and strength, coordination, and range.

Main outcome measures: Pain and fatigue were recorded before and after each session to assess feasibility. Treatment outcomes were assessed before training (pre), after 10 sessions (interim), after 20 sessions (post), and at 3-months follow-up and included the Berg Balance Scale and gait speed.

Results: Participants averaged 150.1±2.7 minutes per session. Median presession and postsession pain scores were 0 (out of 10) for 20 sessions; median presession fatigue scores ranged from 0 to 2.5 (out of 10); and postsession scores ranged from 3 to 5.5 (out of 10). Four outcome measures demonstrated significant improvement from the pretest to interim, with 7 out of 10 participants exceeding the minimal detectable change (MDC) for fast walking speed. At the posttest, 2 additional measures were significant, with more participants exceeding the MDCs. Changes in fast walking speed and Timed Up and Go test were significant at follow-up.

Conclusions: Limited fluctuations in pain and fatigue scores indicate feasibility of IMT in this population. Participants demonstrated improvements in walking speed, mobility, and balance postintervention and maintained gains in fast walking speed and mobility at 3 months.

Keywords: Brain injuries; Gait; Rehabilitation.

Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Pre and post session pain scores are presented in box plots. The median daily score for the participants is represented by the solid black line. The circles represent the outliers. The range lines indicate the limits of the first and third quartile of the interquartile range.

Figure 2

Pre and post session fatigue scores are presented in box plots. The median daily score for the participants is represented by the solid black line. The circles represent the outliers. The range lines indicate the limits of the first and third quartile of the interquartile range.