Impact of motor therapy with dynamic body-weight support on Functional Independence Measures in traumatic brain injury: An exploratory study

Emily Anggelis, Elizabeth Salmon Powell, Philip M Westgate, Amanda C Glueck, Lumy Sawaki, Emily Anggelis, Elizabeth Salmon Powell, Philip M Westgate, Amanda C Glueck, Lumy Sawaki

Abstract

Background: Contemporary goals of rehabilitation after traumatic brain injury (TBI) aim to improve cognitive and motor function by applying concepts of neuroplasticity. This can be challenging to carry out in TBI patients with motor, balance, and cognitive impairments.

Objective: To determine whether use of dynamic body-weight support (DBWS) would allow safe administration of intensive motor therapy during inpatient rehabilitation and whether its use would yield greater improvement in functional recovery than standard-of-care (SOC) therapy in adults with TBI.

Methods: Data in this retrospective cohort study was collected from patients with TBI who receive inpatient rehabilitation incorporating DBWS (n = 6) and who received inpatient rehabilitation without DBWS (SOC, n = 6). The primary outcome measure was the change in Functional Independence Measures (FIM) scores from admission to discharge.

Results: There was significant improvement in total FIM scores at discharge compared to admission for both the DBWS (p = 0.001) and SOC (p = 0.005) groups. Overall, the DBWS group had greater improvement in total FIM score and FIM subscales compared to the SOC group.

Conclusions: Our results suggest DBWS has the potential to allow a greater intensity of therapy during inpatient rehabilitation and yield better outcomes compared to SOC in patients with TBI.

Keywords: Rehabilitation; assistive technology; humans; inpatient; neuroplasticity; trauma.

Conflict of interest statement

This study was funded by the Cardinal Hill Rehabilitation Hospital Endowed Chair in Stroke and Spinal Cord Injury Rehabilitation (0705129700) and supported by the HealthSouth Therapy Grant. The funding body had no role in the collection, analysis and interpretation of data, or in writing the manuscript. There are no financial benefits to the authors. There are no conflicts of interest related to this research or this manuscript.

Figures

Fig.1
Fig.1
The mean total FIM score on admission and discharge was greater for patients using the Zero G versus SOC.
Fig.2
Fig.2
The mean Motor FIM and Cognitive FIM subscales on admission and discharge were greater for patients using the Zero G versus SOC.
Fig.3
Fig.3
The differences in mean FIM score on admission to discharge showed statistical significance in both cognitive and motor function in patients using the DBWS versus SOC.

References

    1. Arciniegas, D. B., Held, K., & Wagner, P. (2002). Cognitive Impairment Following Traumatic Brain Injury. Curr Treat Options Neurol, 4(1), 43-57.
    1. Beaulieu, C. L., Peng, J., Hade, E. M., Corrigan, J. D., Seel, R. T., Dijkers, M. P., & Bogner, J. (2019). Impact of Level of Effort on the Effects of Compliance with the 3-Hour Rule. Arch Phys Med Rehabil. doi:10.1016/j.apmr.2019.01.014
    1. Bland, D. C., Zampieri, C., & Damiano, D. L. (2011). Effectiveness of physical therapy for improving gait and balance in individuals with traumatic brain injury: a systematic review. Brain Inj, 25(7-8), 664-679. doi:10.3109/02699052.2011.576306
    1. Brasure, M., Lamberty, G. J., Sayer, N. A., Nelson, N. W., MacDonald, R., Ouellette, J., & Wilt, T. J. (2012) Multidisciplinary Postacute Rehabilitation for Moderate to Severe Traumatic Brain Injury in Adults. Rockville; (MD: ).
    1. Brown, T. H., Mount, J., Rouland, B. L., Kautz, K. A., Barnes, R. M., & Kim, J. (2005). Body weight-supported treadmill training versus conventional gait training for people with chronic traumatic brain injury. The Journal of head trauma rehabilitation, 20(5), 402-415.
    1. Centers for Disease Control and Prevention. Traumatic Brain Injury & Concussion. (April 27, 2017). .
    1. Corso, P., Finkelstein, E., Miller, T., Fiebelkorn, I., & Zaloshnja, E. (2006). Incidence and lifetime costs of injuries in the United States. Inj Prev, 12(4), 212-218. doi:10.1136/ip.2005.010983
    1. Dobkin, B. H. (1993). Neuroplasticity. Key to recovery after central nervous system injury. West J Med, 159(1), 56-60.
    1. Esquenazi, A., Lee, S., Wikoff, A., Packel, A., Toczylowski, T., & Feeley, J. (2017). A Comparison of Locomotor Therapy Interventions: Partial-Body Weight-Supported Treadmill, Lokomat, and G-EO Training in People With Traumatic Brain Injury. PM R, 9(9), 839-846. doi:10.1016/j.pmrj.2016.12.010
    1. Glees, P., & Cole, J. (1949). The reappearance of coordinated movements of the hand after lesions in the hand area of the motor cortex of the rhesus monkey. J Physiol, 108(1), Proc, 33.
    1. Jonasson, L. S., Nyberg, L., Kramer, A. F., Lundquist, A., Riklund, K., & Boraxbekk, C. J. (2016). Aerobic Exercise Intervention, Cognitive Performance, and Brain Structure: Results from the Physical Influences on Brain in Aging (PHIBRA) Study. Front Aging Neurosci, 8, 336. doi:10.3389/fnagi.2016.00336
    1. Kleim, J. A., & Jones, T. A. (2008). Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res, 51(1), S225-239. doi:51/1/S225 [pii] 10.1044/1092-4388(2008/018)
    1. Mao, Y. R., Lo, W. L., Lin, Q., Li, L., Xiao, X., Raghavan, P., & Huang, D. F. (2015). The Effect of Body Weight Support Treadmill Training on Gait Recovery, Proximal Lower Limb Motor Pattern, and Balance in Patients with Subacute Stroke. BioMed research international, 2015, 175719. doi:10.1155/2015/175719
    1. Muehlhan, M., Marxen, M., Landsiedel, J., Malberg, H., & Zaunseder, S. (2014). The effect of body posture on cognitive performance: a question of sleep quality. Frontiers in human neuroscience, 8, 171. doi:10.3389/fnhum.2014.00171
    1. Nudo, R. J. (2011). Neural bases of recovery after brain injury. J Commun Disord, 44(5), 515-520. doi:S0021-9924(11)00026-8 [pii] 10.1016/j.jcomdis.2011.04.004
    1. Peterson, M., & Greenwald, B. D. (2015). Balance problems after traumatic brain injury. Arch Phys Med Rehabil, 96(2), 379-380. doi:10.1016/j.apmr.2013.06.012
    1. Smith, P. J., Blumenthal, J. A., Hoffman, B. M., Cooper, H., Strauman, T. A., Welsh-Bohmer, K., & Sherwood, A. (2010). Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosom Med, 72(3), 239-252. doi:10.1097/PSY.0b013e3181d14633
    1. Turner-Stokes, L., Pick, A., Nair, A., Disler, P. B., & Wade, D. T. (2015). Multi-disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database Syst Rev(12), CD004170. doi:10.1002/14651858.CD004170.pub3
    1. Weaver, J. (2015). Motor Learning Unfolds over Different Timescales in Distinct Neural Systems. PLoS Biol, 13(12), e1002313. doi:10.1371/journal.pbio.1002313
    1. Wolf, S. L., Winstein, C. J., Miller, J. P., Taub, E., Uswatte, G., Morris, D., & Nichols-Larsen, D. (2006). Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA, 296(17), 2095-2104. doi:10.1001/jama.296.17.2095

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