Original article
Effects of Environmental Demands on Locomotion After Traumatic Brain Injury

https://doi.org/10.1016/j.apmr.2006.02.031Get rights and content

Abstract

Vallée M, McFadyen BJ, Swaine B, Doyon J, Cantin J-F, Dumas D. Effects of environmental demands on locomotion after traumatic brain injury.

Objective

To determine the effects of increasingly demanding environments related to simultaneous visual tasks and physical obstructions on the locomotor ability of people with traumatic brain injury (TBI).

Design

Group comparison study.

Setting

Gait analysis laboratory within a postacute rehabilitation facility.

Participants

Volunteer sample of 9 people (8 men, 1 woman; age, 39.3±13.0y) with moderate to severe TBI and a comparison group of 9 subjects without neurologic problems matched for age and sex (8 men, 1 woman; age, 39.7±12.3y).

Interventions

Not applicable.

Main Outcome Measures

Reading times for the Stroop bar and Stroop word tasks, walking speeds, stride lengths, and obstacle clearance margin.

Results

The TBI group was slower than the control group in performing the Stroop bar task during sitting (P=.002), and while avoiding the narrow obstacle (P=.05), and in performing the Stroop word task while avoiding the wide obstacle (P=.019). Despite their relatively normal gait speeds on level ground, subjects with TBI walked more slowly than control subjects for the narrow (P=.024) and the wide (P=.019) obstacle conditions and for the most complex dual task (P=.042). Greater lead-limb clearance margins were observed for the TBI group than for control subjects for all conditions whereas no differences were found for the trail limb except at the far end of the wide obstacle.

Conclusions

Despite their good recovery of locomotor function, with respect to normal level walking speeds and ability to avoid obstacles, subjects with moderate and severe TBI showed residual deficits in relation to greater difficulties in dealing with environments that challenge their locomotor and attentional abilities. The use of such naturally based dual tasks may help identify some of the environmental obstructions to social participation after TBI.

Section snippets

Participants

We recruited people who had suffered TBI from the TBI unit of the Québec Rehabilitation Institute (QRI). All subjects suffered only 1 TBI, with severity ratings of moderate or severe based on a combination of the hospital admission Glasgow Coma Scale (GCS) score, duration of posttraumatic amnesia (PTA), length of the loss of consciousness, and interpretation of the neuroradiologic examination.26 Subjects also had to be able to walk at a speed greater than 0.7m/s without assistance or walking

Results

We compared 9 subjects (8 men, 1 woman) with a moderate or severe TBI (table 1) with 9 control subjects matched for age (39.7±12.3y) and sex (8 men, 1 woman). The clinical gait speeds of the TBI group were quite good.

Discussion

The results of the present study provide insight into the residual deficits of people with a moderate or severe TBI who can ambulate independently. Although in unobstructed environments these subjects had levels of locomotor function similar to those of control subjects, we found group differences for dependent variables related to increases in complexity in both the cognitive and locomotor tasks. There did not appear to be a simple change in behavior in direct relation to additional physical

Conclusions

Despite their good locomotor recovery, subjects with moderate to severe TBI showed residual deficits for walking within environments with physical obstructions and dual tasks. Given the similarity of such dual tasks to daily locomotor activities, they have the potential to be used in the assessment and rehabilitation of people with TBI.

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    Supported by the Canadian Institutes of Health Research (grant no. 64408).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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    Copyright © 2006 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.