Kaski Diego, Buttell Joseph, Greenwood Richard
a Institute of Neurology, University College London , London , UK.
b Regional Neurological Rehabilitation Unit , Homerton University Hospital , London , UK.
Disabil Rehabil. 2018 Apr;40(7):856-858. doi: 10.1080/09638288.2016.1276976. Epub 2017 Jan 23.
To further understand the mechanisms underlying gait impairment following traumatic brain injury.
A 58-year-old man presented with marked unsteadiness and motion sensitivity following a severe traumatic brain injury. He underwent a 6-week inpatient rehabilitation program focused on re-weighting and subsequently re-integrating ascending interoceptive information, by gradual reduction of maladaptive visual fixation techniques. We report clinical neurological outcomes and measures of functional outcome, as well as an objective assessment of visual dependency (the rod and disk test) at baseline and after the rehabilitation.
Clinically, the patient had gait unsteadiness exacerbated by visual motion. A significant reduction in visual dependency occurred with tailored multi-disciplinary rehabilitation via gradual removal of visual fixation strategies that the patient had developed to maintain balance (t-test; p < 0.01), as well as clinical improvements in gait, balance, and functional outcome.
We highlight the importance of visual dependency in the generation of maladaptive gait strategies following brain injury. Our data suggest assessing and treating visual dependency to be an important component of gait rehabilitation after traumatic brain injury. Implications for rehabilitation Whilst gait disturbance in TBI is multifactorial, abnormal visual dependency may be important but under-recognised component of the disorder. Visual dependency can be easily and objectively assessed by the bedside in patients using a dynamic rod and disc test. Tailored rehabilitation with gradual reduction of maladaptive visual fixation can reduce visual dependency and contribute to improved gait and balance following TBI.
进一步了解创伤性脑损伤后步态障碍的潜在机制。
一名58岁男性在严重创伤性脑损伤后出现明显的步态不稳和运动敏感。他接受了为期6周的住院康复计划，该计划通过逐渐减少适应不良的视觉固定技术，着重于重新调整体重并随后重新整合上升的内感受信息。我们报告了临床神经学结果和功能结局指标，以及在基线和康复后对视觉依赖（杆盘试验）的客观评估。
临床上，患者的步态不稳因视觉运动而加重。通过逐步去除患者为维持平衡而形成的视觉固定策略进行的针对性多学科康复，视觉依赖显著降低（t检验；p <0.01），同时步态、平衡和功能结局也有临床改善。
我们强调了视觉依赖在脑损伤后适应不良步态策略产生中的重要性。我们的数据表明，评估和治疗视觉依赖是创伤性脑损伤后步态康复的重要组成部分。
虽然创伤性脑损伤中的步态障碍是多因素的，但异常的视觉依赖可能是该疾病的重要但未被充分认识的组成部分。使用动态杆盘试验可以在床边轻松、客观地评估患者的视觉依赖。通过逐渐减少适应不良的视觉固定进行的针对性康复可以减少视觉依赖，并有助于改善创伤性脑损伤后的步态和平衡。
