Tiwari Devashish, Daly Carol, Alsalaheen Bara
a Department of Physical Therapy , University of Michigan-Flint , Flint, MI, USA.
Physiother Theory Pract. 2018 Feb;34(2):137-145. doi: 10.1080/09593985.2017.1370750. Epub 2017 Sep 6.
Adolescents with traumatic brain injury (TBI) are often discharged from physical therapy (PT) services without transitioning into exertional conditioning programs. Active participation in physical activities with peers at school is essential to achieve a sense of accomplishment and acceptance. Factors such as reduced aerobic fitness and residual gait impairments can lead to limited participation and peer interaction. The purpose of this case report was to describe the impact of home-based circuit training (HBCT) focusing on strength and balance on gait speed (GS), energy expenditure, and functional performance in a 17-year-old female with severe TBI. The participant sustained a TBI from a motor vehicle crash. Although she was ambulatory and independent with the basic activities of daily living following two years of rehabilitation, she presented with activity limitations and participation restrictions at school. The participant performed a 4-week HBCT program developed by a school physical therapist that focused on strength and balance. At the end of 4 weeks, improvements were observed in 6 MWT (change = 79.7 m), GS (change = 0.22 m/s), and the COPM scores (performance score change = 2.8, satisfaction score change = 2.2, MCID = 2). Improvements in functional performance, gait speed, and self-perception of occupational performance were observed following 4-week HBCT. Future clinical trials on short duration, HBCT program for children and young adults with TBI are recommended in order to establish effectiveness of HBCT.
创伤性脑损伤(TBI)青少年患者在结束物理治疗(PT)后,往往未能过渡到运动调节训练项目。在学校与同龄人积极参与体育活动对于获得成就感和被接纳感至关重要。有氧适能下降和残留步态障碍等因素可能导致参与度受限和同伴互动减少。本病例报告旨在描述针对一名17岁重度TBI女性患者开展的以力量和平衡为重点的家庭循环训练(HBCT)对其步态速度(GS)、能量消耗和功能表现的影响。该参与者因机动车事故导致TBI。尽管经过两年康复后她能够独立行走并完成日常生活基本活动,但在学校仍存在活动受限和参与限制的情况。该参与者执行了由学校物理治疗师制定的为期4周的HBCT计划,该计划侧重于力量和平衡训练。4周结束时,6分钟步行试验(变化 = 79.7米)、步态速度(变化 = 0.22米/秒)和加拿大职业表现测量(COPM)评分(表现评分变化 = 2.8,满意度评分变化 = 2.2,最小临床重要差异[MCID] = 2)均有改善。为期4周的HBCT后,观察到功能表现、步态速度和职业表现自我认知均有改善。建议未来针对儿童和青少年TBI患者开展关于短期HBCT计划的临床试验,以确定HBCT的有效性。