1 Department of Neurology, Oregon Health & Science University , Portland, Oregon.
2 Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University , Portland, Oregon.
J Neurotrauma. 2018 May 15;35(10):1167-1177. doi: 10.1089/neu.2017.5231. Epub 2018 Mar 23.
Turning is common in daily activity and requires rapid, coordinated reorientation of the head, trunk, and pelvis toward the new direction of travel. Yet, turning gait has not been well explored in populations with mild traumatic brain injury (mTBI) who may alter their turning behavior according to self-perceived symptoms or motor dysfunction. The purpose of this study was to examine turning velocities and coordination in adults with chronic mTBI (>3 months post-injury and still reporting balance complaints) during a task simulating everyday ambulation. We hypothesized that individuals with chronic mTBI would reduce their angular velocity when turning and increase the variability of head-pelvis coordination compared with controls, and that the reduction in velocity and increased variability would be associated with their self-reported symptom score. Forty-two adults (14 chronic mTBI, 28 controls) completed the Neurobehavioral Symptom Inventory before walking 12 laps around a marked course containing two 45-degree turns, four 90-degree turns, and two 135-degree turns. Inertial sensors collected angular velocities of the head and pelvis. After adjusting for covariates, participants with chronic mTBI had significantly slower lap times and peak angular velocities of the pelvis (p < 0.01) compared with the control group. The peak velocity timing (PVT) between peak velocities of the head and pelvis, and the variability of that timing was significantly greater in participants with chronic mTBI (p < 0.01). Within the chronic mTBI group, somatosensory symptoms were associated with slower angular velocities of the head and pelvis (p = 0.03) and increased PVT variability (p < 0.01). The results suggest individuals with chronic mTBI with worse somatic symptoms have impaired head stabilization during turning in situations similar to everyday life. These results encourage future research on turning gait to examine the causal relationship between symptoms and daily locomotor function in adults with chronic mTBI.
转弯在日常活动中很常见，需要头部、躯干和骨盆迅速协调地转向新的行进方向。然而，患有轻度创伤性脑损伤（mTBI）的人群中，转弯步态并没有得到很好的研究，他们可能会根据自我感知的症状或运动功能障碍改变转弯行为。本研究的目的是在模拟日常步行的任务中，检查慢性 mTBI 成年人的转弯速度和协调性。我们假设慢性 mTBI 患者在转弯时会降低角速度，并增加头-骨盆协调的可变性，与对照组相比，与他们的自我报告症状评分相关。42 名成年人（14 名慢性 mTBI，28 名对照组）在完成神经行为症状量表后，在标记的路线上走 12 圈，该路线包含两个 45 度转弯、四个 90 度转弯和两个 135 度转弯。惯性传感器采集头部和骨盆的角速度。在调整协变量后，与对照组相比，慢性 mTBI 患者的圈速和骨盆的峰值角速度明显较慢（p<0.01）。头-骨盆峰值速度之间的峰值速度定时（PVT）以及该定时的可变性在慢性 mTBI 患者中显著更大（p<0.01）。在慢性 mTBI 组中，躯体感觉症状与头部和骨盆的角速度较慢（p=0.03）和 PVT 变异性增加（p<0.01）相关。结果表明，躯体症状较严重的慢性 mTBI 患者在类似于日常生活的情况下转弯时头部稳定性受损。这些结果鼓励对转弯步态进行进一步研究，以检查成年慢性 mTBI 患者症状与日常运动功能之间的因果关系。
