Klima Dennis, Morgan Lindsay, Baylor Michelle, Reilly Cordia, Gladmon Daniel, Davey Adam
1 Department of Physical Therapy, University of Maryland Eastern Shore, Princess Anne, MD, USA.
2 Department of Rehabilitation, Anne Arundel Medical Center, Annapolis, MD, USA.
Percept Mot Skills. 2019 Feb;126(1):50-69. doi: 10.1177/0031512518809203. Epub 2018 Nov 20.
Injuries sustained from traumatic brain injury (TBI) culminate in both cognitive and neuromuscular deficits. Patients often progress to higher functioning on the Rancho continuum even while mobility deficits persist. Although prior studies have examined physical performance among persons with chronic symptoms of TBI, less is known about the relatively acute phase of TBI as patients prepare for rehabilitation discharge. The aims of this cross-sectional study were to (a) compare balance and gait performance in 20 ambulant persons with moderate to severe TBI who were nearing rehabilitation discharge with their age-matched controls and (b) describe performance with thresholds for fall risk and community navigation. During a designed task circuit, 40 participants (20 persons with TBI and 20 controls) performed the Timed Up and Go (TUG), gait velocity, and Walking and Remembering tests. Balance testing included the Fullerton Advanced Balance Scale (FABS) and instrumented Modified Clinical Test for Sensory Interaction in Balance (MCTSIB). Statistical analyses included analysis of covariance for group comparisons and a multivariate analysis of covariance for MCTSIB sway velocities with anthropometric controls. The TBI group (mean [ M] age = 42, standard deviation [ SD] =19.5 years; 70% males) performed significantly more poorly on all mobility tests ( p < .05) and their scores reflected a potential fall risk. Gait velocity was significantly slower for the TBI versus control group ( M = .96, SD = 2.6 vs. M = 1.5, SD = 2.2 m/s; p < .001), including TUG times ( M = 13.5, SD = 4.9 vs. M = 7.7, SD = 1.4; p < .001). TBI participants also demonstrated significantly greater sway velocity on all MCTSIB conditions ( p < .01) and lower performance on the FABS ( p < .001). Performance indices indicate potential fall risk and community navigation compromise for individuals with moderate to severe TBI. Physical performance scores support the need for continued interventions to optimize functional mobility upon discharge.
创伤性脑损伤（TBI）造成的损伤最终会导致认知和神经肌肉功能障碍。即使运动功能障碍仍然存在，患者在兰乔认知功能分级量表上的功能往往会逐渐改善。尽管先前的研究已经考察了患有慢性TBI症状者的身体表现，但对于TBI相对急性期（即患者准备出院接受康复治疗时）的情况却知之甚少。这项横断面研究的目的是：（a）比较20名接近康复出院的中度至重度TBI行走患者与其年龄匹配的对照组的平衡和步态表现；（b）描述跌倒风险阈值和社区行走能力方面的表现。在一个设计好的任务环节中，40名参与者（20名TBI患者和20名对照组）进行了定时起立行走测试（TUG）、步态速度测试以及行走与记忆测试。平衡测试包括富勒顿高级平衡量表（FABS）和仪器化的平衡感觉交互作用改良临床测试（MCTSIB）。统计分析包括用于组间比较的协方差分析以及针对MCTSIB摆动速度与人体测量学对照因素的多变量协方差分析。TBI组（平均年龄[M]=42岁，标准差[SD]=19.5岁；70%为男性）在所有运动测试中的表现明显更差（p<.05），其分数反映出存在潜在的跌倒风险。与对照组相比，TBI组的步态速度明显更慢（M=.96，SD=2.6对M=1.5，SD=2.2米/秒；p<.001），包括TUG时间（M=13.5，SD=4.9对M=7.7，SD=1.4；p<.001）。TBI参与者在所有MCTSIB测试条件下的摆动速度也明显更高（p<.01），在FABS测试中的表现更低（p<.001）。表现指标表明，中度至重度TBI患者存在潜在的跌倒风险和社区行走能力受限的情况。身体表现分数支持在出院时继续进行干预以优化功能移动性的必要性。
