Cesar Guilherme M, Buster Thad W, Burnfield Judith M
Department of Physical Therapy, University of North Florida, Jacksonville, FL, United States.
Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, United States.
Front Neurol. 2024 Sep 17;15:1432293. doi: 10.3389/fneur.2024.1432293. eCollection 2024.
Control of reactive balance is key to achieving safe independent walking and engagement in life activities. After traumatic brain injury (TBI), motor impairments and mobility challenges are persistent sequelae. To date, no studies have explored muscle activity of individuals with chronic TBI during a task that requires reactive control of balance.
To investigate lower extremity muscle activity during a reactive balance test performed by adults with chronic severe TBI and matched controls. We hypothesized that abnormal activity of lower extremity muscles would be related with poorer reactive balance performance. Also, we performed an exploratory analysis for those with TBI investigating the impact of unilateral versus bilateral lower extremity involvement in the control of reactive balance.
Ten adults with chronic severe TBI who were independent community ambulators and ten matched controls performed the computerized reactive balance test (Propriotest) while lower extremity muscle activity was recorded. Electromyographic (EMG) activity was contrasted (Mann-Whitney U Test) between groups across each 10 s epoch of the 120 s test. Additionally, test scores were correlated (Spearman) with lower extremity composite EMG activity to distinguish muscle activity patterns related with reactive balance performance. Lastly, reactive balance test scores were correlated with reactive balance test scores and clinical functional measures only for the TBI group.
Although the TBI group exhibited greater EMG activity across the entire test compared with the control group, significant differences were not observed. Greater composite EMG activity correlated significantly with poorer reactive balance performance across most of the 10 s windows of the test.
Greater muscle activity exhibited during the reactive balance test by individuals with chronic severe TBI compared to those without disabilities, particularly at small unexpected perturbations, highlights the greater physiologic effort required to control reactive balance even after independent ambulation is achieved.
反应性平衡的控制是实现安全独立行走和参与生活活动的关键。创伤性脑损伤（TBI）后，运动障碍和活动能力挑战是持续存在的后遗症。迄今为止，尚无研究探讨慢性创伤性脑损伤患者在需要反应性平衡控制的任务中的肌肉活动情况。
研究慢性重度创伤性脑损伤成人及匹配对照组在进行反应性平衡测试时下肢肌肉的活动情况。我们假设下肢肌肉的异常活动与较差的反应性平衡表现有关。此外，我们对创伤性脑损伤患者进行了探索性分析，研究单侧与双侧下肢参与对反应性平衡控制的影响。
10名能够独立在社区行走的慢性重度创伤性脑损伤成人和10名匹配对照组进行计算机化反应性平衡测试（本体感觉测试），同时记录下肢肌肉活动。在120秒测试的每10秒时间段内，对两组之间的肌电图（EMG）活动进行对比（曼-惠特尼U检验）。此外，将测试分数与下肢复合肌电图活动进行相关性分析（斯皮尔曼相关性分析），以区分与反应性平衡表现相关的肌肉活动模式。最后，仅对创伤性脑损伤组的反应性平衡测试分数与反应性平衡测试分数及临床功能指标进行相关性分析。
尽管与对照组相比，创伤性脑损伤组在整个测试过程中表现出更大的肌电图活动，但未观察到显著差异。在测试的大部分10秒时间段内，更大的复合肌电图活动与较差的反应性平衡表现显著相关。
与无残疾者相比，慢性重度创伤性脑损伤患者在反应性平衡测试中表现出更大的肌肉活动，尤其是在小的意外扰动时，这突出表明即使在实现独立行走后，控制反应性平衡仍需要更大的生理努力。
