Original article
Coordination of Dynamic Balance During Gait Training in People With Acquired Brain Injury

https://doi.org/10.1016/j.apmr.2011.11.002Get rights and content

Abstract

Clark RA, Williams G, Fini N, Moore L, Bryant AL. Coordination of dynamic balance during gait training in people with acquired brain injury.

Objective

To investigate movement of the center of mass (COM) during different gait training methods in people with neurologic conditions.

Design

Coordination of the gait cycle, represented by mediolateral COM displacement amplitude, timing, and stability, was assessed during a variety of gait training methods performed in a single session.

Setting

Gait laboratory.

Participants

People who were unable to walk unassisted due to an acquired brain injury (n=17) and healthy control subjects (n=25).

Interventions

The participants performed 7 alternative gait training methods in a randomized order. These were therapist manual facilitation, the use of a gait assistive device, treadmill walking with handrail support, and 4 variations of body weight–support treadmill training with combinations of handrail and/or therapist support.

Main Outcome Measures

Mediolateral COM movement was analyzed in terms of displacement amplitude (overall range of motion), timing (relative to stride time), and stability (steadiness of the movement). Normative values for these measures were acquired from 25 healthy participants walking at a self-selected comfortable pace.

Results

Body weight–support treadmill training without any additional support resulted in significantly (P<.05) greater amplitude, altered timing, and reduced movement stability compared with nonpathologic gait. Allowing handrail support or therapist facilitation reduced this effect and resulted in treadmill training (± body weight support) having lower movement amplitudes when compared with the other training methods. Therapist manual facilitation most closely matched nonpathologic gait for timing and stability.

Conclusions

In the context of overall dynamic gait coordination, no single method of training provides the optimal stimulus. A training program that uses a variety of techniques may provide a beneficial rehabilitation response.

Section snippets

Participants

Seventeen people (10 men; mean age ± SD, 38.7±15.3y; mean height ± SD, 175.0±8.6cm; mean body mass ± SD, 72.4±22.7kg) with an ABI and who could not walk without assistance were recruited from the rehabilitation units at the Epworth Hospital. Other inclusion criteria were the ability to fully weight bear (for those who had sustained an associated lower-limb fracture) and ability and willingness to provide informed consent. Eleven participants had sustained extremely severe (length of

Results

All participants could complete the THERAPIST, BWSTT+T, BWSTT+UL, and BWSTT+T+UL trials; however, 4, 2, and 2 participants were unable to perform the BWSTT, GAIT AID, and TREADMILL protocols, respectively, due to either physical inability or risk to safety. Five participants were responsible for these 8 incomplete trials, and therefore the data for these participants were excluded from further analysis.

The ML COM displacement amplitude results are provided in figure 2A. A significant main

Discussion

This study examined coordination of the COM during a variety of gait training methods in people with an ABI and compared these results to people with nonpathologic gait. Of the training strategies included in this study, BWSTT with no other support or facilitation performed poorly. It resulted in large COM displacements, poor timing of COM movement within the gait cycle, and reduced stability. These timing and stability results are consistent with the study of Kyvelidou et al,20 who observed

Conclusions

These results indicate that treadmill training (±BWS) with handrail support reduces ML displacement of the COM and postural instability during the gait training session. However, this upper-limb support may come at the cost of altering the timing and variability components of the gait pattern. Careful consideration of these factors should be given when implementing a gait rehabilitation program to achieve adequate postural stability for independent gait; however, further research is required to

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    Supported by a grant from the Royal Automobile Club of Victoria.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

    In-press corrected proof published online on Feb 13, 2012, at www.archives-pmr.org.

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