Course Description:

Traumatic brain injury (TBI) is caused by external forces that alter brain function. Motor vehicle accidents, falls, assaults, sports injuries, and gunshots are common causes of TBI. The primary injury disrupts brain tissue at the moment of impact, while secondary injury can occur over the following days, weeks, or months due to biochemical changes caused by processes such as cerebral edema. TBI may result in lifelong impairment of physical, cognitive, behavioral, and emotional function. Characteristic movement disorders include abnormal timing and trajectory of limb movements, impaired balance, and increased postural sway. Loss of ambulation can have a significant impact on a patient’s independence and quality of life, and therefore independent gait is often a major goal of rehabilitation after TBI. Typically, after TBI gait speed is reduced, base of support is widened, and biomechanical abnormalities such as excessive knee flexion at initial foot contact, knee hyperextension during stance, and increased trunk movement are observed. Walking safety can also be affected by cognitive and behavioral impairments, such as impulsivity and memory problems. Outcome is difficult to predict and patients might improve for years; however, recovery of ambulation is more likely in TBI patients who are young, who are less dependent with ambulation at the start of rehabilitation, or whose injuries are less severe. Gait training methods may include parallel bar walking, aquatic therapy, manual facilitation by therapists, use of gait assistive devices, treadmill walking, body weight-supported treadmill walking, or robot-assisted gait training.