Dual task gait after moderate-to-severe traumatic brain injury: Characterization of troubles and consequences

Abstract

Patients suffering from traumatic brain injury (TBI) often present with cognitive but also posture and gait impairments. In this study, we aimed at evaluating the cost of the addition of 3 types of cognitive concurrent tasks on gait parameters, and studying the relationship between dual task cost and patient-reported perception of their confidence in balance and gait in daily living. Spatiotemporal gait parameters were assessed using a GAITRITE mat in 22 moderate-to-severe TBI patients and 26 age-matched healthy controls. The addition of 3 cognitive tasks (letter back-task, substractions by 3, talking when walking) was studied during unobstructed walking and stepping over an obstacle. We also evaluated the relationship between dual task cost during gait and (1) cost in another motor task (Baddeley) and (2) patient perceived confidence in dynamic balance and gait in daily living (ABC scale). Dual task cost during gait was higher in TBI patients compared to healthy controls when walking unobstructed and in the subtraction and talking concurrent tasks. Alteration of gait speed was primarily due to a decrease of step length more than of gait cadence. TBI patients tended to prioritize the cognitive task. Dual task cost during gait was correlated with the Baddeley dual task performance ( r = −0.420; P = 0.003) but not with the ABC scale score. TBI patients exhibit difficulties in dual task gait conditions, which can be easily assessed and should be addressed in rehabilitation. The dual task cost could be not specific to locomotor activities. Finally, other factors seem to explain the alteration in confidence in gait and balance in daily living.