Evaluation of Motor Control Following Pediatric Traumatic Brain Injury: A Pilot Study

Abstract

<h3>Research Objectives</h3> To determine if Walking Dynamic Motor Control (Walk-DMC), a measure used to quantify motor control, is useful for pediatric patients with a traumatic brain injury (TBI) by (1) helping to evaluate the severity of the injury, (2) measuring the progress of motor recovery, and (3) estimating the prospects for motor recovery. <h3>Design</h3> Observational, exploratory study. <h3>Setting</h3> Inpatient Rehabilitation Unit (IRU) in a Pediatric Specialty Hospital. <h3>Participants</h3> Convenience sample of children/adolescents (n=4) who sustained a severe TBI (initial Glasgow Coma Scale ≤ 8) and completed inpatient rehabilitation in a pediatric center. <h3>Interventions</h3> Inpatient rehabilitation therapies including twice daily physical therapy. <h3>Main Outcome Measures</h3> Walk-DMC was collected twice weekly for the first two weeks, then weekly until discharge from IRU. Clinical measures of mobility and balance such as the Pediatric Berg Balance Scale (PBS), Six Minute Walk Test (6MWT), and Timed Up and Go (TUG) were also collected at these time points as patient's mobility allowed. All measures were collected six months post-injury. <h3>Results</h3> Four patients (age 8-17; 2 males, 2 females) with severe TBI were enrolled. All participants demonstrated a reduction in their Walk-DMC and standard of care clinical measures during the initial assessment. Standard of care clinical measures and Walk-DMC improved over the course of the study period however, Walk-DMC did so over a longer time course. Although PBS and TUG normalized in some participants by the six months post-TBI assessment, Walk-DMC did not. <h3>Conclusions</h3> Walk-DMC was diminished after severe TBI, consistent with decreases in standard of care measures. Throughout the study, participants demonstrated improvement in all standard of care measures as they improved by subjective clinical assessment. As Walk-DMC was still diminished at the six-month post-TBI assessment for all participants, it may be that Walk-DMC is more sensitive to detecting ongoing neurologic impairment compared to other clinical measures. Future assessments will include a repeat assessment one-to-two years post-injury to determine if Walk-DMC continues to be suppressed compared to the standard of care clinical measurements. <h3>Author(s) Disclosures</h3> None.