Gait Impairment in Traumatic Brain Injury: A Systematic Review.

Anthony Dever,Alan Godfrey,Lisa Graham,Rodrigo Vitorio,Julia Das,Steven J Marshall,Rachel Mason,Dylan Powell,Samuel Stuart

doi:10.3390/s22041480

Abstract

Introduction: Gait impairment occurs across the spectrum of traumatic brain injury (TBI); from mild (mTBI) to moderate (modTBI), to severe (sevTBI). Recent evidence suggests that objective gait assessment may be a surrogate marker for neurological impairment such as TBI. However, the most optimal method of objective gait assessment is still not well understood due to previous reliance on subjective assessment approaches. The purpose of this review was to examine objective assessment of gait impairments across the spectrum of TBI. Methods: PubMed, AMED, OVID and CINAHL databases were searched with a search strategy containing key search terms for TBI and gait. Original research articles reporting gait outcomes in adults with TBI (mTBI, modTBI, sevTBI) were included. Results: 156 citations were identified from the search, of these, 13 studies met the initial criteria and were included into the review. The findings from the reviewed studies suggest that gait is impaired in mTBI, modTBI and sevTBI (in acute and chronic stages), but methodological limitations were evident within all studies. Inertial measurement units were most used to assess gait, with single-task, dual-task and obstacle crossing conditions used. No studies examined gait across the full spectrum of TBI and all studies differed in their gait assessment protocols. Recommendations for future studies are provided. Conclusion: Gait was found to be impaired in TBI within the reviewed studies regardless of severity level (mTBI, modTBI, sevTBI), but methodological limitations of studies (transparency and reproducibility) limit clinical application. Further research is required to establish a standardised gait assessment procedure to fully determine gait impairment across the spectrum of TBI with comprehensive outcomes and consistent protocols.

Highlights

Gait impairment occurs across the spectrum of traumatic brain injury (TBI); from mild to moderate, to severe
Recent evidence has suggested that objective measures of gait may be useful in TBI assessment, as gait has been shown to be a useful biomarker for neurological impairments [15,16,17]
Most of the removed articles were excluded because they included adolescents (Under 180 s), participants who suffered a previous TBI or did not include a healthy control group

Summary

Introduction

Gait impairment occurs across the spectrum of traumatic brain injury (TBI); from mild (mTBI) to moderate (modTBI), to severe (sevTBI). SevTBI patients demonstrate secondary implications of brain injury such as deviations in physiological variables, namely, systolic blood pressure, oxygen saturation, partial arterial pressure of oxygen, body temperature, serum sodium and glucose [8] These symptoms can present within both the acute and chronic phases of injury and represent a spectrum of injury. For example, 80% of people who suffer mTBI report balance impairments within days of injury [9], and 30% report chronic (longer term; >12 weeks) symptoms of balance and/or gait impairment [10] As such clinical assessment of physical and symptom deficits remain an important component of TBI assessment. No review has examined the gait impairments in TBI across the spectrum of the condition

Methods

Results

Conclusion