Postural Stability Challenges in Narrow Walking after Traumatic Brain Injury

Langenderfer Joseph E,Ustinova Ksenia I,Mara R Thompson

doi:10.13189/saj.2021.090516

Abstract

The aim of this study was to evaluate the predictability and complexity of gait under preferred and narrow walking conditions for groups of TBI and age matched control subjects in order to determine if non-linear measures may be appropriate for identifying gait deviations not detected with more routine techniques. Ten participants from each group walked at preferred gait and with a narrow base of support. Center of mass motion was calculated from marker motion recorded with motion capture. Measures of predictability and complexity of center of mass motion were calculated with Recurrence Quantification Analysis. Walking with a narrow base of support resulted in a less predictable center of mass motion (reduced %Determinism) for TBI and control groups (p=0.0019 and p=0.0008, respectively), but no difference was found between groups. For the TBI group, there was a significant decrease in complexity of center of mass motion (lower Entropy, p=0.0038) with narrow base of support compared to preferred walking, but no difference in Entropy was found between groups. These results suggest non-linear measures determined using techniques such as Recurrence Quantification Analysis might have potential to be valid and reliable measurement techniques for predicting gait deviations in future studies.

Highlights

Observational and instrumental gait analysis is challenging in individuals with post-traumatic brain injury (TBI) when compared to other clinically encountered deficits
TBI participants presented with some amount of ataxia and postural and gait abnormalities (Table 1), according to standard clinical tests and ranges of scores: (a) Ataxia Test by Klockgether [15]: 2–18, 35 indicates severe ataxia; (b) Berg Balance test (BBS) [16]: 45–54 (51.0 ± 3.6), 45 indicates an increased risk of fall; and (c) Functional Gait Assessment Test (FGA) [17] 14–27, 22 indicates an increased risk of fall
There were significant differences in %DET (p

Summary

Introduction

Observational and instrumental gait analysis is challenging in individuals with post-traumatic brain injury (TBI) when compared to other clinically encountered deficits. An expansion of the gait measure list sometimes does not increase sensitivity to detect small changes in gait performance This limitation is because most gait characteristics are derivatives of the same or similar measures, e.g. spatial displacement per time, and naturally correlate one with another. But somehow compensated and not addressed by rehabilitation, respectively, these hidden deviations may manifest at an inappropriate time while walking, cause unexpected perturbations to gait, and increase the risk of fall and injury. In this regard, the development of more sensitive measures for detecting even small or hidden gait deviations is important

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