Abstract
Background: A common and debilitating challenge experienced by people with TBI is gait-associated mobility impairment and persisting cognitive impairments. Cognitive and physical impairments are often addressed independently during rehabilitation, however, increasing evidence links cognitive and motor processes more closely.Objectives: (1) To determine if correlations exist between measures of cognitive and gait recovery, post-TBI. (2) To investigate the predictive power of cognition at 2-months on gait outcomes at 12-months post-TBI.Methods: In this secondary, longitudinal study of cognitive and neural recovery, data from 93 participants admitted to an inpatient neurorehabilitation program were analyzed. Spatiotemporal gait variables [velocity, step time variability (STV), step length variability (SLV)] were collected along with cognitive variables [Trail Making Test-B (TMT-B), Digit Span-Forward (DS-F)]. Spearman's correlation coefficients were calculated between gait and cognitive variables. Multilinear and step wise regression analyses were calculated to determine predictive value of cognitive variables at 2-months on gait performance at 12-months-post TBI.Results: At 2-months post-injury, TMT-B was significantly correlated with gait velocity and STV; and DS-F was significantly correlated with velocity. At 12-months post-injury, TMT-B and DS-F was still significant correlated with velocity. TMT-B at 2-months was correlated with SLV and STV at 12-months; and DS-F correlated significantly with velocity. Regression models showed TMT-B at 2-months predicting STV, SLV, and velocity at 12-months.Conclusions: Significant associations and predictions between physical and cognitive recovery post-TBI were observed in this study. Future directions may consider a “neural internetwork” model as a salient rehabilitation approach in TBI that integrates physical and cognitive functions.
Highlights
A traumatic brain injury (TBI) refers to an external force to the head resulting in structural and/or functional changes to the brain; these are typically associated with acute alterations to consciousness and transient or persisting cognitive, motor, mood and/or somatic symptoms thereafter [1, 2]
A total of 93 individuals qualified for the current study by meeting the following inclusion criteria: [1] acute care diagnosis of TBI; [2] severity as indicated by length of post-traumatic amnesia (LPTA) of >1 h and/or Glasgow Coma Scale (GCS) score of
Exclusion criteria included: [1] diagnosis of an additional independent neurological condition such as Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, Huntington’s disease, lupus, or stroke; [2] history of psychiatric disorder; [3] the etiology of the TBI resulting from a pre-existing or acute neurologic condition, such as a fall caused by a stroke; [4] physical assistance required to complete gait tests; [5] orthopedic injuries affecting both lower extremities; [6] failure to emerge from LPTA by 6 weeks post injury, as measured by the Galveston Orientation Amnesia Test
Summary
A traumatic brain injury (TBI) refers to an external force to the head resulting in structural and/or functional changes to the brain; these are typically associated with acute alterations to consciousness and transient or persisting cognitive, motor, mood and/or somatic symptoms thereafter [1, 2]. It is estimated that over three million people with TBI in the United States are living with a significant long-term disability [2, 4, 5]. Persisting impairments associated with disability include cognitive deficits [1] and neuromotor impairments [6], such as balance [7]. These disabilities adversely affect the livelihood of people with TBI, resulting in loss of productivity. Finkelstein et al [8] found that after being hospitalized, 1 out of 5 Americans with TBI did not return to work 1 year-post-injury, due to a disability, amounting to an estimated $51.2 billion in total lifetime productivity loss. Cognitive and physical impairments are often addressed independently during rehabilitation, increasing evidence links cognitive and motor processes more closely
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