THE EFFECTS OF BODY WEIGHT SUPPORTED GAIT TRAINING and FUNCTIONAL ELECTRICAL STIMULATION ON GAIT SPEED and CONTROL IN AN INDIVIDUAL WITH A TRAUMATIC BRAIN INJURY.

Abstract

Purpose/Hypothesis: The purpose of this study was to determine if body weight supported treadmill training (BWS-TT) and functional electrical stimulation (FES) would improve gait speed and endurance in an individual with a traumatic brain injury. Number of Subjects: One. Materials/ Methods: This study had an ABA design. In condition A, the subject participated in BWS-TT for 10 sessions. In condition B, he participated in BWS-TT with the addition of FES for 8 sessions. FES was controlled by a switch placed in the subject's left shoe. Unweighting his leg in pre-swing triggered electrical stimulation to the left peroneal nerve to help increase left swing. In the last phase of the study, the subject again participated in BWS-TT without FES for 5 sessions. During each session, the subject had 30 percent of his weight supported by the BWS system. Treadmill speed, distance, and time walked were recorded for each trial of walking. The subject performed 3 to 4 trials per session. Data Analysis: Distance walked and walking speed per trial were graphed and visually analyzed using cel-eration lines drawn using the split-middle technique. Results: The subject demonstrated improvements in both distance and speed throughout the course of the study. Examination of the celeration lines revealed he was able to sustain a higher level of consistent improvement while using FES. His walking speed on the treadmill improved from 1.1 mph at the start of the study to 1.7 mph at the end of the first set of BWS-TT sessions. Speed increased to 2.2 mph at the end of sessions with BWS-TT and FES. When he resumed BWS-TT only, speed decreased to 2.0 mph; it increased to 2.2 mph at the end of the study. Distance walked per trial improved from 195 feet in the beginning of the study to 369 feet at the end. Conclusions: The use of BWS-TT can be a useful intervention to increase gait speed and walking distance in an individual with a traumatic brain injury. Adding FES during this intervention increased the improvement in this subject. Clinical Relevance: Decreased independence in gait is a frequent functional limitation in individuals with TBI. Using BWS-TT and FES together as interventions may help improve gait speed and endurance. The FES used in this study was relatively inexpensive and easy to apply, making it feasible for clinical use.