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Table 4.6 Multimodal Interventions for Lower Extremity Rehabilitation Post ABI

by | Dec 5, 2018

Table 4.6 Multimodal Interventions for Lower Extremity Rehabilitation Post ABI

Author Year Country Study Design Sample Size Methods Outcome
Clark et al. (2012) Australia RCT PEDro=3 N=42 Population: Experimental Group (n=17): TBI=11, Stroke=5, Multiple Sclerosis=1; Mean Age=38.7yr; Gender: Male=10, Female=7; Median Time Post Injury=9 mo. Control Group (n=25): Healthy controls; Mean Age=27.8yr; Gender: Male=16, Female=9. Intervention: All participants performed 7 alternative gait training methods in a randomized order. Methods included: therapist manual facilitation, use of gait assistive device, treadmill walking with handrail support, and 4 variations of body weight-support treadmill training with combinations of handrail and/or therapist support. Outcome Measure: Mediolateral Center of Mass Movement, Stride Time, Stability of Movement. 1.        Body weight-support treadmill training without any additional support resulted in greater amplitude, altered timing, and reduced movement stability compared with non-pathologic gait. 2.        Manual facilitation by the therapist most closely matched non-pathologic gait for timing and stability. 3.        The use of therapist facilitation or handrail support reduced the effect and resulted in treadmill training having lower movement amplitudes when compared to other methods of training.
Canning et al. (2003) Australia RCT PEDro=7 N=22 Population:  Severe TBI; Gender: Male=16, Female=6. Experimental Group (n=12): Mean Age=24.75yr; Mean Time Post Injury=75.25d. Control Group (n=10): Mean Age=25.6yr; Mean Time Post Injury=84.6d. Intervention: Patients were divided randomly into either a regular rehabilitation program group (control) group or the intervention group which received the rehabilitation program as well as 4wk of intensive training of sit-to-stand and step-up exercises. Outcome Measure: Sit-to-stand repetitions, Peak Oxygen Consumption (exercise capacity), Oxygen Consumption Workload Test (exercise efficiency). 1.        The experimental group performed a mean of 87 repetitions of sit-to-stand and 42 repetitions of step-ups per working day. 2.        The intervention group had a 62% improvement in the number of sit-to-stands performed in 3min (motor performance) compared to 18% increase in the control group (p=0.03). 3.        There were no significant between-group differences in the improvements made in exercise capacity (p=0.36) or efficiency (p=0.38). 4.        The increase in exercise capacity for the intervention group was significant with an increase in VO2peak from 0.75L/min to 1.14L/min (p<0.01).
        Peters et al. (2014) USA Pre-Post N=10 Population: TBI; Median Age=35.4yr; Gender: Male=6, Female=2; Median Time Post Injury=9.9yr. Intervention: Participants went through 20 days of intensive mobility training (5 d/wk for 4wk). Sessions included gait training with body-weight-supported treadmill, balance activities, strength coordination, and range of motion training. Outcome Measure: Berg Balance Scale, Dynamic Gait Index (DGI), 10 Metre Walk Test (10MWT), 6 Minute Walk Test (6MWT), 30 sec Sit-to-Stand test, Timed Up and Go (TUG) test, Walking While Talking Test average errors/ alternating letters, Falls Efficacy Scale (FES), Quality of Life after Brain Injury, Global Rate of Change Scale, Fatigue. 1.        The average session was 150.1±2.7min. 2.        Fatigue scores ranged from 0 to 2.5 (out of 10) before sessions and 3 to 5.5 after. 3.        From pre-test to post-test, significant improvements were seen for the FES (p=0.01), DGI (p=0.049), 10MWT (p=0.03), TUG (p=0.01), and 6MWT (p=0.03). 4.        From pre-test to follow-up (3mo), significant improvements were sustained for the 10MWT (p=0.02) and the TUG (p=0.03).
Hirose et al. (2013) Japan PCT N=15 Population: TBI=8, Stroke=7; Gender: Male=11, Female=4. Control Group (n=6): Mean Age=59.8yr. Intervention Group (n=9): Mean Age=49.9yr. Intervention: The control group received passive exercise and the intervention group received Electrical Muscle Stimulation (EMS) weekly (30min with stimulation cycles of 10 sec) in addition to passive exercise for 6wk. Outcome measure: Rate of Atrophy. 1.        There was a significant difference in the rate of atrophy between the EMS and control group, the EMS group showing less, in all 4 compartments (anterior and posterior thigh and leg) at day 14 (p<0.001). 2.        At 6wk the cross-sectional area was examined again, showing a significant difference between groups, with the EMS group showing less atrophy. (p<0.001).
Williams et al. (2019) Australia Prospective Controlled Trial NInitial=22, NFinal=22 Population: TBI=12; Mean Age=25.5±10.7yr; Gender: Male=10, Female=2; Mean Time Post Injury=374±486d; Severity: Mean PTA=57.8±25.9d.  Intervention: Healthy participants and individual with TBI completed a 6mo rehabilitation program focused on functional ballistic activities and task-specific practice to compare lower-limb joint mechanics during running. Outcome measures were assessed at baseline and 6mo follow-up. Outcome Measures: Average power absorbed and generated at the hip, knee, and ankle joints during stance.   1.        When compared to healthy controls, those with TBI ran with greater average power absorption at the hip (-.27W/kg versus -61W/kg; p<.05), reduced average power absorption at the knee (-2.03W/kg versus -1.02W/kg; p<.05) and reduced average power generation at the ankle (2.86W/kg versus 2.06W/kg; p<.05). 2.        Only average power generation at the ankle improved following six months of rehabilitation for the participants with TBI (2.06W/kg versus 2.79W/kg; p<.05).