Estimating Highest Capacity Performance During Evaluation of Walking for Individuals with Traumatic Brain Injury

Research Objectives: To assess the role of fear of falling and balance confidence in a clinician guarding (overhead) vs. overhead harness condition.
To validate and assess a safe top walking speed measure for participants with TBI.

Design: Repeated measures over 3 days (1 testing environment per day) for overground (clinical standard), overhead track (suspended torso and thigh harness), and robotic treadmill (harness system over a treadmill belt). Participants will complete walking assessments using the 10-meter walk test, 5 times sit-to-stand, and 6-minute walk test. Top walking speed is performed in the robotic treadmill safety-enhanced environment. Fear of fall and walking confidence are assessed at baseline.

Setting: The Moody Neurorehabilitation Institute in Galveston, TX provides inpatient post-acute brain injury rehabilitation. We will conduct evaluations on site in their gymnasium.

Participants: Our study sample will include 28 post-TBI individuals currently enrolled at the Moody Neurorehabilitation Institute. Participants must be 1) English-speaking, 2) 18+ years old, 3) ambulatory with or without assistive devices, 4) medically stable (controlled hypertension, no arrhythmia, stable cardiovascular status), 5) for subjects with expressive aphasia, a caregiver must be able to provide assistance when needed.

Interventions: Repeated measures design, no applied interventions.

Main Outcome Measures: Comfortable Walking Speed (meters/second): 10-meter walk test (comfortable)
Fast Walking Speed: 10-meter walk test (fast)
Top Walking Speed: In the robotic treadmill environment (safety-enhanced), participants are instructed to do their best to keep up with the speed set by the administrator. The fastest speed successfully completed is documented as the top walking speed.
Strength: 5 times sit-to-stand
Endurance: 6-minute walk test

Results: Preliminary results from the first 8 participants show that walking strength and fast walking speeds are predictors of top walking speeds obtained in the robotic treadmill environment, but it is too soon to make statistically significant conclusions. Complete data will be collected and analyzed by the conference date.

Conclusions: Methods that reduce the fear of falling during walking assessments are critically needed, as true walking ability may be greater than standard overground tests can determine.

Author(s) Disclosures: None