Improved ability to achieve single leg stance increases gait efficiency following single leg stance intervention in adults post brain injury

Boyer, A; Spence, NJ

Abstract

Purpose: Acquired brain injury (ABI) survivors rate walking impairments as their most severe limitation. Following ABI adults walk 60 cm/s slower than healthy adults. Following ABI reduced gait speed correlates with reduced single leg stance (SLS) which is considered the most important component of gait accounting for 60% of the gait cycle. Studies of predominantly small samples demonstrate specific SLS intervention can improve SLS and gait speed post cerebrovascular accident (CVA) and to a lesser extent traumatic brain injury (TBI). Given that only these two types of brain injury have been researched to date, there is a lack of research for the whole ABI population as many additional ABI conditions such as encephalitis, meningioma, hypoxia and sub-arachnoid haemorrhage (SAH) have yet to be explored.

The aim of this study was to determine if an improved ability to achieve SLS leads to a more efficient gait pattern following SLS intervention in adults with ABI.

Methods: Pilot pre-test–post-test experimental design utilising a control group (CG) with adults with ABI from an inpatient neurorehabilitation unit. The experimental group (EG) received usual therapy alongside SLS intervention with the CG receiving usual therapy only. Treatment based on neuro-developmental technique (NDT) was carried out for a maximum of forty-five minutes, four times per week for six weeks. SLS was measured using Goal Attainment Scale (GAS) based on SLS test (SLST) and gait efficiency was measured using 10m walk test (10MWT).

Results: Twenty-six participants were recruited and randomly allocated to EG (n = 13) and CG (n = 13). Seven diagnoses were represented including TBI, CVA, meningioma, SAH, encephalitis, hypoxia and brainstem bleed. 92% of participants in EG achieved greater than GAS minimal clinical important difference (MCID) of ten compared to 31% in CG (p = 0.002 and p = 0.025 respectively). 77% of EG achieved greater than 10MWT MCID of 0.14m/s compared to 38% in CG (p = 0.001 and p = 0.033 respectively). As the p-value was set at 0.05 each of these results were statistically significant indicating group differences were due to SLS intervention. 61.5% of EG also progressed to being community ambulators compared to only 31% in CG despite both groups starting with a baseline of 46% of participants being household ambulators.

Conclusion(s): Specific SLS intervention improved SLS (measured by GAS utilising SLS test) and gait speed (measured by 10m walk test) greater than usual intervention in adults with an ABI, indicating SLS intervention in conjunction with usual therapy could aid SLS and gait post ABI. Future research with larger samples and matched groups would enable generalisation to the whole ABI population.

Impact: This research indicates potential benefits of SLS intervention on gait efficiency and community ambulation for adults post ABI and will be adopted into normal practice for this inpatient rehabilitation unit. Data will continue to be collected which could contribute towards further larger scale studies with increased number of participants. This will allow for the heterogenous nature of ABI and enable generalisability of the findings to the wider ABI community.

• Presentation Conference Type: Conference Paper (published)
• Conference Name: Physiotherapy UK 2021 Conference
• End Date: Nov 6, 2021
• Publication Date: Feb 16, 2022
• Deposit Date: Feb 22, 2022
• Journal: Physiotherapy (Deleted)
• Electronic ISSN: 1230-8323
• Publisher: De Gruyter
• Volume: 114
• Issue: Sup. 1
• Pages: e51
• DOI: https://doi.org/10.1016/j.physio.2021.12.304
• Publisher URL: https://doi.org/10.1016/j.physio.2021.12.304
• Related Public URLs: https://www.journals.elsevier.com/physiotherapy/
• Additional Information: Access Information : This is a published conference abstract.; Event Type : Conference