Exoskeleton Gait Training with Traditional Physical Therapy Management of a Patient with Polytrauma Injuries and Diffuse Axonal Injury: A Case Report

Abstract

Purpose People with polytrauma injuries along with diffuse axonal brain injury (TBI+DAI) present unique challenges to the physical therapist during comprehensive inpatient rehabilitation. The literature available to rehabilitation professionals regarding exoskeleton gait training (EGT) in the traumatic brain injury (TBI) population is limited. The purpose of this case report is to describe the use of EGT and traditional physical therapy management of an adult with polytrauma injuries and TBI+DAI during an inpatient rehabilitation stay. Methods The subject was a 31 year old veteran male diagnosed with polytrauma injuries and TBI+DAI, resulting from a high speed motor vehicle collision. He began to emerge from comatose state 8 days post-injury, was admitted to an inpatient rehabilitation facility and began physical therapy 23 days post-injury. He participated in physical therapy one to two times daily for 60 minute sessions with five additional EGT sessions and two community re-integration outings, for an average of 7 sessions per week throughout episode of care. Results Measures were taken at admission and were reassessed weekly. Functional Independence Measure total score increased from 62 to 117 and the motor subscale increased from 37 to 89. Berg Balance Scale score increased from 0 to 54. Gait distance increased from 20 feet with quad cane and moderate assistance from physical therapist to 5,755 feet with single point cane and modified independence. Conclusion This case reports describes the use of off-label EGT in addition to traditional physical therapy management that was successful in increasing the quality and efficiency of gait in an individual with polytrauma injuries and TBI+DAI.