Sensorimotor recovery in children after traumatic brain injury: analyses of gait, gross motor, and fine motor skills

Abstract

The recovery of gait, gross motor proficiency, and hand function was examined in 23 children (13 males, 10 females; age 4 years 7 months to 15 years 10 months) with traumatic brain injury (TBI) over five months of in patient rehabilitation. We used gait analysis, the Gross Motor Function Measure, the Developmental Hand Function Test, and the Purdue Pegboard test. Brain injury had been severe (initial Glasgow Coma Scale GCS <8) in 17 children and moderate (GCS 8–10) in six children. Compared with healthy control children of the same age and sex, repeated gait analyses in ambulatory children with brain injury showed significant reductions of velocity, stride length and cadence, and impaired balance. Spatiotemporal gait variables were correlated with Gross Motor Function Measure scores. Hand function tests revealed deficits in fine motor skills, speed, and coordination. Degree of impairment increased with trauma severity. Despite significant improvements, differences in gait velocity, stride length, and hand function of children with brain injuries and controls were still present about 8 months after TBI. Hand motor skills improved less than gait. Young age at injury was not associated with better recovery.

Surgical Intervention for Spastic Upper Extremity Improves Lower Extremity Kinematics in Spastic Adults: A Collection of Case Studies

“…This is in agreement with previous studies (Teasdale et al, 1979;Authier et al, 1995) suggesting that there is a plausible effect of age and functional recovery, as youth plays a prominent factor in neuroplasticity following brain injury (Uswatte and Taub, 2010;Rutović et al, 2019). Additionally, other studies have shown that, depending on the severity of spasticity, some patients might demonstrate significant gait recovery levels (e.g., increased walking velocity) while other might show minimal improvements (Knutsson and Richards, 1979;Kuhtz-Buschbeck et al, 2003;Watson and Hitchcock, 2004;Tilson et al, 2010;Jang and Kwon, 2016;Marque et al, 2019), as observed postoperatively in SP1. Even though the joint kinematic parameters of the lower limbs in SP1 didn't show outstanding improvements over time, at 12 months postoperatively the patient was able to ambulate comfortably with a cane; no longer relying on a wheelchair.…”

Diffuse traumatic brain injury and the sensory brain

“…Cognitive deficits include attention and memory deficits, reduction in information processing speed and psychiatric disorders . Motor impairments include deficits in fine motor skills, such as finger‐tapping and grip strength, and coordination, whereby patients have impaired gait and balance . Persistent sensory deficits have been demonstrated extensively across a number of tasks and across modalities .…”

“…The causes of the prolonged functional deficits in diffuse TBI are rarely known . The absence of obvious cell death and the array of cognitive and memory deficits suggests a substantial but subtle functional alteration with ramifying consequences and one beyond resolution of standard imaging and/or histology. It is worth noting here that TBI‐induced deficits in cognition, memory and movement are invariably viewed as resulting from damage to brain areas specific to those functions.…”

“…Other studies using more direct measurements of sensory abilities have reported cases of auditory and visual changes in adult TBI in the form of longer P300 wave latencies and smaller amplitudes . Speeded motor tasks and response time tasks are also affected in mild to moderate diffuse TBI, again suggesting disturbances in sensorimotor processing, and there are many long‐lasting cognitive impairments even after motor function has recovered . It remains an open question as to the extent to which the long‐term sensory deficits may contribute to the cognitive and motor deficits.…”

Gross Motor Function Measure‐66 trajectories in children recovering after severe acquired brain injury

“…). Kuhtz‐Buschbeck et al . found that GMFM scores correlated with kinematic measures derived from gait analysis in a sample of 5‐ to 15‐year‐old children rehabilitating from severe TBI.…”