The Use of Gait Analysis for Surgical Recommendations in Traumatic Brain Injury

Abstract

Traumatic brain injury causes unpredictable errors in the patient's gait by introducing varying mixtures of spasticity, contractures, primitive flexion and extension synergies, and impaired selective control. Surgical release or transfer of the offending muscles can improve the patient's ability to walk if functional errors have been accurately identified. While clinical testing is inadequate, instrumented motion analysis and dynamic electromyography can supply an accurate definition of the abnormalities in muscle action and provide guidelines for distinguishing local from referred motion errors. Examples of the diagnostic differences related to the equinovarus foot and the common types of knee dysfunction are presented.

People Preferentially Increase Hip Joint Power Generation to Walk Faster Following Traumatic Brain Injury

“…Similarly, the cause of reduced ankle power generation at push-off in TBI may not be solely attributable to muscle weakness, particularly in a population susceptible to spastic equinovarus. [11][12][13][14][15] Nineteen of the participants with TBI elected not to attempt faster gait trials. Although data were collected for their self-selected gait trials, we do not know the impact of increasing speed on their gait performance.…”

“…Although equinovarus deformity affecting push-off after TBI has been well documented, [11][12][13][14][15] deficiencies in proximal muscle groups have not been explored. Management of fixed equinovarus deformity caused by contracture is typically managed surgically, [11][12][13] whereas botulinum toxin injection is the primary intervention for dynamic equinovarus deformity caused by spasticity. 15 Although reduced ankle power generation at push-off results in a slow asymmetrical gait pattern, 12,15 the impact of this deformity on proximal muscle power generation has not been reported.…”

The reliability of three-dimensional kinematic gait measurements: A systematic review

“…Gait analysis services typically include those with gait conditions such as CP [46], spinal cord injury [47,48], spina bifida and acquired brain injury [49]. Furthermore, research studies have used 3DGA to characterise gait disorders and examine intervention efficacy in diseases such as Parkinson's disease [50], myelomenigocele [51], and CP [52].…”

Observational gait analysis in traumatic brain injury: Accuracy of clinical judgment

“…To date, no study has reported the accuracy of OGA in an adult neurological population for multiple gait variables. Although 3DGA has been recommended for TBI [11,12], the accuracy of OGA has not been established. Therefore, the purpose of this study was to investigate the accuracy of clinician's visual observations of gait abnormalities that limit mobility following TBI and determine if experience, the type of gait variable, observational plane or body segment had an effect on accuracy.…”