Training motor control in the cervical spine improves reliability of gait parameters in individuals with traumatic brain injury

Research Objectives: Individuals with chronic moderate traumatic brain injury (cMTBI) commonly exhibit changes in the variability and consequently decreased reliability of gait characteristics. These impairments are more pronounced in conditions that demand high levels of neuromuscular coordination such as stepping over obstacles while walking. Since head and neck movement control can influence gait, the purpose of this study was to analyze whether cervical motor control training affects reliability of gait parameters in patients with cMTBI.

Design: Intervention study (before-after trial).

Setting: The study was conducted in outpatient rehabilitation centers.

Participants: Twenty individuals were enrolled in the study; ten with cMTBI and ten age-and-gender matched unimpaired individuals.

Interventions: All individuals received 16 sessions of training (20min per session) targeting motor control of the cervical spine with The Butterfly Method (NeckCare, Kopavogur, Iceland) over an 8 week-period.

Main Outcome Measures: Gait with stepping over an 8-inch high object was measured using OptoGait (Microgate, Bolzano, Italy) pre and post intervention. Parameters included: step and stride time, double support%, time stance%, , propulsive phase%, load response%, pre-swing% and walking base. Reliability was analyzed using intraclass correlation coefficient (ICC) and coefficient of variation (CV).

Results: Low to excellent reliability of gait parameters with stepping over an obstacle was observed before training in the cMTBI group (ICC -.720 - .941; CV 1.8 – 11.2), but was considerably higher in unimpaired individuals (ICC .728 - .968; CV 1.2 – 6.5). Reliability of gait in individuals with cMTBI increased after training (.370 on average for ICC, ICC .678 – .829; CV 1.4 – 8.6) and reached similar values to unimpaired individuals.

Conclusions: Targeted training to improve motor control of the cervical spine have a positive impact on reliability of gait characteristics in individuals with cMTBI in tasks that involve higher neuromuscular coordination.

Author(s) Disclosures: None to disclose