摘要:

The temporal–spatial characteristics of the gait of patients with traumatic brain injury (TBI) were investigated and compared with those of normal gait and the gait of stroke survivors. A slower walking velocity is evident in the TBI population when compared with normal. The average walking speed of TBI survivors is faster than that of stroke patients and is mainly related to a longer step length. TBI survivors produce a gait pattern with a prolonged stance period for the unaffected limb, without prolonged stance period for the affected limb, and a shorter step length for the unaffected limb.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

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.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Spastic paretic stiff-legged gait is a frequently encountered gait problem in patients with traumatic brain injury, as well as in many other patients with upper motor neuron disease. Formerly, spasticity of the quadriceps was considered to be the sole cause of stiff-legged gait. Quantitative gait analysis, however, may implicate hip flexor weakness or poor ankle mechanics as the cause of stiff-legged gait. We discuss the use of an algorithm to evaluate stiff-legged gait in traumatic brain injury using a quantitative gait analysis system such that the specific etiology of stiff-legged gait can be identified and can serve as the basis of a treatment plan.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This article describes a novel therapeutic system for locomotion training and learning for patients with a wide range of neurological and musculoskeletal disorders. The technique embraces the notion that locomotion therapy should be goal oriented and task specific. The task specificity includes a partial weight-bearing device that permits the posture/equilibrium, movement, and weight-bearing components of gait function to operate concurrently, even in patients with serious deficits. In addition, it allows interaction with therapists and others to facilitate locomotion control, particularly during the early stages of gait therapy. Neurobiological bases for this technique and early clinical results are discussed, and two case studies of patients with traumatic brain injury (TBI) are presented. Although well-designed efficacy studies are needed, clearly this therapeutic approach to locomotor disorders among TBI patients meets the various criteria for recovery of gait function established in this article.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The split tibialis anterior tendon transfer (SPLATT), Achilles tendon lengthening, and toe flexor release are proven and effective procedures for correcting a spastic equinovarus deformity of the foot. Paresis is a prominent feature of upper motoneuron syndrome. Lengthening the Achilles tendon, although necessary to correct the equinus, further weakens the gastrocnemius–soleus muscle group. The calf paresis commonly results in the need for an ankle-foot orthosis (AFO) during ambulation. Previous studies have shown that despite the correction of the equinovarus deformity, only one third of patients were able to ambulate without an AFO. The need for continued use of an AFO was because of insufficient calf strength to stabilize the tibia during late stance when the body mass is anterior to the ankle joint. This study prospectively evaluated the results of transfer of the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) to the os calcis in 30 patients. The transfer was done in an effort to augment the strength of the gastrocnemius–soleus muscle complex. Twenty-five patients in group I (the control group) underwent SPLATT, Achilles tendon lengthening, and toe flexor release. Thirty patients in group II (the study group) underwent the identical procedures plus the additional FHL and FDL transfer to the os calcis. Postoperatively, the varus and toe flexion deformities were corrected in all feet. In group II, two feet had a mild residual equinus that did not interfere with ambulation. Of the 11 patients who were not independent community ambulators in group I, 7 (64%) improved ambulatory status by at least one level after surgery. Of the 15 patients who were not independent community ambulators in group II, 14 (93%) improved ambulatory status by at least one level after surgery. In group I, 10 of 25 (40%) of the patients were brace free at follow-up. In group II, 21 of 30 (70%) were brace free at follow-up (χ2,P= .025). These results indicate that the addition of an FHL and FDL transfer to the os calcis at the time of SPLATT, Achilles tendon lengthening, and toe flexor release improves calf strength and allows greater increase in function and less reliance on orthotics.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

We evaluated the evidence for effectiveness of rehabilitation methods throughout the phases of recovery from traumatic brain injury (TBI) in adults. MEDLINE, HealthSTAR, CINAHL, PsycINFO, and the Cochrane Library were searched, and a total of 3,098 abstracts were reviewed. The strongest studies were critically appraised and their data placed in evidence tables. Results showed that to determine the effectiveness of rehabilitation interventions for persons with TBI, a commitment must be made to population-based studies, strong controlled research design, standardization of measures, adequate statistical analysis, and specification of health outcomes of importance to persons with TBI and their families.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The Traumatic Brain Injury (TBI) Model Systems Program has been funded by the National Institute on Disability and Rehabilitation Research (NIDRR) since 1987. Until recently, this program has consisted of four centers that conducted priority-focused research on specific aspects of TBI and analyzed data on the basis of a uniform, comprehensive national database. In 1997, $5 million in additional funding was allocated for the expansion of this program. In October 1998, after a competitive renewal process, a total of 12 new centers were awarded, bringing the total TBI Model Systems to 17. In addition to the creation of new centers, funding was provided for specific collaborative research projects and increased resources for the TBI National Data Center. Below are the abstracts for both the newly funded systems and the existing systems.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

In 1996, Congress enacted Public Law 104-166, the Traumatic Brain Injury (TBI) Act, to provide for the conduct of expanded studies and the establishment of innovative programs with respect to TBI.1As part of the Act, the Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), is responsible for implementing the TBI State Demonstration Grant Program to improve health and other services regarding persons with TBI and their families. Currently, the TBI State Demonstration Grant Program includes two categories of grants: Planning and Implementation. Planning Grants are available to states that wish to develop the core components necessary to improve the overall infrastructure of the state system. These four components include establishment of an advisory board, the identification of a coordinating agency and designated staff, the completion of a comprehensive needs/resource assessment, and the development of a statewide action plan. Those states that can successfully demonstrate core capacity are eligible for grants in the Implementation category. Implementation grants provide resources to implement statewide systems and models that will improve and enhance access to comprehensive and coordinated services for individuals with TBI and their families.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID