Measuring early predictors for recovery of walking ability in patients with moderate and severe traumatic brain injury. A feasibility study
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Background: Survivors after traumatic brain injury (TBI) often suffer from long-term disability in motor functions including gait. Predicting motor recovery in the first clinical phase after traumatic brain injury is important to choose the most appropriate rehabilitation setting. Objective: The purpose of this study was to examine the feasibility of measuring functional outcomes in patients with moderate (MTBI) and severe traumatic brain injury (STBI) at the clinical phase. Design: A prospective observational pilot study was conducted. Methods: Twelve patients were included at the Radboud University Nijmegen Medical Centre within 72 hours after onset of TBI. A set of 12 functional outcomes was measured, with a follow up at one and two weeks after TBI. Each functional variable was examined whether these met the following feasibility criteria: T0: 50%, T1: 50-75% and T2: 75%. Barriers hampering the assessment of functional outcomes, were reported. Results: The highest feasibility scores were found at the Brunnstrom stages (T1=87.5%, T2=83.3%) and the Modified Ashworth Scale (MAS) (T1=75%, T2=83,3%). Functional outcomes at the level of activities, scored low (T0=16.7%, T1=37.5%, T2=50%). During the first 2 weeks after trauma none of the patients was able to perform a walking test (T0, T1, T2=0%). Assessments were hampered by barriers like sedation, not able to follow instructions, bed rest, reduced physical capacity or no walking ability. Limitations: A single-center study in an university hospital, with a small sample (n=12) and a large number of lost to follow two weeks after trauma (50%), reduced the generalizability. Conclusions: The measurements Brunnstrom stages and MAS were feasible to measure in the clinical phase in patients with MTBI and STBI. Other functional outcomes were limited to assess within two weeks after TBI.