Locomotor Recovery Following Traumatic Brain Injury
Locomotor Recovery Following Traumatic Brain Injury
The purpose of this study is to investigate the effectiveness of two different walking
 training interventions on the recovery of strength, mobility, walking and other measures of
 health in individuals following traumatic brain injury. During this study, participants will
 aim to complete up to 15 training sessions over 4-5 weeks of each intervention with at least
 a 4 week break between interventions. Each training session will last approximately 1 hour,
 while testing sessions performed at the beginning and end of each intervention will last
 approximately 3-4 hours. Participation in this research study may last up to 6 months
 including screening and baseline testing. The possible benefits to participant from
 participation in this study include increased strength of the participants leg muscles and
 improved walking ability
The primary goal of the proposed study is to identify the contributions of the amount of
 task-specific practice on locomotor (i.e., walking) recovery in patients with (> 6 Months)
 traumatic brain injury (TBI). The investigator will do this by building on our previous work
 directed towards identifying the essential exercise training parameters that maximize
 locomotor recovery. Consistent with principles of motor learning and exercise physiology, the
 investigator contend that certain training (i.e., dosage) parameters of physical
 rehabilitation, including the type (specificity) and amount of task practice, are critical to
 mobility outcomes following neurological injury. Previous work suggests these training
 parameters may influence locomotor recovery in patients with other neurological disorders
 (i.e., stroke), although few studies have attempted to delineate similar contributions of
 amount of task-specific practice in neurologic injury. Indeed, no studies have carefully
 controlled these training parameters during physical rehabilitation of patients with
 neurologic injury, and such interventions are rarely utilized in the clinical setting.
 Reasons for these knowledge gaps from other rehabilitation studies to patients with
 neurologic injury or lack of clinical implementation are unclear, but may be due to adherence
 to traditional rehabilitation theories. One concern is that practicing only stepping tasks
 reduces attention towards hallmark physical impairments following neurologic injury, such as
 loss of strength or postural stability, which are considered primary determinants of
 decreased mobility. Only a few studies have addressed whether providing only structured
 stepping training can mitigate these impairments without their explicit practice, but not in
 the neurologic injury population. A related concern is that focused stepping training without
 significant attention towards impairments or gait quality may exaggerate altered movement
 strategies, which could be reinforced with repeated practice. However, there is little data
 to suggest "worsening" of abnormal gait patterns following high intensity training. Rather,
 recent findings suggest patients demonstrate more normal kinematics. If focused task specific
 (i.e., stepping) training is to be applied clinically, participant must delineate its
 contributions towards improving locomotor function, and their effects on underlying
 impairments and gait kinematics.

 Central hypotheses are that stepping training in TBI results in:1) greater locomotor gains as
 compared to non-specific interventions; 2) gains in selected impairments underlying gait
 dysfunction (i.e., strength and metabolic capacity and efficiency); and, 3) improvements in
 gait quality. To test these hypotheses, the proposed crossover, assessor-blinded, randomized
 clinical trial (RCT) is designed to test the effects of specificity of rehabilitation
 training applied early-post-stroke. In this RCT, patients > 6 post-TBI will be allocated ≤ 15
 sessions over approximately 4-5 weeks of high-intensity stepping training or conventional
 therapy. Importantly, training intensity will be held constant to account for this potential
 confounding factor. Blinded assessments will be performed prior to and following each
 training paradigm.
Inclusion Criteria:

 -  > 6 months post traumatic brain injury

 -  18-75 years old

 -  ability to walk without physical assistance

 -  Self selected walking speed of 0.01-1.0 m/s

 Exclusion Criteria:

 -  <18 years old

 -  >75 years old

 -  self selected walking speed of > 1.0 m/s

 -  < 3 months from botulinum toxin injection

 -  Above the knee brace

 -  Currently receiving physical therapy