(Kiosk 4) Using a Novel Robotic-treadmill Platform Protocol in Addition to Customary Overground Rehabilitation for Gait Improvement in a Traumatic Brain Injured Individual: A Case Report

Case Diagnosis: A 21-year-old male with a history of TBI and thoracic spine fracture following a motor vehicle accident.

Case Description or Program Description: The patient was referred to an integrated inpatient post-acute neurological rehabilitation center, focusing on the continued medical and rehabilitative management of complications subsequent to his brain injury three months after the accident. During his Physical Therapy (PT) sessions, in addition to usual and customary overground training, he participated in three-times-weekly sessions over four weeks using a robotic treadmill platform (KineAssist) that allows “self-driven”/intentional movement with body weight support and safety from falls and the ability to provide resistive forces to improve strength, provide forward-aiding forces to improve speed, and balance perturbations to improve dynamic stability. Outcome measures were comfortable and fast 10-Meter-Walk-Test (10MWT), 6-Minutes-Walk-Test (6MWT), and Berg Balance Score (BBS).

Setting: MoodyNeuro Rehabilitation Center

Assessment/Results: Participant showed large-scale improvements across all outcomes assessed. The 6MWT distance improved by 91% (206.6-396.2m); the BBS improved by 12 points (32/56-44/56). The self-selected 10MWT improved by 23% (0.89-1.10 m/s), and the fast-speed 10MWT improved by 35% (1.23-1.67 m/s).

Discussion (relevance): Traumatic Brain Injury (TBI) due to trauma and/or neurologic disease is a leading cause of long-term disability in the United States. Gait impairments observed within the post-TBI population can greatly impact walking abilities and pose various challenges. This case report describes a 4-week novel robotic treadmill system and training protocol focused on key neuromechanical elements required to improve walking performance in a young adult with TBI.

Conclusions: An individualized robotic treadmill gait training protocol was successfully used with a young adult with Traumatic Brain Injury in addition to his customary overground training and contributed to a marked improvement in his endurance, strength, speed, and dynamic stability, exceeding available minimal clinically important distances for all outcome measures. Neuromechanical challenges via a robotic treadmill may enable individuals to perform walking-related training tasks with less fear of physical harm and to develop techniques for safe mobility in their environment.