Improvement in postural alignment is associated with recovery of mobility after complex acquired brain injury: An observational study

ABSTRACT

Purpose

Determine how mobility changes over 6 months in people unable to walk at 8-weeks post-Acquired Brain Injury (ABI); if there is an association over time between postural alignment and mobility post-ABI; and if alignment after ABI becomes closer to healthy alignment over time.

Methods

Fourteen adults with ABI, evaluated over 6 months, and a reference sample of 30 healthy adults were studied. The primary measure for changes in mobility was the Clinical Outcome Variables Scale (COVS). Secondary measures were sit-to-stand, timed standing holding rails, independent walking speed and number of testing conditions achieved. The Functional Independence Measure (FIM) was scored at rehabilitation admission and discharge. To analyze postural alignment, participants were recorded in sitting and standing, each repeated holding rails, and walking if able. Three-dimensional kinematic data were used to quantify whole-body postural alignment, equal to mean segment displacements from the base of support in the transverse plane. Associations between three-dimensional kinematic alignment scores and COVS scores were calculated using Linear Mixed-Effects Models.

Results

Participants made significant improvements in COVS scores, most secondary mobility scores, and FIM scores over time (p ≤ .001). Relationships between increasing COVS scores and decreasing sitting and standing mal-alignment scores were statistically significant. Visual analysis of graphed segment positions indicated that sitting and standing alignment became more similar to healthy alignment over time; this was not clear for walking.

Conclusion

Improvement in postural alignment may be a factor for improving mobility in people with severe impairments after ABI.

KEYWORDS:

• Posture
• torso
• trunk
• stroke
• head injury

Acknowledgments

Thanks to the participants for their generous contributions throughout the project, and to the staff of the SA Brain Injury Rehabilitation Service for their support.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This work was supported by an Australian Government Research Training Program Scholarship for the lead author, and grant funding from the Lifetime Support Authority of South Australia (under grant GA00035) and Royal Adelaide Hospital Research Committee (under grant 9705). DT is funded by the National Health and Medical Research Council as a Career Development Fellow (ID: 1126229).