Postural alignment during unsupported walking following acquired brain injury: Application of a new measure.

BACKGROUND

Impaired postural alignment is commonly observed following acquired brain injury (ABI), and improved postural alignment is associated with mobility recovery in the pre-ambulant phase (i.e. sitting and standing) following ABI. It is unknown whether this association exists for walking.

RESEARCH QUESTIONS: This study aimed to; i) determine whether the postural alignment and dispersion (PAD) score, previously validated in sitting and standing, can be applied to quantify postural alignment during walking in people with ABI, and ii) whether the PAD discriminates those with slower and faster self-selected walking speed.

METHODS

Forty-two adults with mobility limitations following ABI, who could walk without assistance for 10 m, and 34 healthy controls (HCs) underwent three-dimensional gait analysis at their self-selected walking speed. Outcome measures were the PAD score (whole-body postural alignment), walking speed (m/s), lateral centre of mass displacement (dynamic postural control), and the Gait Profile Score (walking quality). Outcome measures were evaluated for between-group differences (t-tests and Cohen's d effect size) and individual incidence of abnormality.

RESULTS

Adults with ABI had significantly higher PAD scores compared to HCs (p < 0.05; ES > 0.49). Within the ABI cohort, PAD scores were not significantly different at both more affected (p > 0.05; ES 0.37) and less affected (p > 0.05; ES 0) midstance between faster (≥ 0.8 m/s) and slower walkers (< 0.8 m/s). In contrast, dynamic postural control and walking quality were significantly worse in those participants who walked slower (p < 0.01; ES > 0.80). Prevalence of abnormality was low, capturing 19 % and 26 % of participants for the more affected and less affected lower limb PAD scores.

SIGNIFICANCE: Preliminary evidence suggests postural alignment may be impaired during walking in people with ABI. The PAD did not discriminate between slower or faster walkers within the ABI cohort. Further research is required to determine the optimal method for measuring postural alignment during walking.