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Europa Medicophysica 2002 December;38(4):215-218

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: English

Gait patterns after traumatic brain injury

Gradenigo B.

Centro Cardinal Ferrari”, Fontanellato (Parma)

Back­ground. ­Gait anal­ysis can be ­used to sub­di­vide a pop­u­la­tion of ­patients ­into dif­ferent ­groups, ­according to the pat­terns of move­ment. In ­this way it can be pos­sible to ­plan spe­cific ther­a­peutic inter­ven­tions for ­each pat­tern of move­ment. The clas­sifi­ca­tions of ­Knuttson, ­Winter, ­Muroy and ­Perry are exam­ined.
­Methods. The clas­sifi­ca­tion of ­gait pat­terns pro­posed by ­Knuttson is ­based on goni­o­metric ­data for the ­knee and the ­ankle and on emg. The clas­sifi­ca­tion of ­Winter is ­based on goni­o­metric ­data ­from the ­3 prin­cipal ­joints of the leg. The clas­sifi­ca­tion of ­Mulroy and ­Perry is ­based on ­velocity and goni­o­metric ­data ­from the ­knee at ter­minal ­stance ­phase and at preswing ­phase. ­These clas­sifi­ca­tions, orig­i­nally ­addressing ­patients ­with cereb­ro­vas­cular dis­ease, are ­used for a ­group of 14 sub­jects ­with trau­matic ­brain ­injury.
­Results. ­According to ­Knuttson’s clas­sifi­ca­tion ­patients are ­divided as fol­lows: ­type I (pre­ma­ture acti­va­tion of ­calf mus­cles) no. 7 (50%), ­type II (­marked low­ering of emg ­activity) 0 (0%), ­type III (co-acti­va­tion) no. 4 (29%), ­type IV (­more com­plex ­types) no. 3 (21%). There­fore ­with the clas­sifi­ca­tion of ­Knuttson is pos­sible to ­assign 79% of ­patients, ­while 21% of ­cases are ­labeled as ­type IV (­more com­plex ­types). ­According to the clas­sifi­ca­tion of ­Winter ­patients are ­divided as fol­lows: ­group I (insuf­fi­cient ­ankle con­trol) no. 6 (43%), ­group II (­same ­problem ­plus ­ankle ­plantar ­flexion in ­stance ­phase) no. 3 (21%), ­group III (reduc­tion of ­knee ­flexion ­motion in the ­swing ­phase due to quad­ri­ceps over­ac­tivity) no. 1 (7%), ­group IV (­same ­problem of ­group III, ­plus ­flexed posi­tion of the hip ­with ­reducted ­range of ­motion) no. 2 (14%), ­plus 2 unclas­si­fi­able sub­jects (14%). ­According to ­Mulroy and ­Perry’s clas­sifi­ca­tion ­patients are ­divided as fol­lows: ­group 1 (­fast) no. 5 (36%), ­group 2 (mod­erate) no. 6 (43%), ­group 3 (­flexed) no. 1 (7%), ­group 4 (­extended) no. 2 (14%).
Con­clu­sions. ­This ­study sug­gests ­that the ­gait clas­sifi­ca­tions ­born for the ­upper ­motor ­neuron ­lesion due to cereb­ro­vas­cular dis­ease can be use, yet ­with ­some lim­i­ta­tions, in sub­jects ­with trau­matic ­brain ­injury. Of the 3 clas­sifi­ca­tion exam­ined the clas­sifi­ca­tion of ­Mulroy and ­Perry ­seems to fit ­better ­with ­this ­type of ­patients as it is pos­sible to ­assign all ­patients, ­although ­some iso­lated goni­o­metric ­values are dif­ferent ­from the ­expected ­ones.