This Case Study describes the gait of a patient who suffered from a traumatic brain injury due to a motor cycle accident
Mr. TK is a 37 year old male who suffered a traumatic injury to the head following a motorcycle accident, in which he was riding without a helmet.
RIGHT Upper Extremity: No increase in muscle tone and muscle strength was Grade 4/5 across all joints. Active Range of Motion (ROM) was within functional limits.
RIGHT Lower Extremity: No increase in muscle tone was detected. Muscle strength was Grade 4+/5 across all joints and ROM was within functional limits.
LEFT Upper Extremity: The left upper extremity demonstrated severe flexor patterns and increased tone were detected in the left elbow, wrist and finger flexors. Muscle strength was Grade 3/5 across all joints and flexion and extension movements were restricted.
LEFT Lower Extremity: The left lower extremity demonstrated an extensor pattern due to increased tone in the Left ankle plantarflexors and knee extensors. Muscle strength was Grade 3-/5 across all joints. Flexion at the hip and knee was restricted and the ankle had a plantarflexion contracture of 10 degrees.
Initial gait assessment indicated that the gait functions of balance and forward progression were significantly affected. Hence, the intervention would focus on: Balance/Stability; Progression and Symmetry. The patient was prescribed a solid-ankle ankle foot orthosis (AFO) to address the excessive plantarflexion observed at the ankle. The following video shows the patient’s gait with the AFO.
The Gait Comparison Chart was used to compare the patient’s gait before and after the intervention. The patient’s gait pattern with the AFO is very similar to the pattern without the AFO and there is no significant improvement gait pattern due the intervention. The gait functions were either unchanged or changed slightly after the intervention. The AFO was successful in eliminating the deviation of Forefoot Contact and Excessive Plantarflexion during Swing. However, it introduced a new deviation of Foot/Toe Drag. The AFO did not address any deviations at the knee or pelvis.
In terms of temporal-spatial deviations, the Left step length increased with the AFO, which resulted in symmetrical step length between the Right and Left limbs. There is also an improvement in the Left stance time, but the stance time on the Right limb is still greater than the Left, and asymmetry between the limbs is noticeable. The AFO did not address the gait functions of Balance and Progression and so it can be concluded that the intervention was not effective. A different intervention should be tried, such as a different type of AFO or a knee-ankle-foot orthosis (KAFO).