Recovery of ambulation during inpatient rehabilitation: physical therapist prognosis for children and adolescents with traumatic brain injury

BACKGROUND AND PURPOSE: Evidence to guide physical therapist prognosis for recovery of the ability to ambulate in children and adolescents with traumatic brain injury (TBI) is limited. The aim of this study was to delineate a predictive model and determine the value of key demographic and clinical variables in establishing a prognosis for ambulation without the assistance of a device or person over 15.24 m on a flat, level surface following inpatient rehabilitation. SUBJECTS AND METHODS: For this retrospective study, a consecutive series of 95 children and adolescents with TBI (aged 2-18 years) admitted to an inpatient rehabilitation program was assessed using information from medical records. A multiple logistic regression analysis was conducted to identify predictors for ambulation at the time of discharge from the rehabilitation setting. RESULTS: Fifty-six percent of the children achieved ambulation at discharge. Lower-extremity hypertonicity (measured on physical therapist examination as resistance to passive stretch), brain injury severity, and lower-extremity injury together were predictors of the ability to ambulate. DISCUSSION AND CONCLUSION: Impairment and injury-related variables were important in predicting a minimal level of unassisted ambulation after discharge from inpatient rehabilitation. Awareness of predictors of recovery of the ability to ambulate that are gathered as part of a physical therapist's examination may assist in developing a prognosis for ambulation and in establishment of an appropriate plan of care.     

Early versus later admission to postacute rehabilitation: impact on functional outcome after traumatic brain injury

OBJECTIVE: To examine the impact of participation in a postacute community reentry program on functional outcome after traumatic brain injury (TBI). DESIGN: Cohort, nonrandomized, intervention study. Pretest-posttest, follow-up design. SETTING: Nonprofit outpatient community reentry program affiliated with an inpatient rehabilitation hospital. PARTICIPANTS: Three groups of persons with moderate to severe TBI differing in length of time between injury and admission. The first group entered postacute rehabilitation within 6 months of injury (n=115); the second group, between 6 and 12 months (n=23); and the third group, greater than 12 months (n=29). INTERVENTIONS: Persons with TBI participated in a postacute community reentry program (average, 4.3mo) that emphasized (1) teaching compensatory strategies to address residual cognitive deficits; (2) arranging environmental supports to maximize functioning; (3) counseling and education to address personal and family adjustment and to improve accurate self-awareness; and (4) transition from simulated activities in the clinic to productive activities in the community. MAIN OUTCOME MEASURES: Disability Rating Scale, Supervision Rating Scale, and the Community Integration Questionnaire. RESULTS: All groups showed improvements between admission and discharge on measures of overall disability, independence, home competency, and productivity, and these gains were maintained at follow-up. For the group beginning postacute rehabilitation the earliest (<6mo postinjury) independence continued to improve after discharge. Community integration total score and home competency also continued to improve even after discharge. CONCLUSIONS: The results point toward the effectiveness of postacute rehabilitation in improving functional outcome after TBI even for persons who have reached stable neurologic recovery at 12 or more months postinjury.     

Early cognitive status and productivity outcome after traumatic brain injury: findings from the TBI model systems

OBJECTIVE: To evaluate the contribution of early cognitive assessment to the prediction of productivity outcome after traumatic brain injury (TBI) adjusted for severity of injury, demographic factors, and preinjury employment status. DESIGN: Inception cohort. SETTING: Six inpatient brain injury rehabilitation programs. PARTICIPANTS: A total of 388 adults with TBI whose posttraumatic amnesia (PTA) resolved before discharge from inpatient rehabilitation. INTERVENTIONS: Administered neuropsychologic tests during inpatient stay on emergence from PTA. Follow-up interview and evaluation. Predictor measures also determined. MAIN OUTCOME MEASURE: Productivity status at follow-up 12 months postinjury. RESULTS: Multiple logistic regression analysis revealed that preinjury productivity status, duration of PTA, education level, and early cognitive status each made significant, independent contributions to the prediction of productivity status at follow-up. When adjusted for all other predictors, persons scoring at the 75th percentile on early cognitive status (less impaired) had 1.61 times greater odds (95% confidence interval [CI], 1.07-2.41) of being productive follow-up than those scoring at the 25th percentile (more impaired). Without adjustment, persons scoring at the 75th percentile had 2.46 times greater odds (95% CI, 1.77-3.43) of being productive at follow-up. CONCLUSIONS: Findings support the utility of early cognitive assessment by using neuropsychologic tests. In addition to other benefits, early cognitive assessment makes an independent contribution to prediction of late outcome. Findings support the clinical practice of performing initial neuropsychologic evaluations after resolution of PTA.     

Analyses of gait,reaching, and grasping in children after traumatic brain injury

OBJECTIVE: To evaluate motor behavior in children after traumatic brain injury (TBI) with quantitative instrumented measures of gait and of functional hand movements (reaching, grasping) and with clinical assessments. DESIGN: Case-control study. SETTING: Tertiary pediatric trauma rehabilitation center in Germany. PARTICIPANTS: Twenty children (age range, 6-13 y) with moderate or severe TBI were examined 1+/-1.2 years (mean +/- standard deviation) postinjury. Fifteen were reexamined 2 months later. Control data were obtained from 20 healthy children and matched for age, gender, and school grade. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Quantitative measures included 10 spatiotemporal gait parameters and 6 variables describing reaching and grasping. Qualitative scores of gait and upper-limb movements were also obtained. RESULTS: Gait velocity and step and stride lengths were significantly smaller in children after TBI than in control subjects (Mann-Whitney U test, P<.05). Reach-to-grasp movements of the TBI children were characterized by a significantly longer reaction time (Mann-Whitney U test, P<.05) and movement duration, reduced velocity, and coordination deficits. The instrumented measures did not change significantly in 2 months. Several significant correlations between clinical and instrumented measures were obtained. CONCLUSION: Functional motor behavior is affected in children after moderate or severe TBI. To supplement clinical assessments with objective data, impairments of gait, reaching, and grasping movements can be recorded with instrumented measures.     

Exploring the capacity to ambulate after a period of prolonged mechanical ventilation

Purpose

The purposes were to assess the functional recovery of those who survived a prolonged intensive care unit (ICU) stay by reporting the proportion who were able to ambulate independently at hospital discharge and also to examine if the time duration between admission and when the patient first stood impacted on their capacity to ambulate at discharge.

Materials and Methods

A retrospective review was conducted of medical records of ICU patients in 2007 to 2008, who were mechanically ventilated for 168 hours or more, and survived their acute care stay. Main outcome measures were (1) ambulation status before admission and at time of hospital discharge and (2) time between admission to the ICU and when the patient first stood.

Results

A total of 190 patients were included. Before admission, 189 (99%; 95% confidence interval [CI], 98%-100%) were ambulating independently, of whom 180 (95%) did not require a gait aid. On discharge from acute care, 89 (47%; 95% CI, 40%-54%) were ambulating independently, of whom 54 (61%) did not require a gait aid. Compared with those who stood within 30 days of ICU admission, a delay in standing of between 30 and 60 days increased the odds 5-fold (95% CI, 2-11) of being unable to ambulate independently at the time of discharge.

Conclusions

After a prolonged ICU admission, more than 50% of patients were unable to ambulate independently by hospital discharge, with the time between admission and first stand, being an important predictor of this outcome.     

Clinical correlation between motor evoked potentials and gait recovery in poststroke patients

OBJECTIVE: To evaluate, in patients with a stroke in the area of the middle cerebral artery, whether transcranial magnetic stimulation values from the affected lower limb correlated with the degree of gait recovery. DESIGN: The prognostic evaluation in subjects with complete lower-limb palsy, inability to walk, and dependence in the activities of daily living, 1 month after vascular injury. SETTING: University-affiliated rehabilitation hospital. PARTICIPANTS: Twenty consecutive patients (12 women, 8 men) were enrolled 1 month poststroke (30+/-5 d); all patients concluded the rehabilitation program, which lasted 6 months. INTERVENTION: Barthel Index score, Hemiplegic Stroke Scale (HSS) score, and motor evoked potentials (MEPs) from the tibialis anterior muscle were performed 1, 4, and 7 months poststroke. The Wilcoxon signed-rank test, Mann-Whitney U test, and Spearman rank-order correlation coefficient were employed. MAIN OUTCOME MEASURES: The independence of gait defined as an HSS gait score of 3 or less (ability to walk without assistance apart from a stick or cane). RESULTS: Patients with no recordable MEPs 1 month poststroke never regained walking ability; patients with MEPs of 8% or more (13.11+/-5.95) regained independent gait at discharge. It was not possible to predict walking capacity in patients with MEPs less than 8% (4.0+/-1.41). Four months postinjury, walking capacity was achieved only by the patients with MEPs of 18% or more (23.1+/-6.2). CONCLUSIONS: In the postacute phase of stroke, the lower-limb MEP amplitudes could be a supportive tool for prognosis of lower-limb motor outcome.     

Plasma amino acid concentrations during late rehabilitation in patients with traumatic brain injury

OBJECTIVES: To investigate whether the basal plasma amino acid concentrations in patients with traumatic brain injury (TBI) have returned to levels found in healthy controls at about 17 months postinjury and to determine the effect of intake of a mixture of essential amino acids (EAA) on plasma amino acid concentrations in TBI versus healthy controls. DESIGN: Peripheral venous amino acid concentrations in subjects with TBI were compared with concentrations in healthy controls both at rest and for 1 hour after intake of 7g of EAA. SETTING: Postacute brain injury rehabilitation center. PARTICIPANTS: Six men with TBI (age +/- standard deviation, 27+/-6y; months postinjury, 17+/-4) and 6 healthy men (age, 43+/-7y). INTERVENTION: Intake of a drink consisting of 7g of EAA. MAIN OUTCOME MEASURES: Individual and total plasma amino acid concentrations. RESULTS: Total amino acid concentration was about 12% lower in TBI versus controls (P=.022). Valine was reduced by 33% in the TBI group versus controls (P=.003), whereas the other EAA did not differ between groups. After intake of the EAA drink, plasma non-EAA increased to a significantly higher level in controls versus TBI subjects (P=.017). CONCLUSIONS: Plasma total amino acid concentration is still reduced 17 months postinjury in patients with TBI versus healthy controls, mainly because of a lower valine level. This may be of importance for both brain and muscle metabolic functions, and warrant further study. Further, ingested EAA are apparently not as readily converted to non-EAA in TBI patients as in healthy controls, suggesting that in recovery from TBI, certain non-EAA may become provisionally essential.     

Outcome after traumatic brain injury: effects of aging on recovery

OBJECTIVE: To identify differences in outcome after traumatic brain injury (TBI) compared with orthopedic injuries as a function of age. DESIGN: Longitudinal data analyses from an inception cohort. SETTING: Outpatient rehabilitation program. PARTICIPANTS: Eighty-two orthopedic injury patients and 195 TBI patients. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Independent living, employment, and level of functioning 1 to 2 years after injury. RESULTS: Older patients and those with TBI were more likely to have increased dependence postinjury. Older TBI patients were more likely to have changes in employment status compared with orthopedic injury patients younger or TBI. The Mayo-Portland Adaptability Inventory and Disability Rating Scale were moderately predictive of level of functioning, return to employment, and independent living status 1 to 2 years postinjury. Injury severity was only mildly predictive of outcome. CONCLUSIONS: The effect of age on outcome affects recovery from neurologic injuries and, to a lesser extent, orthopedic injuries. Outcome after TBI is best predicted by patients' age and estimates of level of function at discharge. Findings suggest that older patients and those with TBI have a greater likelihood of becoming physically and financially dependent on others. Rehabilitation efforts should focus on maximizing levels of independence to limit financial and emotional costs to patients and their families.     

Acute hospitalization and discharge outcome of neurologically intact trauma patients sustaining thoracolumbar vertebral fractures managed conservatively with thoracolumbosacral orthoses and physical therapy

OBJECTIVES: To identify the acute hospital discharge functional status achieved and the amount of physical therapy (PT) and occupational therapy (OT) received by neurologically intact patients with thoracolumbar vertebral fractures managed only by bracing with a custom-molded thoracolumbosacral orthosis (TLSO). These patients would be expected to ambulate independently soon after receiving their TLSOs unless they had concomitant lower extremity injuries, but they may need assistance with lower extremity activities of daily living. DESIGN: Retrospective study. SETTING: Urban, level I trauma center. PATIENTS: Twenty-seven subjects who sustained one or more thoracolumbar fractures, were neurologically intact, and were managed nonoperatively with a custom-molded TLSO. OUTCOME MEASURES: Median time to TLSO arrival, start of PT, number of PT sessions, time to ambulate independently from admission, and length of stay (LOS). RESULTS: Median time to TLSO arrival was 2 days, start of PT was 4 days, number of PT sessions was one, time to ambulate independently from admission was 3(1/2) days, and LOS was 5 days. Subjects with lower extremity fractures required significantly (p < .037) more PT sessions to achieve independent ambulation than those without lower extremity fractures. Almost 89% of the subjects ambulated independently with or without an assistive device at discharge. Fifty-nine percent of subjects were discharged home the day they cleared PT for independent ambulation. Only 11% of the subjects received OT. CONCLUSIONS: A majority of neurologically intact patients with thoracolumbar fractures managed conservatively with a TLSO ambulate independently after receiving one or two sessions of PT and can be discharged home on the same day of PT clearance. Patients with lower-extremity fractures need more PT to achieve independent ambulation. The consequences of a minority of these patients being evaluated and seen by OT are not fully known. Future research may be able to document the need for more OT services.     

Functional Outcomes in Traumatic Disorders of Consciousness: 5-Year Outcomes From the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems

Objective

To characterize the 5-year outcomes of patients with traumatic brain injury (TBI) not following commands when admitted to acute inpatient rehabilitation.

Design

Secondary analysis of prospectively collected data from the National Institute on Disability and Rehabilitation Research–funded Traumatic Brain Injury Model Systems (TBIMS).

Setting

Inpatient rehabilitation hospitals participating in the TBIMS program.

Participants

Patients (N=108) with TBI not following commands at admission to acute inpatient rehabilitation were divided into 2 groups (early recovery: followed commands before discharge [n=72]; late recovery: did not follow commands before discharge [n=36]).

Interventions

Not applicable.

Main Outcome Measures

FIM items.

Results

For the early recovery group, depending on the FIM item, 8% to 21% of patients were functioning independently at discharge, increasing to 56% to 85% by 5 years postinjury. The proportion functioning independently increased from discharge to 1 year, 1 to 2 years, and 2 to 5 years. In the late recovery group, depending on the FIM item, 19% to 36% of patients were functioning independently by 5 years postinjury. The proportion of independent patients increased significantly from discharge to 1 year and from 1 to 2 years, but not from 2 to 5 years.

Conclusions

Substantial proportions of patients admitted to acute inpatient rehabilitation before following commands recover independent functioning over as long as 5 years, particularly if they begin to follow commands before hospital discharge.     

Incidence,risk factors,and outcomes of fecal incontinence after acute brain injury: findings from the Traumatic Brain Injury Model Systems national database

OBJECTIVE: To investigate the incidence, risk factors, and outcome in patients with fecal incontinence after acute brain injury. DESIGN: A retrospective study of the incidence of and risk factors contributing to fecal incontinence, and outcomes at admission to and discharge from inpatient rehabilitation and at 1-year follow-up. SETTING: Medical centers in the federally sponsored Traumatic Brain Injury Model Systems (TBIMS). PARTICIPANTS: A total of 1,013 consecutively enrolled rehabilitation inpatients from 17 TBIMS centers who were admitted to acute care within 24 hours of traumatic brain injury and seen at 1-year postinjury between 1990 and 2000. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Incidence of fecal incontinence, length of coma, length of posttraumatic amnesia (PTA), admission Glasgow Coma Scale (GCS) score, length of stay (LOS), FIM instrument scores, disposition at discharge and follow-up, and incidences of pelvic fracture, frontal contusion, and urinary tract infection (UTI). RESULTS: The incidence of fecal incontinence was 68% at admission to inpatient rehabilitation, 12.4% at rehabilitation discharge, and 5.2% at 1-year follow-up. Analysis of variance and chi-square analyses revealed statistically significant associations between the incidence of fecal incontinence at rehabilitation admission and admission GCS score, length of coma and PTA, LOS, and incidence of UTI and frontal contusion. Fecal incontinence at rehabilitation discharge was significantly associated with several variables, including age, discharge disposition, admission GCS score, length of coma, PTA, LOS, FIM scores, and incidence of pelvic fracture and frontal contusion. Significant associations were also found between fecal incontinence at 1-year follow-up and age, discharge and current 1-year disposition, admission GCS score, length of coma, LOS, FIM scores, and incidence of UTI (P<.05). Although logistic regression analyses were significant (P<.001), and predicted continence with 100% accuracy, demographics, injury characteristics, medical complications, and functional outcomes did not predict incontinence at discharge and at 1-year follow-up. CONCLUSIONS: Fecal incontinence is a significant problem after brain injury. Certain factors may increase its likelihood. Further studies evaluating mechanisms of fecal incontinence and treatment or control interventions would be useful.     

Comparing functional status and community integration in severe penetrating and motor vehicle-related brain injuries

Wertheimer JC, Hanks RA, Hasenau DL. Comparing functional status and community integration in severe penetrating and motor vehicle-related brain injuries.

Objective

To examine the functional status of persons surviving a severe penetrating traumatic brain injury (TBI) resulting from a gunshot wound who require inpatient rehabilitation.

Design

Data were collected prospectively at 4 different time periods: rehabilitation admission and discharge and year 1 and year 2 postinjury.

Setting

Rehabilitation hospital within a Traumatic Brain Injury Model System.

Participants

Forty-five persons with severe penetrating brain injury and 45 persons involved in a motor vehicle crash (MVC).

Interventions

Not applicable.

Main Outcome Measures

Disability Rating Scale (DRS), FIM instrument, and Community Integration Questionnaire (CIQ).

Results

Results indicated functional improvements for both the penetrating and motor vehicle severe TBI groups on the DRS and the FIM from rehabilitation admission to discharge. Follow-up data at 1 and 2 years postinjury revealed continued improvements on the DRS and FIM measures for both groups, with the greatest improvement in recovery during the first year. In addition, improved community reintegration emerged between 1 and 2 years postinjury for both groups, as measured by the CIQ. There was a small significant difference on the outcome measures between the 2 groups in the course of their recovery.

Conclusions

Persons who survive severe penetrating brain injuries and who require inpatient rehabilitation may show continuing improvement in functioning over time. For persons receiving inpatient rehabilitation services, initial improvement is most likely to occur during the hospital stay and continue postinjury, with the largest improvement in the first year after injury. Community reintegration can also be expected over time. One can expect similar outcomes for individuals who sustain a severe penetrating brain injury and a severe brain injury ensuing from an MVC.     

FIM量表在外伤性颅脑损伤患者康复疗效评价中的应用

目的 :运用功能独立性评价量表 (FIM )评价外伤性颅脑损伤 (TBI)患者的康复治疗疗效 ,比较闭合性颅脑损伤 (CBI)和开放性颅脑损伤 (OBI)患者的临床特点和康复治疗的效果。方法 :79例TBI患者中 ,5 7例为CBI、2 2例为OBI。运用FIM量表评价两组患者康复治疗前后的功能情况 ,统计患者的入院天数 ,计算FIM效率。结果 :CBI和OBI患者入院时的FIM总评分分别为 81.5 1和 73.0 9;出院时FIM总评分分别为 115 .0 4和 117.77,两组平均增加 4 1%和 5 3%。两组患者康复治疗前后FIM各项评分自身相比有非常显著差异 (P <0 .0 0 1) ,但两组之间相比无显著差异。两组患者的FIM效率分别为 1.99分 /天和 1.71分 /天。结论 :康复治疗可有效改善TBI(无论是CBI还是OBI)患者的功能情况。康复治疗应强调早期和综合性治疗     

Early rehabilitation effect for traumatic spinal cord injury

OBJECTIVE: To determine the natural course of traumatic spinal cord injury (SCI) and the effect of early rehabilitation on it. DESIGN: A retrospective, multicenter study. SETTING: Sixteen Rosai hospitals and 1 medical school. PARTICIPANTS: One hundred twenty-three SCI patients (104 men, 19 women; mean age, 48.8 +/- 17.7yr) enrolled. INTERVENTIONS: Dividing the subjects into an early rehabilitation group and a delayed group; differences were ensured by international classification of SCI. MAIN OUTCOME MEASURES: Using the American Spinal Injury Association (ASIA) classifications, the motor recovery rate (MRR) was defined as (ASIA motor score at discharge - ASIA motor score at admission)/(100 - ASIA motor score at admission). The regression lines for FIM instrument score and ASIA motor score were determined for 6 subgroups (early or delayed tetraplegia, central cord injury, paraplegia) by the MRR staging. The regression lines for physical or cognitive FIM score and ASIA motor score were also determined for 6 subgroups. RESULTS: Three stages were obtained: acute stage: 2 weeks postinjury; recovery stage: 2 weeks to 6 months postinjury; and chronic stage: more than 6 months postinjury. Regression lines showed that rehabilitation improved physical functional independence for ASIA motor score, especially in the early rehabilitation subgroups. There was no correlation between cognitive FIM score and ASIA motor score in 6 subgroups. CONCLUSION: Early SCI rehabilitation contributes to good physical activities of daily living for motor function.     

Reduced plasma levels of tyrosine,precursor of brain catecholamines,and of essential amino acids in patients with severe traumatic brain injury after rehabilitation

OBJECTIVE: To investigate whether levels of plasma tyrosine and tryptophan, precursors of brain catecholamine and serotonin neurotransmitters, respectively, and other essential amino acids (EAA) may return to normal in patients with severe traumatic brain injury (TBI) after 2 months in a hospital rehabilitation center. DESIGN: Peripheral plasma concentrations of tyrosine, tryptophan, and other EAAs in subjects with severe TBI, both at admission (44+/-11d postinjury) and at discharge from the center (110+/-15d after acute event) were compared with concentrations in control subjects. SETTING: Tertiary care rehabilitation setting in Italy. PARTICIPANTS: Ten men (26.6+/-12.6y) with TBI and 6 healthy subjects (controls) matched for age, sex, voluntary loss of body weight, and sedentary lifestyle. INTERVENTIONS: Not applicable. Main Outcome Measures: Concentrations of brain neurotransmitter precursor amino acids and of EAA. RESULTS: On admission, patients had lower plasma tyrosine, leucine, valine, methionine, and phenylalanine concentrations than did control subjects. The plasma concentrations of tryptophan were similar in the 2 groups. These amino acid abnormalities were still present at discharge. CONCLUSION: The levels of plasma tyrosine and many EAA in patients with TBI did not recover by discharge (110+/-15d) from rehabilitation. Plasma tryptophan concentrations were similar in patients and controls.     

不同病程创伤性颅脑损伤患者运动功能康复效果的回顾性分析

目的：探讨创伤性颅脑损伤后不同时期介入康复治疗对患者运动功能及日常生活活动能力的疗效影响。方法：对163例创伤性颅脑损伤患者的临床资料进行回顾性分析。根据康复治疗介入的时间（〈3个月、3-6个月、6-12个月、1-2年、〉2年）将患者分为5组，于治疗前及治疗2个月后评定患肢的运动功能、ADL能力及步行能力。结果：康复治疗介入时间〈3个月组和3—6个月组的患者上下肢及手的运动功能、步行能力和ADL均有显著提高（P〈0．05）；6-12个月组的患者除步行能力无明显改善外，其余功能均有显著提高（P〈0．05）；1-2年组的患者其上肢功能和ADL能力均有显著提高（P〈0．05），但其余功能均无提高；而〉2年组的患者只有ADL能力有显著提高（P〈0．05）．结论：系统正规的康复治疗有利于创伤性颅脑损伤后不同时期康复的患者。康复医师应根据康复介入的时间，确定康复治疗的重点。     

A case report: Application of the upright motor control test on physical therapy intervention of an individual following a stroke

This case report shows the application of the Upright Motor Control Test in the physical therapy management of an individual following a stroke. The individual is a 43-year-old male who sustained an infarct of the right thalamus 2 days prior to inpatient rehabilitation admission. Observational gait analysis and the Upright Motor Control Test isolated the primary gait deficit as left hip and ankle extension in the stance phase of gait. Physical therapy interventions focused on specific functional tasks that challenged hip extension so that he could resume the activities in which he engaged prior to the stroke. After a 3 week length of stay in inpatient rehabilitation, the individual demonstrated an improvement in the outcome measures, functional progression with ambulation (level and stairs), and transfers sufficient to be discharged home. This case illustrates how standardized outcome measures assisted the clinician in isolating the gait impairments that limited his ability to ambulate within his home environment. Subsequently, the plan of care and physical therapy interventions focused on these deficits to maximize the functional outcomes.     

A case report: application of the upright motor control test on physical therapy intervention of an individual following a stroke

This case report shows the application of the upright motor control test in the physical therapy management of an individual following a stroke. The individual is a 43-year-old male who sustained an infarct of the right thalamus 2 days prior to inpatient rehabilitation admission. Observational gait analysis and the upright motor control test isolated the primary gait deficit as left hip and ankle extension in the stance phase of gait. Physical therapy interventions focused on specific functional tasks that challenged hip extension so that he could resume the activities in which he engaged prior to the stroke. After a 3 week length of stay in inpatient rehabilitation, the individual demonstrated an improvement in the outcome measures, functional progression with ambulation (level and stairs), and transfers sufficient to be discharged home. This case illustrates how standardized outcome measures assisted the clinician in isolating the gait impairments that limited his ability to ambulate within his home environment. Subsequently, the plan of care and physical therapy interventions focused on these deficits to maximize the functional outcomes.